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Nyakutombwa, Content P., Wilfred N. Nunu, Nicholas Mudonhi, and Nomathemba Sibanda. "Factors Influencing Patient Satisfaction with Healthcare Services Offered in Selected Public Hospitals in Bulawayo, Zimbabwe." Open Public Health Journal 14, no. 1 (April 20, 2021): 181–88. http://dx.doi.org/10.2174/1874944502114010181.
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Introduction: Patient satisfaction with health care services is vital in establishing gaps to be improved, notably in public health facilities utilised by the majority in Low and Middle-Income Countries. This study assessed factors that influenced patient satisfaction with United Bulawayo Hospitals and Mpilo Hospital services in Bulawayo in Zimbabwe. Methods: A cross-sectional survey was conducted on 99 randomly selected respondents in two tertiary hospitals in Bulawayo. Chi-squared tests were employed to determine associations between different demographic characteristics and patient satisfaction with various services they received. Multiple Stepwise Linear regression was conducted to assess the strength of the association between different variables. Results: Most of the participants who took part in the study were males in both selected hospitals. It was generally observed that patients were satisfied with these facilities' services, symbolised by over 50% satisfaction. However, patients at Mpilo were overall more satisfied than those at United Bulawayo Hospitals. Variables “received speciality services,” “average waiting times,” and “drugs being issued on time” were significant contributors to different levels of satisfaction observed between Mpilo and United Bulawayo Hospitals. Conclusion: Generally, patients are satisfied with the services and interactions with the health service providers at United Bulawayo Hospitals and Mpilo Hospitals. However, patients at Mpilo were more satisfied than those at United Bulawayo Hospitals. There is generally a need to improve pharmaceutical services, outpatient services, and interaction with health service provider services to attain the highest levels of patient satisfaction.
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Hunt, Jenny, Katherine Bristowe, Sybille Chidyamatare, and Richard Harding. "‘So isolation comes in, discrimination and you find many people dying quietly without any family support’: Accessing palliative care for key populations – an in-depth qualitative study." Palliative Medicine 33, no. 6 (March 12, 2019): 685–92. http://dx.doi.org/10.1177/0269216319835398.
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Background: Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest. Aim: To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe. Design: Qualitative study using thematic analysis of in-depth interviews and focus groups. Setting/participants: A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge). Results: Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care. Conclusion: Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.
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Mashamba, Alethea, and Elsbeth Robson. "Youth reproductive health services in Bulawayo, Zimbabwe." Health & Place 8, no. 4 (December 2002): 273–83. http://dx.doi.org/10.1016/s1353-8292(02)00007-2.
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Sidandi, Paul. "Rehabilitation psychiatry: description of a provincial setting in Zimbabwe." Psychiatric Bulletin 14, no. 9 (September 1990): 552–54. http://dx.doi.org/10.1192/pb.14.9.552.
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Psychiatric services in Zimbabwe are, by African standards, relatively sophisticated and are modelled on the British system. A new patient is assessed using the Maudsley history-taking format modified to suit local situations, and a mental state examination. A physical examination and routine investigations follow. X-ray facilities and basic laboratory work-up such as haematology and microscopy are available at Provincial level. EEG, ultrasonography, echoencephalography, CT scanning and serum anticonvulsant levels are available in Harare and Bulawayo.
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Makoni, Talent M., Pruthu Thekkur, Kudakwashe C. Takarinda, Sinokuthemba Xaba, Getrude Ncube, Nonhlahla Zwangobani, Julia Samuelson, et al. "Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study." BMJ Open 10, no. 5 (May 2020): e033035. http://dx.doi.org/10.1136/bmjopen-2019-033035.
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ObjectivesWHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10–24 years) VMMC clients getting ‘successfully linked’ to ASRH services and factors associated with ‘not being linked’.DesignThis was a cohort study using routinely collected secondary data.SettingAll three VMMC clinics of Mt Darwin district and Bulawayo province.Primary outcome measuresThe proportion of ‘successfully linked’ was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and ‘not being linked’.ResultsOf 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were ‘successfully linked’ to ASRH services and the median (IQR) duration for linkage was 6 (0–56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with ‘not being linked’ to ASRH services.ConclusionLinkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.
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Moyo, Idah, and Margaret Macherera. "The experiences of sex workers accessing HIV care services in Bulawayo, Zimbabwe." African Health Sciences 21, no. 2 (August 2, 2021): 593–602. http://dx.doi.org/10.4314/ahs.v21i2.14.
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Background: Although sub-Saharan African countries have rolled out massive HIV treatment and care programmes, there is little evidence of these having embraced key population groups particularly female sex workers. Due to the criminalisation of sex work in countries like Zimbabwe, research on HIV and its impact on this group is sparse. The absence of an enabling environment has hindered access to HIV care and treatment services for female sex workers.
Objectives: To gain an in-depth understanding of the experiences of female sex workers accessing HIV care and treatment services to enhance programming and planning for this key population group.
Methods: This study was qualitative and phenomenological. Data saturation determined the sample size of 20 participants. Data was collected using in-depth interviews that were audio recorded, transcribed, and subjected to thematic content anal- ysis.
Results: Our findings demonstrate varying dynamics between the private and public sector HIV care services for sex work- ers, with facilitators and barriers to access to care.
Conclusion: Health workers need sensitization and training in the provision of differentiated care. For effective linkage to and retention in care an enabling environment is critical.
Keywords: Linkage to care; retention in care; enabling environment; facilitators; barriers.
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Mangombe, Aveneni, Philip Owiti, Bernard Madzima, Sinokuthemba Xaba, Talent M. Makoni, Kudakwashe C. Takarinda, Collins Timire, et al. "Does peer education go beyond giving reproductive health information? Cohort study in Bulawayo and Mount Darwin, Zimbabwe." BMJ Open 10, no. 3 (March 2020): e034436. http://dx.doi.org/10.1136/bmjopen-2019-034436.
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ObjectivePeer education is an intervention within the voluntary medical male circumcision (VMMC)–adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10–24 years) counselled.DesignA cohort study involving all young people counselled by 95 peer educators during October–December 2018, through secondary analysis of routinely collected data.SettingAll ASRH and VMMC sites in Mt Darwin and Bulawayo.ParticipantsAll young people counselled by 95 peer educators.Outcome measuresCensor date for assessing receipt of services was 31 January 2019. Factors (clients’ age, gender, marital and schooling status, counselling type, location, and peer educators’ age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated.ResultsOf the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%–13% referrals. Non-referral for HTS decreased with clients’ age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%–80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20).ConclusionWe found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators’ gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.
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Ngwenya, Solwayo. "Stillbirth rate and causes in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe." Tropical Doctor 48, no. 4 (August 8, 2018): 310–13. http://dx.doi.org/10.1177/0049475518789030.
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A global concern is to end preventable stillbirths by the year 2030. The objective of this study was to document the stillbirth rate and causes of stillbirths in a low-resource setting. This was a retrospective descriptive study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in Bulawayo, Zimbabwe during the period January to December 2016. There were 8801 live births and 268 stillbirths (rate: 30.5/1000). The majority(81.3%) were macerated. Pre-term labour, pre-eclampsia, eclampsia and abruptio placenta accounted for 51.1%. In 29.9%, the cause could not be identified. A high proportion of macerated stillbirths were unexplained; hence this calls for a renewed focus on community-based approaches to reduce delays in seeking care. Investment in robust diagnostic means and further training of healthcare workers to improve case definition are both urgently required.
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Tsang, Eileen Yuk-ha, Shan Qiao, Jeffrey S. Wilkinson, Annis Lai-chu Fung, Freddy Lipeleke, and Xiaoming Li. "Multilayered Stigma and Vulnerabilities for HIV Infection and Transmission: A Qualitative Study on Male Sex Workers in Zimbabwe." American Journal of Men's Health 13, no. 1 (January 2019): 155798831882388. http://dx.doi.org/10.1177/1557988318823883.
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Male sex workers are marginalized in most societies due to intersectional stigma between prostitution and homosexuality. In Zimbabwe, a proliferation of male sex workers in major cities such as Harare and Bulawayo has been reported. However, there is a shortage of studies that explore their lives. The current qualitative study aims to describe the practices of sex work, life contexts, and HIV risks and vulnerabilities based on in-depth interviews among 15 male sex workers in Bulawayo. Our studies suggest that the stigma against male sex workers comes from diverse sectors including culture (“homosexuality is un-African, introduced by the Whites”), religion (“same sex is a sin before the God”), law and police (“homosexuality is illegal in Zimbabwe. Engaging in it can send one to prison”), media (“the media is hostile to sex workers particularly men as we are regarded as abnormal and unclean”), and their family (“should they get to know about it, they will disown me”). In this context, male sex workers were excluded from national HIV prevention and treatment programs. They had limited knowledge and many misconceptions about HIV. The stigma and discrimination from health-care providers also discouraged them from health seeking or HIV testing. The non-disclosure to female partners of convenience and sexual relations further increased their vulnerabilities to HIV infection and transmission. Current efforts to address the HIV epidemic should pay attention to male sex workers and tackle the intersecting stigma issues. male sex workers need support and tailored HIV prevention and treatment services to improve their HIV prevention practices, health, and well-being.
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Kurebwa, Jeffrey. "Adolescent Sexual Reproductive Health Services in Bindura Urban of Zimbabwe." International Journal of Patient-Centered Healthcare 9, no. 2 (July 2019): 1–20. http://dx.doi.org/10.4018/ijpch.2019070101.
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This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.
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Nhapi, Tatenda Goodman. "Socioeconomic Barriers to Universal Health Coverage in Zimbabwe: Present Issues and Pathways Toward Progress." Journal of Developing Societies 35, no. 1 (March 2019): 153–74. http://dx.doi.org/10.1177/0169796x19826762.
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This article assesses Zimbabwean health services, using a social workers’ social development paradigm to analyze the dynamics of Zimbabwe’s Social Security program, focusing on universal health access for older persons, orphans, and vulnerable children. This article identifies the key factors that have done the most to shape health policy administration in the broader context of social policies and social security in Zimbabwe. The discussion is framed around the need for pro-poor social policies, social inclusivity, and the efforts to ensure universal health access. Despite numerous reports, newspaper op-eds and consultancy documents offering opinions on the state of social service delivery in the country, most critics lack empirical data and end up being very anecdotal as they critique the present system. The socioeconomic context of Zimbabwe is therefore analyzed here, with the best available statistical evidence provided, followed by assessment of social policy interventions. Current challenges to access health services are evaluated using a human rights-based social policy approach. The recent Zimbabwe Ministry of Finance-led consultative process crafted a 2016 document, the Poverty Reduction Strategies Papers (PRSPs), as an overall strategy for transforming the Zimbabwean health sector. The article concludes by recommending community-based health insurance approach as most appropriate intervention for ensuring health inclusivity and enhancing health for all in Zimbabwe.
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Gazimbi, Martin Marufu, and Monica Akinyi Magadi. "INDIVIDUAL- AND COMMUNITY-LEVEL DETERMINANTS OF ANTENATAL HIV TESTING IN ZIMBABWE." Journal of Biosocial Science 51, no. 2 (March 6, 2018): 203–24. http://dx.doi.org/10.1017/s002193201800007x.
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SummaryThis study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women’s economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.
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Nyazema, Norman Z. "The Zimbabwe Crisis and the Provision of Social Services." Journal of Developing Societies 26, no. 2 (June 2010): 233–61. http://dx.doi.org/10.1177/0169796x1002600204.
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Historically, health care in Zimbabwe was provided primarily to cater to colonial administrators and the expatriate, with separate care or second-provision made for Africans. There was no need for legislation to guarantee its provision to the settler community. To address the inequities in health that had existed prior to 1980, at independence, Zimbabwe adopted the concept of Equity in Health and Primary Health Care. Initially, this resulted in the narrowing of the gap between health provision in rural areas and urban areas. Over the years, however, there have been clear indications of growing inequities in health provision and health care as a result of mainly Economic Structural Adjustment Policies (ESAP), 1991–1995, and health policy changes. Infant and child mortality have been worsened by the impact of HIV/AIDS and reduced access to affordable essential health care. For example, life expectancy at birth was 56 in the 1980s, increased to 60 in 1990 and is now about 43. Morbidity (diseases) and mortality (death rates) trends in Zimbabwe show that the population is still affected by the traditional preventable diseases and conditions that include nutritional deficiencies, communicable diseases, pregnancy and childbirth conditions and the conditions of the new born. The deterioration of the Zimbabwean health services sector has also partially been due to increasing shortages of qualified personnel. The public sector has been operating with only 19 per cent staff since 2000. Many qualified and competent health workers left the country because of the unfavourable political environment. The health system in Zimbabwe has been operating under a legal and policy framework that in essence does not recognize the right to health. Neither the pre-independence constitution nor the Lancaster House constitution, which is the current Constitution of Zimbabwe, made specific provisions for the right to health. Progress made in the 1980s characterized by adequate financing of the health system and decentralized health management and equity of health services between urban and rural areas, which saw dramatic increases in child survival rates and life expectancy, was, unfortunately, not consolidated. As of 2000 per capita health financing stood at USD 8.55 as compared to USD 23.6, which had been recommended by the Commission of Review into the Health Sector in 1997. At the beginning of 2008 it had been dramatically further eroded and stood at only USD 0.19 leading to the collapse of the health system. Similarly, education in Zimbabwe, in addition to the changes it has undergone during the different periods since attainment of independence, also went through many phases during the colonial period. From 1962 up until 1980, the Rhodesia Front government catered more for the European child. Luckily, some mission schools that had been established earlier kept on expanding taking in African children who could proceed with secondary education (high school education). Inequity in education existed when the ZANU-PF government came into power in 1980. It took aggressive and positive steps to redress the inequalities that existed in the past. Unfortunately, the government did not come up with an education policy or philosophy in spite of massive expansion and investment. The government had cut its expenditure on education because of economic and political instability. This has happened particularly in rural areas, where teachers have left the teaching profession.
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Fawcus, S., M. Mbizvo, G. Lindmark, and L. Nyström. "A Community-Based Investigation of Maternal Mortality from Obstetric Haemorrhage in Rural Zimbabwe." Tropical Doctor 27, no. 3 (July 1997): 159–63. http://dx.doi.org/10.1177/004947559702700314.
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In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100 000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.
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Madziyauswa, Victor. "Assessing sustainability of community managed NGOs’ WASH interventions in rural Zimbabwe: the case of Chivi district in Masvingo province." Journal of Water, Sanitation and Hygiene for Development 8, no. 4 (November 13, 2017): 640–49. http://dx.doi.org/10.2166/washdev.2017.049.
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Abstract Availability and accessibility to water and good sanitation add considerably towards improving human lives and in the development of every country. In a number of instances, central governments have been unable to meet the requirements and needs of their respective citizens in totality, mainly due to capacity constraints and other competing demands. This has seen non-government organizations (NGOs) inspired to provide communities with those services. Concern has been raised about sustainability of community managed NGOs’ services in rural areas of Zimbabwe. This study assesses sustainability of community managed NGOs’ rural WASH services with a view to producing recommendations on how sustainability of NGOs’ services might be enhanced by working with other stakeholders. The study's major finding was that NGOs’ services in rural areas lack a clear mechanism of enhancing continuity. Forty-five households, three water point committees, two schools and one clinic from three wards were interviewed. Respondents were chosen using purposive sampling techniques from ward 18, 19 and 20. Semi-structured interviews were conducted with the use of an interview guide. The study recommends the need for government to prioritize the rural WASH sector in resource allocation. This will ensure that infrastructure maintenance and repairs are implemented in conjunction with involved communities.
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Busza, Joanna, Tarisai Chiyaka, Sithembile Musemburi, Elizabeth Fearon, Calum Davey, Sungai Chabata, Phillis Mushati, et al. "Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial." Health Policy and Planning 34, no. 5 (June 1, 2019): 337–45. http://dx.doi.org/10.1093/heapol/czz037.
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Abstract Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters’ Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention’s implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe’s changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.
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Alikali, Moses. "The attitudes and activities of pastors and faith leaders in Zimbabwe on the use of family planning methods among their members." Christian Journal for Global Health 4, no. 2 (July 11, 2017): 66–74. http://dx.doi.org/10.15566/cjgh.v4i2.188.
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Background
Faith leaders are important gatekeepers in disseminating reproductive health messages and influencing positive behavior change within communities. Faith leaders are seen as the most powerful, visible, and reachable form of authority, even trusted more than governments or non-profit organizations. In addition to providing counsel and advice aimed at enhancing health and wellbeing of the worshippers, faith leaders also play an important role in advocating and influencing what is taught in schools and what services are provided in healthcare facilities. Because of this influence, faith leaders often have an unparalleled opportunity—indeed, a moral obligation—to prioritize conversations about family planning, advocating, and closing the contraception gap.
The overall objective of this study was to ascertain the attitude and activities of pastors and faith leaders in Zimbabwe on the use of family planning methods among their members. The result revealed that some faith leaders believed that spreading information about family planning education was the responsibility of the government and tended to avoid such responsibility. However, through training on family planning advocacy, much can be achieved.
Methods
Qualitative study methods were used to better understand the attitude and activities of pastors and faith leaders in Zimbabwe on the use of family planning methods among their members. The participants of this survey were drawn from 8 of 10 provinces in Zimbabwe, which include: Bulawayo, Harare, Manicaland, Mashonaland Central, Mashonaland East, Mashonaland West, Masvingo, and Matabeleland North.
Paper-based questionnaires were answered by 24 pastors and 26 faith leaders in Zimbabwe (Table 1) through personal face-to-face meetings, while interviews were conducted with a select few pastors and faith leaders. The samples were drawn from randomly selected churches in Zimbabwe. Data was analyzed using Epi info 7 and Microsoft Excel.
Results
Generally, the pastors and faith leaders understood the benefits of longer birth intervals for the health of their members and their children, and the need for them to be involved in family planning awareness. However, both seemed slow to incorporate family planning into their programs. The faith leaders indicated an interest in being a part of various forms of campaigns to promote family planning if they could be equipped with correct information on family planning. Many strongly believed family planning to be of great importance to them and their families in situations where their financial incomes were low, and that family planning could reduce the rate of abortion. A majority agreed family planning was in agreement with their religious beliefs. Some felt their members had basic information on family planning methods, but only 44 percent of the faith leaders actually counseled their members on family planning methods from time to time. Although many would like to be part of those who create awareness in their various places of worship, only 28 percent of them had the right information on family planning through training.
Conclusion
One major factor for the limited involvement of faith leaders in family planning awareness is their lack of correct information on family planning. The gap can be narrowed by organizing family planning advocacy training workshops. Networks such as Africa Christian Health Association Platform (ACHAP), the Islamic Medical Association of Zimbabwe (IMAZ), Zimbabwe Association of Church-Related Hospitals (ZACH), and Zimbabwe Council of Churches (ZCC) can also be leveraged to disseminate and accelerate the spread of family planning information.
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Orne-Gliemann, J., T. Mukotekwa, A. Miller, F. Perez, M. Glenshaw, P. Nesara, and F. Dabis. "Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe." Public Health Nutrition 9, no. 5 (August 2006): 563–69. http://dx.doi.org/10.1079/phn2005881.
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AbstractObjectiveTo describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.DesignA cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.SettingThe study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.SubjectsThe interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.ResultsOverall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.ConclusionThe HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.
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van Reisen, Mirjam, Mia Stokmans, Munyaradzi Mawere, Mariam Basajja, Antony Otieno Ong'ayo, Primrose Nakazibwe, Christine Kirkpatrick, and Kudakwashe Chindoza. "FAIR Practices in Africa." Data Intelligence 2, no. 1-2 (January 2020): 246–56. http://dx.doi.org/10.1162/dint_a_00047.
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This article investigates expansion of the Internet of FAIR Data and Services (IFDS) to Africa, through the three GO FAIR pillars: GO CHANGE, GO BUILD and GO TRAIN. Introduction of the IFDS in Africa has a focus on digital health. Two examples of introducing FAIR are compared: a regional initiative for digital health by governments in the East Africa Community (EAC) and an initiative by a local health provider (Solidarmed) in collaboration with Great Zimbabwe University in Zimbabwe. The obstacles to introducing FAIR are identified as underrepresentation of data from Africa in IFDS at this moment, the lack of explicit recognition of situational context of research in FAIR at present and the lack of acceptability of FAIR as a foreign and European invention which affects acceptance. It is envisaged that FAIR has an important contribution to solve fragmentation in digital health in Africa, and that any obstacles concerning African participation, context relevance and acceptance of IFDS need to be removed. This will require involvement of African researchers and ICT-developers so that it is driven by local ownership. Assessment of ecological validity in FAIR principles would ensure that the context specificity of research is reflected in the FAIR principles. This will help enhance the acceptance of the FAIR Guidelines in Africa and will help strengthen digital health research and services.
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Makurirofa, L., J. Mavu, P. Mangwiro, and M. Nyamuranga. "Women's Knowledge, Attitudes and Practices (KAP) Relating to Breast and Cervical Cancers in Rural Zimbabwe: A Cross Sectional Study in Mudzi District, Mashonaland East Province." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 8s. http://dx.doi.org/10.1200/jgo.18.67500.
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Background: Breast and cervical cancer constitute the most common cancers among women in sub-Saharan Africa. In Zimbabwe, cervical cancer accounts for more than a third of all cancers among women of African descent. Cancer knowledge levels, attitudes and practices of people in different sections of society, especially in remote and disadvantaged peripheral areas, should be assessed to guide current cancer interventions. Aim: This study aimed to assess breast and cervical cancer knowledge, attitudes and practices of women of reproductive age, in Mudzi District, Republic of Zimbabwe. The study forms the baseline for cancer intervention in this remote, rural district. Methods: This cross-sectional, community-based survey was conducted by triangulation of both quantitative and qualitative research methods. A total of 409 survey household questionnaires were administered to women of reproductive age (15-49 years) in 2014. Key informant interviews and focus group discussions were conducted to provide context for the survey responses. Results: The response rate was 100%. Nearly 85% of respondents had heard of cancer. About 34.2% did not know of any cervical cancer risk factors, while 51% were not familiar with the signs and symptoms of cervical cancer. About 55% had not discussed cancer issues with partners in the past 12 months, and only 27.4% had discussed cancer issues with partners at all. Most of the respondents (96.2%) had never undergone cervical cancer screening. The majority of the respondents (70.8%) had never discussed breast cancer issues with community members. About 70% had never discussed cervical cancer issues with community members. Conclusion: This study revealed a lack of awareness and comprehensive knowledge about breast and cervical cancer. It also revealed low self-risk perception, low uptake of cancer early detection services and low capacity of local health institution in offering cancer services. It is recommended that the scaling-up of cancer information dissemination and early detection services must be prioritized, including training of local health institutions.
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Kachale, Fannie, Imelda Mahaka, Fatima Mhuriro, Mary Mugambi, Joseph Murungu, Barbra Ncube, Getrude Ncube, et al. "Integration of HIV and sexual and reproductive health in the era of anti-retroviral-based prevention: findings from assessments in Kenya, Malawi and Zimbabwe." Gates Open Research 5 (September 15, 2021): 145. http://dx.doi.org/10.12688/gatesopenres.13330.1.
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Background: Though substantial progress has been made to curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. With the scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon, countries have a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV/SRH services. Methods: This article is a comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi and Zimbabwe to highlight cross-country trends and context-specific realities around HIV/SRH integration. The analyses in Kenya and Zimbabwe were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager project and include 20 health facility assessments, 73 key informant interviews and six community dialogues. In Malawi, the analysis was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 key informant interviews and a review of national policies and program implementation in Blantyre. Findings were validated through a review of literature and policies in each country. Results: The policy environment in all three countries is conducive to HIV/SRH integration, though operationalization continues to present challenges, with most policies preceding and not accounting for oral PrEP rollout. National coordination mechanisms, youth-friendly health services and prevention of mother-to-child transmission programs are promising practices, while siloed and resource-constrained health systems, limited provider capacity, lack of support for demand generation and structural factors exacerbate barriers to achieving integration. Conclusions: As new HIV prevention products are introduced, demand for integrated HIV/SRH services is likely to grow. Investing in HIV/SRH integration can help to ensure sustainable, government-led responses to the HIV epidemic, streamline service delivery and improve the health outcomes and lives of AGYW.
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Ndori-Mharadze, Tendayi, Elizabeth Fearon, Joanna Busza, Jeffrey Dirawo, Sithembile Musemburi, Calum Davey, Xeno Acharya, Sibongile Mtetwa, James R. Hargreaves, and Frances Cowan. "Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015." Journal of the International AIDS Society 21 (July 2018): e25138. http://dx.doi.org/10.1002/jia2.25138.
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Muhumuza, Richard, Andrew Sentoogo Ssemata, Ayoub Kakande, Nadia Ahmed, Millicent Atujuna, Mangxilana Nomvuyo, Linda-Gail Bekker, et al. "Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa." Archives of Sexual Behavior 50, no. 4 (May 2021): 1729–42. http://dx.doi.org/10.1007/s10508-020-01880-y.
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Abstract Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. Few studies have explored adolescents and young people’s perspectives toward PrEP. We conducted 24 group discussions and 60 in-depth interviews with males and females aged 13–24 years in Uganda, Zimbabwe, and South Africa between September 2018 and February 2019. We used the framework approach to generate themes and key concepts for analysis following the social ecological model. Young people expressed a willingness to use PrEP and identified potential barriers and facilitators of PrEP uptake. Barriers included factors at individual (fear of HIV, fear of side effects, and PrEP characteristics), interpersonal (parental influence, absence of a sexual partner), community (peer influence, social stigma), institutional (long waiting times at clinics, attitudes of health workers), and structural (cost of PrEP and mode of administration, accessibility concerns) levels. Facilitators included factors at individual (high HIV risk perception and preventing HIV/desire to remain HIV negative), interpersonal (peer influence, social support and care for PrEP uptake), community (adequate PrEP information and sensitization, evidence of PrEP efficacy and safety), institutional (convenient and responsive services, provision of appropriate and sufficiently resourced services), and structural (access and availability of PrEP, cost of PrEP) levels. The findings indicated that PrEP is an acceptable HIV prevention method. PrEP uptake is linked to personal and environmental factors that need to be considered for successful PrEP roll-out. Multi-level interventions needed to promote PrEP uptake should consider the social and structural drivers and focus on ways that can inspire PrEP uptake and limit the barriers.
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Chidakwa, Patience, Clifford Mabhena, Blessing Mucherera, Joyline Chikuni, and Chipo Mudavanhu. "Women’s Vulnerability to Climate Change: Gender-skewed Implications on Agro-based Livelihoods in Rural Zvishavane, Zimbabwe." Indian Journal of Gender Studies 27, no. 2 (June 2020): 259–81. http://dx.doi.org/10.1177/0971521520910969.
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Climate change presents a considerable threat to human security, with notable gender disproportions. Women’s vulnerability to climate change has implications on agro-based livelihoods, especially the rural populace. The primary purpose of this study was to assess women’s vulnerability to climate change and the gender-skewed implications on agro-based livelihoods in rural Zvishavane, Zimbabwe. A qualitative approach that used purposive sampling techniques was adopted. Data was collected through 20 in-depth interviews with 11 de jure and 9 de facto small-scale female-headed farmer households. Two focus group discussions with mixed de facto and de jure small-scale female-headed farmer households were also conducted. Five key informant interviews were held with departmental heads of the Ministry of Women’s Affairs, Gender and Community Development; the Agriculture Technical Extension Service Department; the Livestock Production Department; the Runde Rural District Council and the Meteorological Services Department. Gendered effects were noted in terms of increased roles and responsibilities for women. Observations showed that there was an increase in distances travelled by women to fetch water owing to a depleted water table. Climate-induced migration of men due to depleted livelihoods in rural areas has also increased roles and responsibilities for women. The traditional male responsibilities assumed by women included cattle herding and ox-driven ploughing. This study concluded that adaptation strategies towards vulnerability to climate change have to be gender-sensitive and area-specific. This study also recommended that response programmes and policies meant to curb existing gendered vulnerabilities should be informed by evidence because climate-change effects are unique for different geographical areas. Moreover, adaptation activities should be mainstreamed in community processes so as to reduce the burden on women and increase sustainability opportunities.
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Mhlanga-Gunda, Rosemary, Stephanie Kewley, Nehemiah Chivandikwa, and Marie-Claire Van Hout. "Prison conditions and standards of health care for women and their children incarcerated in Zimbabwean prisons." International Journal of Prisoner Health 16, no. 3 (April 27, 2020): 319–36. http://dx.doi.org/10.1108/ijph-11-2019-0063.
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Purpose The Sub-Saharan African (SSA) region remains at the epicentre of the HIV epidemic and disproportionately affecting women, girls and prisoners. Women in prison are a minority group and their special health needs relating to gender sensitivity, reproductive health, their children and HIV/AIDs are frequently neglected. Our study responded to this need, and aimed to investigate the issue. Design/methodology/approach A qualitative study using focus group discussions and key informant interviews explored the perspectives of women in prison, correctional officers, correctional health professionals and non-governmental organisations around prison conditions and standards of health care while incarcerated in a large female prison in Zimbabwe. Narratives were transcribed and analysed using thematic analysis. Findings The three key themes that emerged are as follows: “Sanitation and hygiene in the prison”, “Nutrition for women and children” and “Prison-based health services and health care”. Divergence or agreement across perspectives around adequate standards of sanitation, hygiene, quality and adequacy of food, special diets for those with health conditions, access to health care in prison and the continuum of care across incarceration and community are presented. Practical implications Understanding prison environmental cultures which shape correctional staff’s understanding and responsiveness to women in prison, environmental health conditions and access to health care are vital to improve conditions and continuum of care in Zimbabwe. Originality/value Policy and technical guidance continues to emphasise the need for research in SSA prisons to garner insight into the experiences of women and their children, with a particular emphasis on the prison environment for them, their health outcomes and health-care continuum. This unique study responded to this need.
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DUBE-MAWEREWERE, VIRGININIA. "A medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe." Journal of Forensic Practice 17, no. 2 (May 11, 2015): 134–48. http://dx.doi.org/10.1108/jfp-10-2014-0036.
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Purpose – The purpose of this paper is to develop a medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe. Design/methodology/approach – Grounded theory of the Charmaz (2006, 2014) persuasion was used. An exploratory qualitative design was utilised. The theoretical framework that was used as a point of departure was Pierre Bourdieu’s conceptual canon. Participants were purposefully and theoretically sampled. These included the judiciary, patients, patients’ family, psychiatrists, nurses, social workers, experts in forensic psychiatric practice. They were 32 in total. Findings – The findings reflected a need to realign the dislocation and dissonance between and within the fields of the prison system, medical system, and the judiciary. The realignment was done by co-constructing a therapeutic jurisprudent medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe with participants who were stakeholders in forensic psychiatric rehabilitation. Research limitations/implications – The study was focused on male forensic psychiatric patients rehabilitation and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. However, it is possible that including females in the study could have added perspective to the study. This also limits the generalisation of findings beyond the male forensic psychiatric participants. Services beyond the experience of participants translate to the notion that findings cannot be generalised beyond the parameters of the study. Future research and service evaluation and audit need to be considered. The study findings focused on the “psychiatric” aspect and did not emphasise the “forensic” aspect of the service delivery service. Future research may need to feature physical provisions and progression pathways with reference to “forensic” risk reduction as a parallel goal. Practical implications – The study calls for the following: Transformation of the medico-judicial system, adjusting legislation and restructuring of the public service; changing of public attitudes to enable implementation of the medico-judicial framework; there is need for a step by step process in the implementation of the framework in which training needs of service staff, social workers, community leaders and key stakeholders will need to be addressed; the proposed changes presented by the model will require cultural, financial and infrastructural shifts. Social implications – There is need for policy makers to re-enfranchise or rebrand forensic psychiatric rehabilitation services in Zimbabwe. This could positively involve the marketing of forensic psychiatric rehabilitation to the stakeholders and to the public. This is projected to counter the stigma, disinterest and disillusionment that run through both professionals and public alike. This will foster a therapeutic jurisprudence that upholds the dignity and rights of forensic psychiatric patients. Originality/value – This work is an original contribution to forensic psychiatry in Zimbabwe. Research in that area is prohibitive because of the complexity of processes that are followed. This research is therefore ground breaking.
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Hove, Mediel, Tinashe Nyamunda, and Patience Mukwambo. "Violent state operations at Chiadzwa (Zimbabwe) diamond fields 2006-2009." Journal of Aggression, Conflict and Peace Research 6, no. 1 (January 7, 2014): 56–75. http://dx.doi.org/10.1108/jacpr-11-2012-0014.
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Purpose – The purpose of this paper is to investigate the debilitating socio-economic impact caused by the diamonds at Chiadzwa area in Zimbabwe on the illegal mining community that emerged and inhabited the hills of Chiadzwa between 2006 and the beginning of 2009. The research was carried out for academic proposes, as an advocacy strategy to expose the abuses and violent state operations perpetrated by the security forces. In addition, it intends to equip policy makers and implementers about the heavy handedness of Zimbabwe's security sector during its operations in the area in an effort to enable policy implementers to defend the rights of the affected people at Chiadzwa. Design/methodology/approach – The methodology engaged was chiefly qualitative and the study was a product of primary sources (especially in-depth interviews) and secondary sources (text books, journal articles, newspapers and the internet). Purposive and snowballing sampling techniques were used to collect the data between 2007 and 2009. Collected data were analysed and compiled between 2009 and 2013. Some of the names used in this study for our respondents are pseudo and this was done to ensure anonymity and secure the providers of information against possible retribution. On the other hand real names were used in particular where violent state driven operations were discussed. Findings – Initially the government of Zimbabwe was reluctant to intervene in the illegal extraction of diamonds in search of political leverage. Later it responded with violent manipulative strategies and operations with detrimental consequences on the illegal miners. The brutal strategies employed by individuals and the state led to injury, illness and death of people amid a harsh socio-economic environment. Research limitations/implications – A number of respondents preferred to use pseudonyms because they feared that information collected could be used against them. Practical implications – The study is a good example of conflict between the state machinery and its citizens over a natural resource. It reveals excessive use of force by the state which appears to be the norm in other countries where diamonds are dubbed “blood diamonds”. Social implications – In the midst of the diamond-related violence a new and vibrant social identity emerged commonly referred to as magweja. The area experienced challenges especially with regards to the provision of health services and the traditional use of herbs was endangered by the destruction of vegetation. Originality/value – It reveals a milieu, state regulation enforcement and security agents, magombiro (armed robbers or murderers) all who discharged violence on magweja the foremost victims of the violent systems and practices. In addition, it encourages policy markers and implementers to devise non-violent strategies when dealing with illegal exploitation of natural resources.
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Meagher, R. C., and T. Tingberg. "(A165) Red Cross Health Erus, a Modular Approach to the Challenge of Evolving Emergencies." Prehospital and Disaster Medicine 26, S1 (May 2011): s47—s48. http://dx.doi.org/10.1017/s1049023x11001634.
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Emergency Response Units (ERUs) were pioneered over a decade ago by the International Federation of Red Cross and Red Crescent Societies (IFRC), with the intention of providing a standardized, rapid global tool for response in disasters. Health ERUs are one example of several types of ERUs on stand-by in various countries around the world. Their tented infrastructure, basic medical equipment, and pre-trained personnel allow for the provision of surge medical capacity where it is needed. Commonly used set-ups include a Basic Health Care Unit and a Referral Hospital. The recently-introduced Rapid Deployment Emergency Hospital allows for a lighter, highly mobile infrastructure, with surgical and emergency medical capacity. The modular design of these ERUs allows for deployment with materials “tailored” to the disaster. Their flexibility has been demonstrated in public health emergencies such as the nation-wide cholera epidemic that occurred in Zimbabwe (2008) and more recently in earthquake-damaged Haiti (2010) and flood-affected Pakistan (2010). Health ERUs already on the ground in post-earthquake Haiti were able to re-organize equipment for use in cholera treatment units and centers, and additional ERUs were deployed specifically to set-up treatment centers. In Pakistan, a mobile clinic set-up was used to deliver primary health services to displaced populations, including psychosocial support initiatives and community health messages to minimize the emergence of communicable diseases. The Community Health module (CHM) is a new module in development since 2009. Experience has shown that disrupted health systems, combined with displaced populations can create a fertile environment for communicable disease outbreaks. The CHM addresses primary, secondary and tertiary prevention early in emergencies by engaging communities and more specifically National Society volunteers in epidemic control. The modular design of Health ERUs allow for a rapid and comprehensive approach to delivery of health care in a disaster, with a longitudinal perspective of population needs.
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Matongera, Trylee Nyasha. "The effects of relief food aid on food production and consumption patterns of communal farmers in Chigodora community, Case study: Zimbabwe." Review of Social Sciences 2, no. 3 (March 31, 2017): 24. http://dx.doi.org/10.18533/rss.v2i3.73.
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<p>The research study focuses on the effects of relief food aid on food production and consumption patterns of communal farmers in Chigodora Ward 15, Mutare District. The researcher adopted a descriptive research design. Data collection instruments used in this research study included questionnaires, interviews as well as published documents. Questionnaires targeted households in selected villages. The researcher used a cluster sampling strategy in selecting villages and random sampling technique was used to select households from the selected villages. Interviews targeted key informants such as the Agritex Extension Officer, Mutare Rural District Council Social Services Director, and Chitakatira Health Care leader, Ward 15 Councilor, Plan International Selection Director and The Village Heads. Key informants were selected using purposive sampling technique. The researcher found out that relief food aid beneficiaries in Chigodora Ward 15 receive maize, beans, cooking oil and porridge on a monthly basis. Plan international is the only humanitarian organization which supplies food in the community. Since the involvement of food aid agencies in Chigodora, production of indigenous crops such as finger millet, sorghum and rapoko decreased. New crops such as peas are now grown. The major factors driving the persistence of relief food are HIV and AIDS, climate change, lack of fair distribution of farming inputs, the restructuring of the agricultural system and dependency syndrome. Short term impacts of relief food aid on food production and access include impacts on local taste, promotes laziness and compromises access to local foods. Long term impacts mentioned were, overall decrease in food production, disincentives on farmers to produce and exposure to low quality and unsafe products. The suggest the government of Zimbabwe needs to adequately assist and empower communal farmers to produce enough food from their fields through modern technologies as well as providing farmers with loans for inputs such as fertilizers, pesticides and equipment to improve productivity.</p><p> </p>
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Mukona, Doreen, Stephen Peter Munjanja, Mathilda Zvinavashe, and Babil Stray-Pederson. "Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients’ Perspective." Journal of Diabetes Research 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/3578075.
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Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semistructured questionnaire. Detailed notes were taken during the interviews which were also being audiotaped. Data were analysed thematically and manually. Themes identified were barriers and possible solutions to nonadherence to therapy. Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions were fostering social support, financial support, and improvement of hospital services. Individualised care of women with diabetes is essential, and barriers and possible solutions identified can be utilised to improve care.
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Mhlanga, Maxwell, Midion Chidzonga, and Clara Haruzivishe. "The Long-Term Effect of the Integrated Care Model on Child Morbidity in Murewa District, Zimbabwe: A pragmatic Trial." Global Journal of Health Science 12, no. 13 (November 17, 2020): 138. http://dx.doi.org/10.5539/gjhs.v12n13p138.
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BACKGROUND: Poor access and utilisation of health care services remains a big challenge in rural communities in low to middle income countries leading to high prevalence of preventable childhood illnesses and death. Many community mobilisation models have been employed to address this. However, scientific evidence remain scanty on the long-term effects of such models to inform policy-makers on how to reduce preventable child morbidity and mortality and to provide guidance on what is pragmatic. The purpose of this study was to determine the long-term effects of the Integrated Care Model (ICM) on child morbidity and mortality in Zimbabwe.
METHODS: This was a pragmatic trial that used a quasi-experimental design. The study used population based sampling to enrol villages into either intervention sites or control sites from two health centres in Murewa District. Target sampling was used to enrol children aged 0-48 months into the study. A total of 1380 children were enrolled and followed up prospectively for a period of 18 months. The disease condition that were being tracked were pneumonia, diarrhoea, fever and Malaria.
RESULTS: We performed negative binomial logistic regression to determine the long-term effects of the intervention on child morbidity, adjusting for the number of under-fives in each village/cluster, village size, distance to the clinic and number of under-fives in each cluster. Overall, the intervention reduce the risk of general child morbidity by 83% [RR=0.17, 95% CI (0.14-0.23)]. The intervention reduced risk of incidence of pneumonia by 79% [RR=0.21, 95% CI (0.10-0.45)], risk of incidence of diarrhoea by 80% [RR=0.20 95% CI (0.15-0.29)], fever by 91%[RR=0.09, 95% CI (0.04-0.22)] and malaria by 73%[RR=0.27, 95% CI (0.14-0.51)].The incidence rate of childhood severe illnesses was reduced by 79%[RR=0.24, 95% CI (0.11-0.40)] through the intervention.
CONCLUSION: This study sought to determine the long term effects of the Integrated Care Model on Child Morbidity in Murewa district, Zimbabwe. Study results revealed that indeed the ICM had a statistically significant impact on child morbidity in the long-term. Countries in low resource settings can benefit from the use of such a low-cost high impact model to reduce not only child morbidity and mortality, but also to address maternal health challenges.
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Stewart, Miriam, Kaysi Eastlick Kushner, CindyLee Dennis, Michael Kariwo, Nicole Letourneau, Knox Makumbe, Edward Makwarimba, and Edward Shizha. "Social support needs of Sudanese and Zimbabwean refugee new parents in Canada." International Journal of Migration, Health and Social Care 13, no. 2 (June 12, 2017): 234–52. http://dx.doi.org/10.1108/ijmhsc-07-2014-0028.
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Purpose The purpose of this paper is to examine support needs of African refugee new parents in Canada, and identifies support preferences that may enhance the mental health of refugee parents and children. Design/methodology/approach In all, 72 refugee new parents from Zimbabwe (n=36) and Sudan (n=36) participated in individual interviews. All had a child aged four months to five years born in Canada. Refugee new parents completed standardized measures on social support resources and support seeking as a coping strategy. Four group interviews (n=30) with refugee new parents were subsequently conducted. In addition, two group interviews (n=30) were held with service providers and policy influencers. Findings Separated from their traditional family and cultural supports, refugee new parents reported isolation and loneliness. They lacked support during pregnancy, birth, and postpartum and had limited interactions with people from similar cultural backgrounds. Refugees required support to access services and overcome barriers such as language, complex systems, and limited financial resources. Support preferences included emotional and information support from peers from their cultural community and culturally sensitive service providers. Research limitations/implications Psychometric evaluation of the quantitative measures with the two specific populations included in this study had not been conducted, although these measures have been used with ethnically diverse populations by other researchers. Practical implications The study findings can inform culturally appropriate health professional practice, program and policy development. Originality/value The study bridges gaps in research examining support needs and support intervention preferences of African refugee new parents.
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Tessema, Zemenu Tadesse, and Amare Minyihun. "Utilization and Determinants of Antenatal Care Visits in East African Countries: A Multicountry Analysis of Demographic and Health Surveys." Advances in Public Health 2021 (January 13, 2021): 1–9. http://dx.doi.org/10.1155/2021/6623009.
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Background. The health care a woman receives during pregnancy is important for her survival and baby, both at the time of delivery and shortly after that. In the context of high maternal morbidity and mortality in sub-Saharan Africa, fewer than 80% of pregnant women receive antenatal care visit services. Receiving antenatal care visits at least four times increases the likelihood of receiving effective maternal health interventions through the antenatal period. This study aimed to identify the utilization and determinants of attending at least four visits in 12 East African countries. Methods. The study used the demographic and health survey data from 12 East African countries from 2008 to 2018. The DHS program adopts standardized methods involving uniform questionnaires, manuals, and field procedures to gather information comparable across countries globally. A multivariable logistic regression model was fitted to identify the determinants of completing at least four antenatal care services. With their 95% CI obtained from the adjusted multilevel logistic regression model, the adjusted odds ratio was presented to show the magnitude of the relationship between the independent variable and completing antenatal care visits. Results. The pooled utilization of attending at least four antenatal care visit in the East African region was 52.44% (95% CI: 52.13, 52.74), with the highest attending at least four or more antenatal care visit visits in Zimbabwe (75.72%) and the lowest attending at least four or more antenatal care visit visits in Ethiopia (31.82%). The significant determinants of completing at least four ANC visits were age category (24–34 (AOR = 1.24, 95% CI: 1.18, 1.31) and 35–49 (AOR = 1.42, 95% CI: 1.32, 1.53)); being married women (AOR = 1.11, 95% CI: 1.1.05, 1.16); education levels of primary education (AOR = 1.20, 95% CI: 1.13, 1.27), secondary education (AOR = 1.24, 95% CI: 1.24, 1.47), and higher education (AOR = 1.91, 95% CI: 1.62, 2.14); birth order (2–4 (AOR = 0.75, 95% CI: 0.70, 0.79) and 5+ (AOR = 0.63, 95% CI: 0.58, 0.68)); planned pregnancy (AOR = 0.81, 95% CI: 0.75, 0.86); contraceptive utilization (AOR = 1.36, 95% CI: 1.29, 1.43); wealth status of middle (AOR = 1.11, 95% CI: 1.05, 1.17) and rich (AOR = 1.25, 95% CI: 1.18, 1.32); having no problem accessing health care (AOR = 1.0.95, 95% CI: 0.89, 0.97); and living countries. Conclusions. The coverage of completing the recommended antenatal care visit was low in the region. Age, marital status, mother’s and partner’s education, women’s occupation, birth order, planned pregnancy, contraceptive utilization, wealth status, healthcare accessibility, and living countries were the major determinants of completing recommended antenatal care visits. Therefore, intersectoral collaboration to promote female education and empowerment, improve geographical access to health care, and strengthen implementation of antenatal care policies with active community participation is recommended. In addition, creating a conducive environment in entrepreneurial activities for poor women is needed.
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Wogrin, Carol, Nicola Willis, Abigail Mutsinze, Silindweyinkosi Chinoda, Ruth Verhey, Dixon Chibanda, and Sarah Bernays. "It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV." PLOS ONE 16, no. 3 (March 3, 2021): e0248018. http://dx.doi.org/10.1371/journal.pone.0248018.
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Introduction Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. Methods We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18–24) from across 10 intervention districts and audio recorded 200 of the peer supporters’ monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. Results A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Conclusion Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.
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Chaibva, C. N., J. H. Roos, and V. J. Ehlers. "Adolescent mothers’ non-utilisation of antenatal care services in Bulawayo, Zimbabwe." Curationis 32, no. 3 (September 9, 2009). http://dx.doi.org/10.4102/curationis.v32i3.1219.
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Adolescent pregnancies are high risk obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. The purpose of the study was to identify factors influencing adolescents' non-utilisation of ANC services in Bulawayo. The Health Belief Model (HBM) was used to contextualise the study. A quantitative, non-experimental, descriptive research design was adopted, using structured interviews to collect data. Purposive, non-probability sampling was used to conduct structured interviews with 80 adolescent mothers from the postnatal wards who had delivered their babies without attending ANC. Factors influencing these adolescent mothers’ non-utilisation of ANC services included socio-economic issues, individuals' perceptions about ANC, limited knowledge about ANC, policies and structural barriers. However, these adolescents knew that delivering their babies with skilled attendance could enhance the outcomes for the mothers and babies, would help secure documents to facilitate the acquisition of their children's birth certificates, and that obstetric complications required the services of skilled midwives/doctors. Policy-related issues, such as requiring national identity cards from pregnant adolescents (or from their spouses) prohibited some of them from utilising ANC services. There is a need to improve adolescents’ reproductive health outreach (including ANC) programmes and to offer free ANC services in Zimbabwe. Restrictive policies, such as the required identity cards of the pregnant adolescents (or their husbands), impacted negatively on the accessibility of ANC services and should be addressed as a matter of urgency in Bulawayo.
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Tongayi Mwedzi, Nqobizitha Siziba, Oghenekaro Nelson Odume, Eisen Nyamazana, and Innocent Mabika. "Responses of macroinvertebrate community metrics to urban pollution in semi-arid catchments around the city of Bulawayo, Zimbabwe." Water SA 46, no. 4 October (October 27, 2020). http://dx.doi.org/10.17159/wsa/2020.v46.i4.9071.
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River health monitoring is becoming increasingly important because of the anthropogenic activities that continue to impact on water quality and biodiversity of aquatic systems. This study aimed at identifying and evaluating macroinvertebrate community-based metrics that best respond to degradation due to urban pollution in riverine systems of Bulawayo, Zimbabwe. Data (physicochemical variables and macroinvertebrate specimens) were collected from 17 sites over 3 seasons. The sites were selected across an impairment gradient comprising less impacted, moderately impacted and heavily impacted sites. Heavily impacted sites had the highest levels of total dissolved solids, conductivity, salinity, turbidity, total phosphates, total nitrogen, chemical oxygen demand and sedimentary zinc. Dissolved oxygen was significantly highest in less impacted sites. Sensitivity of 24 macroinvertebrate metrics to this impairment gradient were assessed. A total of 5 metrics were identified as sensitive to modifications in water quality due to urban pollution. These metrics were taxon richness, South African Scoring System (SASS5) score, average score per taxon (ASPT), percentage collectors and percentage scrapers. The selected metrics will be useful for the monitoring and assessment of the studied riverine systems and can be further integrated into one multimetric index that combines a range of indices and allows the integration of ecological information for better management of aquatic ecosystems in this region.
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Ncube, Mthuthukisi. "Exploring the prevalence of the sexually transmitted marks phenomenon in higher education institutions." South African Journal of Science 115, no. 11/12 (November 27, 2019). http://dx.doi.org/10.17159/sajs.2019/6326.
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Countries steadfastly pursue academia as a necessary step towards socio-economic development, which places a mandate on institutions of higher learning to stir host-country economies through university deliverables. In Zimbabwe, this entails the Ministry of Higher and Tertiary Education, Science and Technology Development’s ‘doctrine’ spelling out the philosophy of ‘Education 5.0’ which emphasises teaching/learning, research, community engagement, innovation, and commercialisation of goods and services. However, academic dishonesty, such as that through ‘sexually transmitted marks’ (STM), threatens the realisation of such mandates. Although the norm is that such sexual transactions are initiated by academics, evidence shows students also initiate such relationships. Consequently, efforts to eliminate this threat to academic integrity should not only focus on lecturers, but also be extended to students. This paper contributes towards unmasking experiences of STM between male lecturers and female students, female lecturers and male students, and female students and male students, as determined from former university students and university alumni in Bulawayo. Exposing these practices allows for open consultation and adoption of good practices from similar institutions worldwide.
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"ADOLESCENTS SEXUAL REPRODUCTIVE HEALTH RIGHTS ISSUES IN RURAL ZIMBABWE." International Journal of Applied Research on Public Health Management 7, no. 1 (January 2022): 0. http://dx.doi.org/10.4018/ijarphm.2022010102.
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This study was aimed at examining the knowledge and perceptions of adolescents on Adolescent Sexual and Reproductive Health (ASRH) rural Zimbabwe. Adolescents in Zimbabwe faces limited access to health information and services. Different factors like poverty, gender inequality, socio-cultural and economic status play a crucial role in determining adolescent’s access to ASRH knowledge. Qualitative research methodology was used in the study. Data was gathered through key informant interviews and Focus Group Discussions (FGDs). The culture of communicating ASRH problems with parents was non-existent in most cases save for girls who indicated that they got information from their mothers during menstruation periods. Adolescents indicated that they had limited access to ASRH services available in their community. They further indicated that they were not utilising these services for various reasons such as social stigma, lack of information, poor quality service and the negative attitude displayed by some nurses and counsellors at the nearest health centre.
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Muzvondiwa, Blender, and Roy Batterham. "Building health system responsiveness to noncommunicable diseases for Gweru District adults, Zimbabwe: a case study." Journal of Health Research ahead-of-print, ahead-of-print (March 30, 2021). http://dx.doi.org/10.1108/jhr-07-2020-0248.
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PurposeGweru District, Zimbabwe faces a major challenge of noncommunicable diseases (NCDs). Globally, health systems have not responded successfully to problems in prevention and management of NCDs. Despite numerous initiatives, reorienting health services has been slow in many countries. Gweru District has similar challenges. The purpose of this paper is to explore what the health systems in Zimbabwe have done, and are doing to respond to increasing numbers of NCD cases in adults in the nation, especially in the district of GweruDesign/methodology/approachThe study employed a descriptive narrative review of the academic and grey literature, supplemented by semi-structured key informant interviews with 14 health care staff and 30 adults living with a disease or caring for an adult with a disease in Gweru District.FindingsRespondents identified many limitations to the response in Gweru. Respondents said that screening and diagnosis cease to be helpful when it is difficult securing medications. Nearly all community respondents reported not understanding why they are not freed of the diseases, showing poor understanding of NCDs. The escalating costs and scarcity of medications have led people to lose trust in services. Government and NGO activities include diagnosis and screening, provision of health education and some medication. Health personnel mentioned gaps in transport, medication shortages, poor equipment and poor community engagement. Suggestions include: training of nurses for a greater role in screening and management of NCDs, greater resourcing, outreach activities/satellite clinics and better integration of diverse NCD policies.Research limitations/implicationsParticipant responses were greatly influenced by the current political and economic situation in Zimbabwe, so responses may reflect short-term crises rather than long-term trends.Originality/valueThis research offers an understanding of NCD strategies and their limitations from the bottom-up, lived experience perspective of local health care workers and community members.
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Midzi, Senamiso, Lwazi Sibanda, and Joyce Mathwasa. "PROVISION OF QUALITY EDUCATION IN PRIVATE SCHOOLS: REFLECTIVE PRACTICES IN LOW-COST PRIVATE SECONDARY SCHOOLS IN BULAWAYO METROPOLITAN PROVINCE, ZIMBABWE." European Journal of Social Sciences Studies 6, no. 2 (March 9, 2021). http://dx.doi.org/10.46827/ejsss.v6i2.1016.
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Quality in education has become a cause for concern to every stakeholder in education. The study sought to assess the provision of quality education in low-cost private secondary schools in Bulawayo Metropolitan Province. The study adopted the interpretivist paradigm in qualitative approach, using a case study design. Semi-structured interviews and document analysis were used for collecting thematically analysed data from purposively sampled four school heads and six teachers from low-cost private secondary schools. The study established that in pursuit for quality education, selected schools employed qualified teachers who engage in continuous professional development programmes to sharpen their teaching skills. The findings revealed that the schools understudy are making efforts to offer practical science and computer lessons using the limited resources to ensure the provision of quality education. It emerged that selected schools use e-learning and multimedia resources which arouse learners’ interests and increase the retention rates. It came out that the schools understudy have environmental clubs which work together with school health departments in attending to sanitary issues. Whilst selected schools practiced heterogeneous grouping, the findings revealed that learners with physical disabilities are not enrolled in those schools due to lack of appropriate physical facilities and there are no teachers with relevant expertise to teach learners with special needs. The study revealed that the Ministry of Primary and Secondary Education provided guidelines in the form of policy documents and circulars to monitor the provision of quality education in the selected schools. Despite the efforts made by low-cost secondary schools in providing quality education, the study found that high staff turnover is negatively affecting the quality of education due to lack of continuity in learning. The findings indicated that inadequate learning resources and infrastructure such as libraries, computer and science laboratories, internet services, and lack of teachers with special needs expertise adversely affected the provision of quality education. The study concludes that lack of financial resources is a hindrance in the provision of quality education in low-cost secondary schools. The study recommends that a comparative study on provision of quality education should be conducted in private trust secondary schools.
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Ray, Sunanda, and Robert Mash. "Innovation in primary health care responses to COVID-19 in Sub-Saharan Africa." Primary Health Care Research & Development 22 (2021). http://dx.doi.org/10.1017/s1463423621000451.
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Abstract Background: In May 2020, the African Journal of Primary Health Care and Family Medicine invited submissions on lessons learnt from responses to the COVID-19 pandemic from primary care providers in Africa. This included descriptions of innovations and good practices, the management of COVID-19 in district health services and responses of communities to the outbreak. Aim: To synthesise the lessons learnt from the COVID-19 pandemic in the Africa region. Methods: A thematic document analysis was conducted on twenty-seven short report publications from Botswana, Ghana, Nigeria, South Africa, Uganda and Zimbabwe. Findings: Eight major themes were derived from the data: community-based activities; screening and testing; reorganisation of health services; emergency care for COVID-19; maintenance of essential non-COVID-19 health services; caring for the vulnerable; use of information technology; and reframing training opportunities. Community health workers were a vital community resource, delivering medications and other supplies to homes, as well as following up on patients with chronic conditions. More investment in community partnerships and social mobilisation was proposed. Difficulties with procurement of test kits and turn-around times were constraints for most countries. Authors described how services were reorganised for focused COVID-19 activities, sometimes to the detriment of essential services and training of junior doctors. Innovations in use of internet technology for communication and remote consultations were explored. The contribution of family medicine principles in upholding the humanity of patients and their families, clear leadership and planning, multidisciplinary teamwork and continuity of care was emphasised even in the context of providing critical care. Conclusions: The community-orientated primary care approach was emphasised as well as long-term benefits of technological innovations. The pandemic exposed the need to deliver on governmental commitments to strengthening primary health care and universal health coverage.
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Tafuma, Taurayi A., Nyikadzino Mahachi, Chengetai Dziwa, Tafara Moga, Paul Baloyi, Gladys Muyambo, Auxilia Muchedzi, et al. "Barriers to HIV service utilisation by people living with HIV in two provinces of Zimbabwe: Results from 2016 baseline assessment." Southern African Journal of HIV Medicine 19, no. 1 (August 9, 2018). http://dx.doi.org/10.4102/sajhivmed.v19i1.721.
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Background: The emergence of antiretroviral therapy (ART) transformed HIV from a terminal illness to a chronic disease. However, limited access to health services remains one of many barriers to HIV service utilisation by people living with HIV (PLHIV) in low-resource settings. The goal of this study was to describe the barriers to HIV service utilisation in two provinces of Zimbabwe.Methods: A qualitative descriptive study was conducted with PLHIV and village health workers (VHW) in eight districts within the two provinces. Convenience sampling was used to select the participants. This sampling was limited to communities supported by health facilities with more than 500 PLHIV enrolled into HIV care and treatment. Interviews were audio-recorded and transcripts were subjected to thematic content analysis.Results: A total of 22 community focus group discussions (FGDs) were conducted. Barriers to using HIV services cited in PLHIV and VHW FGDs were similar. These were categorised as health system-related barriers, which include user fees, long waiting times, lack of confidentiality and negative attitudes by healthcare providers, and lack of consistent community-based HIV services. Community-related barriers cited were stigma and discrimination, food insecurity, distance to facilities and counterproductive messaging from religious sectors. Client-related factors reported were inadequate male involvement in HIV-related activities and defaulting after symptoms improved.Conclusion: Our assessment has indicated that there are several barriers to the utilisation of HIV services by PLHIV in the two provinces of Zimbabwe. As new strategies and programmes are being introduced in the current resource-constrained era, efforts should be made to understand the needs of the clients. If programmes are designed with an effort to address some of these challenges, there is a possibility that countries will quickly achieve the 90-90-90 targets set by The Joint United Nations Programme on HIV/AIDS.
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Bandopadhay, N., G. B. Woelk, M. P. Kieffer, and D. Mpofu. "Project ACCLAIM: Intervention Effect on Community Knowledge, Attitudes and Beliefs of Maternal and Child Health and HIV/AIDS in Eswatini, Uganda and Zimbabwe." AIDS and Behavior, March 4, 2021. http://dx.doi.org/10.1007/s10461-021-03202-2.
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AbstractThe ACCLAIM Study aimed to assess the effect of a package of community interventions on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in maternal and child health (MCH) and prevention of mother-to-child HIV transmission (PMTCT) services. The study occurred from 2013 to 2015 in Eswatini, Uganda, and Zimbabwe. The three interventions were: (1) a social learning and action component for community leaders, (2) community days, and (3) peer discussion groups. Household cross-sectional surveys on community members’ MCH and PMTCT knowledge, attitudes, and beliefs were analyzed pre- and post-intervention, using MCH, HIV stigma, and gender-equitable men (GEM) indicators. We used t-tests to measure the significance of mean pre- vs. post-intervention score changes stratified by gender within each intervention arm and generalized linear models to compare mean score changes of the cumulative intervention arms with the community leaders-only intervention. Response rates were over 85% for both surveys for men and women, with a total of 3337 pre-intervention and 3162 post-intervention responses. The combined package of three interventions demonstrated a significantly greater increase in MCH scores for both women (diff = 1.34, p ≤ 0.001) and men (diff = 2.03, p < 0.001). The arms that included interventions for both community leader engagement and community days (arms 2 and 3)led to a greater increase in mean GEM scores compared to the community leader engagement intervention alone (arm 1), for both women (diff = 1.32, p = 0.002) and men (diff = 1.37, p = 0.004). Our findings suggest that a package of community interventions may be most effective in increasing community MCH/HIV knowledge and improving gender-equitable norms.
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Tinago, Chiwoneso B., Edward A. Frongillo, Andrea M. Warren, Vivian Chitiyo, Ashley K. Cifarelli, Shannon Fyalkowski, and Victoria Pauline. "Development and assessment of feasibility of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe." Pilot and Feasibility Studies 7, no. 1 (May 17, 2021). http://dx.doi.org/10.1186/s40814-021-00832-0.
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Abstract Background Adolescent mothers in Zimbabwe often experience stigma, isolation, and lack coping skills and resources to successfully navigate motherhood. Social isolation and stigma are linked to poor mental health outcomes. No interventions currently address mental health of adolescent mothers in Zimbabwe. Peer support groups in other contexts have been effective at increasing social connectedness, self-esteem, and self-efficacy, providing coping mechanisms to manage stigma experiences, in addition to empowering and improving mental health of adolescents and adolescent mothers. To develop a community-based peer support intervention, we aimed to understand the unique needs of adolescent mothers, how peer support groups could address those needs, and the feasibility of implementing the intervention. Methods Focus group discussions were conducted with 86 adolescent mothers aged 14–18 years, 24 community health workers, and 25 key community stakeholders in a low-income high-density community in Harare. Data were analyzed thematically using NVivo 12 software. Results Participants described adolescent mother experiences with stigma and social isolation, in addition to challenges including gossip, lack of employment and educational opportunities, and gaps in services and programming. Peer support groups for adolescent mothers were welcomed to improve mental health, social support, knowledge sharing, and skills building. Participants identified varying preferred frequency and duration of group sessions addressing topics including income generation, mental health, and gossip, facilitated by community health workers at health and community centers. The use of WhatsApp Messenger to support intervention efforts was welcomed as an affordable and user-friendly platform to share information. Implementation (i.e., training, supervision, frequency, location, and co-facilitation) was feasible. Conclusions Adolescent mothers, community health workers and key community stakeholders welcomed the peer support groups as a feasible way to address the mothers’ needs.
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Tembo, Mandikudza, Jenny Renju, Helen A. Weiss, Ethel Dauya, Tsitsi Bandason, Chido Dziva-Chikwari, Nicol Redzo, et al. "Menstrual product choice and uptake among young women in Zimbabwe: a pilot study." Pilot and Feasibility Studies 6, no. 1 (November 23, 2020). http://dx.doi.org/10.1186/s40814-020-00728-5.
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Abstract Background Menstrual health and hygiene (MHH) is a human rights issue; yet, it remains a challenge for many, especially in low- and middle-income countries (LMICs). MHH includes the socio-political, psychosocial, and environmental factors that impact women’s menstrual experiences. High proportions of girls and women in LMICs have inadequate MHH due to limited access to menstrual knowledge, products, and stigma reinforcing harmful myths and taboos. The aim of this pilot was to inform the design of an MHH sub-study and the implementation and scale-up of an MHH intervention incorporated into a community-based cluster-randomized trial of integrated sexual and reproductive health (SRH) services for youth in Zimbabwe. The objectives were to investigate (1) uptake of a novel MHH intervention, (2) menstrual product preference, and (3) the factors that informed uptake and product choice among young women. Methods Female participants aged 16–24 years old attending the community-based SRH services between April and July 2019 were offered the MHH intervention, which included either a menstrual cup or reusable pads, analgesia, and MHH education. Descriptive statistics were used to quantitatively assess uptake and product choice. Focus group discussions and in-depth interviews with participants and the intervention team were used to investigate the factors that influenced uptake and product choice. Results Of the 1732 eligible participants, 1414 (81.6%) took up the MHH intervention at first visit. Uptake differed by age group with 84.6% of younger women (16–19 years old) compared to 79.0% of older women (20–24 years old) taking up the intervention. There was higher uptake of reusable pads (88.0%) than menstrual cups (12.0%). Qualitative data highlighted that internal factors, such as intervention delivery, influenced uptake. Participants noted the importance of access to free menstrual products, analgesics, and MHH education in a youth-friendly environment. External factors such as sociocultural factors informed product choice. Barriers to cup uptake included fears that the cup would compromise young women’s virginity. Conclusions Pilot findings were used to improve the MHH intervention design and implementation as follows: (1) cup ambassadors to improve cup promotion, sensitization, and uptake; (2) use of smaller softer cups; and (3) education for community members including caregivers and partners. Trial registration Registry: Clinicaltrials.gov Registration Number: NCT03719521 Registration Date: 25 October 2018
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Chibango, Vimbai. "Exploring the meanings of male partner involvement in the prevention of MTCT of HIV in Zimbabwe." HTS Teologiese Studies / Theological Studies 76, no. 3 (November 24, 2020). http://dx.doi.org/10.4102/hts.v76i3.6023.
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Male partner involvement (MPI) in the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) is considered as one of the priority interventions in reducing paediatric HIV. However, there is neither a standard definition nor measurement for MPI in PMTCT. The study explored meanings of MPI in PMTCT programmes in Zimbabwe. Eight focus group discussions (FGDs) were conducted with men and women aged 18 years and above. Seven key informants (KII) from health institutions and organisations providing PMTCT services were interviewed. Eight in-depth interviews (IDIs) were conducted with pregnant women at two public health facilities. Thematic analysis was used for data analysis. Five major themes were identified which facilitated our understanding of MPI. Male partner involvement was referred to as participation of male partners in HIV couple counselling and testing. Acceptance of condom use during pregnancy and breastfeeding was deemed vital as this prevents HIV transmission. Male partners were expected to have knowledge of administering antiretroviral drugs to an HIV-exposed child. Provision of financial support was another form of male involvement commonly expected during antenatal and postnatal periods. Faithfulness in marriage was a major theme that was highlighted, especially by respondents in marital relationships. Male partner presence in PMTCT community educational sessions was also considered. However, the provision of male-oriented educational programmes was identified as poor. The study suggested a definition for MPI in PMTCT in Zimbabwe. The merit of this definition was that it took a holistic approach to include activities beyond antenatal activities and HIV testing. Future research should explore how public health institutions could create male-oriented health services within PMTCT programmes, as this has the potential of increasing men’s involvement in PMTCT of HIV.Contribution: This article contributed to the knowledge on how world views, which is shaped by culture and religion, influenced the formation of meanings on MPI PMTCT programmes.
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Tapera, Oscar, Greta Dreyer, Anna Mary Nyakabau, Webster Kadzatsa, Babill Stray-Pedersen, and Stephen James Heinrich Hendricks. "Model strategies to address barriers to cervical cancer treatment and palliative care among women in Zimbabwe: a public health approach." BMC Women's Health 21, no. 1 (April 27, 2021). http://dx.doi.org/10.1186/s12905-021-01322-4.
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Abstract Background Cervical cancer treatment and care remains limited in Zimbabwe despite the growing burden of the disease among women. This study was aimed at investigating strategies to address barriers in accessing treatment and care by women with cervical cancer in Harare, Zimbabwe. Methods A qualitative inquiry was conducted to generate evidence for this study. Eighty-four (84) participants were purposively selected for interviews and participation in focus group discussions. The participants were selected from cervical cancer patients, caregivers of cervical cancer patients, health workers involved in the care of cervical cancer patients as well as relevant policy makers in the Ministry of Health and Child Care. Participants were selected in such as a way as to ensure different of characteristics to obtain diverse perspectives about the issues under study. Discussion and interview guides were used as data collection tools and discussions/interviews were audio-recorded, transcribed and translated into English. Inductive thematic analysis was conducted using Dedoose software. Results Salient sub-themes that emerged in the study at the individual patient level were: provision of free or subsidized services, provision of transport to treating health facilities and provision of accommodation to patients undergoing treatment. At the societal level, the sub-themes were: strengthening of health education in communities and training of health workers and community engagement. Salient sub-themes from the national health system level were: establishment of more screening and treatment health facilities, increasing the capacities of existing facilities, decentralization of some services, building of multidisciplinary teams of health workers, development and rolling out of standardized guidelines and reformation of Acquired Immunodeficiency Virus (AIDS) levy into a fund that would finance priority disease areas. Conclusion This study revealed some noteworthy strategies to improve access to cervical cancer treatment and care in low-income settings. Improved domestic investments in health systems and reforming health policies underpinned on strong political are recommended.
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Chirenda, J., B. Nhlema Simwaka, C. Sandy, K. Bodnar, S. Corbin, P. Desai, T. Mapako, et al. "A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018." BMC Health Services Research 21, no. 1 (March 18, 2021). http://dx.doi.org/10.1186/s12913-021-06212-x.
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Abstract Background Insufficient cost data and limited capacity constrains the understanding of the actual resources required for effective TB control. This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and efficient use of available resources. Methods A multi-disciplinary team applied time-driven activity-based costing (TDABC) to develop process maps and measure the cost of clinical pathways used for Drug Susceptible TB (DS-TB) at urban polyclinics, rural district and provincial hospitals, and community based targeted screening for TB (Tas4TB). The team performed interviews and observations to collect data on the time taken by health care worker-patient pairs at every stage of the treatment pathway. The personnel’s practical capacity and capacity cost rates were calculated on five cost domains. An MS Excel model calculated diagnostic and treatment costs. Findings Twenty-five stages were identified in the TB care pathway across all health facilities except for community targeted screening for TB. Considerable variations were observed among the facilities in how health care professionals performed client registration, taking of vital signs, treatment follow-up, dispensing medicines and processing samples. The average cost per patient for the entire DS-TB care was USD324 with diagnosis costing USD69 and treatment costing USD255. The average cost for diagnosis and treatment was higher in clinics than in hospitals (USD392 versus USD256). Nurses in clinics were 1.6 time more expensive than in hospitals. The main cost components were personnel (USD130) and laboratory (USD119). Diagnostic cost in Tas4TB was twice that of health facility setting (USD153 vs USD69), with major cost drivers being demand creation (USD89) and sputum specimen transportation (USD5 vs USD3). Conclusion TDABC is a feasible and effective costing and management tool in low-resource settings. The TDABC process maps and treatment costs revealed several opportunities for innovative improvements in the NTP under public health programme settings. Re-engineering laboratory testing processes and synchronising TB treatment follow-up with antiretroviral treatments could produce better and more uniform TB treatments at significantly lower cost in Zimbabwe.
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Makhubele, Jabulani, and Louis Nyahunda. "The Importance of Oral Transmission Health Information and Knowledge for Healthy Ageing and High Life Expectancy: The Case of the Mazungunye Community, Masvingo Province, Zimbabwe." Southern African Journal for Folklore Studies 28, no. 2 (December 18, 2018). http://dx.doi.org/10.25159/1016-8427/4310.
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The low life expectancy in Zimbabwe is attributed to poverty and inaccessibility to health care services. Despite these challenges, some people have lived for more than 80 years because of a lifestyle informed by the consistent implementation of age-old orally-transmitted health information and knowledge. The culturally-transmitted health information includes advice on proper nutrition and medical practices, which leads to healthy ageing and high life expectancy. The purpose of this study was to explore the importance of the transmission of health information and knowledge for healthy ageing and a high life expectancy. Furthermore, this study sought to describe the impact of orally-transmitted information on healthy ageing and high life expectancy. A qualitative approach was followed with exploratory and descriptive designs. The findings of the study indicated that the transmission of health information plays a crucial role in promoting healthy ageing and high life expectancy. Additionally, people who have had access to such information and knowledge have a sense of diligence concerning implementing this knowledge, and this contributes to a long and healthy life. The transmission of health information and knowledge is of paramount importance for the health of present generations. The study recommends that this information be documented, since the passing away of critical holders of such information leads to its distortion.
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Sembajwe, Rita, Tendai Shamu, Fortunate Machingura, and Henry Chidawanyika. "Implemention of a Laboratory Information System in Zimbabwe." Online Journal of Public Health Informatics 10, no. 1 (May 22, 2018). http://dx.doi.org/10.5210/ojphi.v10i1.8909.
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Objective: Understand the challenges that exist in the Zimbabwe health systems, that could be addressed through the integration of a Laboratory Information Management System (LIMS).Understand key aspects for consideration when selecting and adapting a LIMS in a resource limited setting.Showcase improvements in laboratory information management processes following adoption of a LIMS.Introduction: Zimbabwe's National Health Laboratory Services faces multiple challenges related to inadequate financial support and skilled human resources, insufficient infrastructure, and inefficient tracking of clinical samples collected by health facilities. The slow turnaround time and poor management of the sample testing process, as well as delivery of results remain critical challenges. Compounding these problems further is a manual system for tracking large volumes of samples. This laborious and time-consuming process is inefficient for management of high amounts of incoming medical samples, frequently resulting in incomplete and inaccurate data. Additionally, health facilities are unable to monitor clinical samples and results in transit, leading to misplaced samples and missing results. Furthermore, although the laboratory service runs on a tiered network system - with lower level laboratories referring surveillance samples to higher level laboratories, processing of samples is not fulfilled promptly. The solutions to these challenges are divergent - sometimes even pointing in different directions. To this end, the Zimbabwe Ministry of Health and Child Care (MoHCC) has identified and integrated a LIMS to improve tracking of samples from the time of collection through results delivery.Methods: Our methods included an environmental needs assessment, user requirement analysis, followed by a LIMS customization and integration. The overarching aim has been to integrate the electronic open source BIKA LIMS into Zimbabwe’s national health information systems (HIS), to improve laboratory information management.The user requirements gathering exercise, included focus group discussion meetings with potential LIMS users, and direct observations, to guide the establishment of LIMS specifications. The needs assessment focused on the system functionality. Specifically, it investigated those aspects that would improve the ability: to track clinical samples such as creating and activating an ‘alerting’ capability when results are not reported within the set turnaround time; for users to see lists and counts of clinical samples at various testing levels; to uniquely identify samples received in the laboratories. Guided by these requirements, an environmental scan of off-the-shelf and open source LIMS platforms was conducted to identify a few options for the Zimbabwe context. Primary factors for shortlisting included: an existing community of practice for support; interoperability; customizability and configurability; and local awareness of the platform. In a LIMS national user’s meeting, involving relevant levels of the health system (Laboratories, Central, Provincial and District hospitals), a review of LIMS platform options was performed to narrow down selections. It evaluated the extent to which the user requirements (Workflow, equipment interface, result management, inter-operable, quality control, and stock management) were being met. Based on the evaluation, a single system (LIMS) was selected, adopted and adapted for use at six representative laboratories, including Zimbabwe’s National Microbiology Reference Laboratory.On-Site classroom and desk-side training, for knowledge transfer to local LIMS users, characterised the implementation phase. Local champions were identified from laboratory technicians and equipped to offer first line support. Both on-site and remote support was provided to LIMS users. The monitoring phase is ongoing, using interview guides and LIMS user meetings to understand challenges and ways to improve the system.Results: A LIMS was successfully customized and integrated into Zimbabwe’s national health information system infrastracture in six regional laboratories, to improve overall laboratory information management, timeliness of reporting and quality control. Since its full implementation between 2013 and 2017, average turnaround time for results improved significantly from 10 to 21 days in 2013 to only 3 days in 2017. Data quality improved; the number of untested clinical samples reduced from an average of 6 in 100 in 2013, to average of less or equal to 1 in 100, in 2017 . Also, there have been observed improvements in Zimbabwe's laboratory information management workflow and results reporting. High user satisfaction and increased LIMS use have led to the demand for LIMS expansion to additional laboratories. The LIMS has also managed to reduce the time required to produce disease notification reports.Conclusions: LIMS are proving to be an effective method for tracking samples and laboratory results in low resource settings like Zimbabwe. LIMS has provided an efficient way for record, store, and track timely reporting of laboratory data, allowing for improved quality of data. Overall, LIMS has increased efficiency in laboratory workflow and introduced the ability to adequately track samples from time of collection.