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1
WATERSTON, T., and D. SANDERS. "Teaching primary health care: some lessons from Zimbabwe." Medical Education 21, no. 1 (January 1987): 4–9. http://dx.doi.org/10.1111/j.1365-2923.1987.tb00506.x.
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Woelk, Godfrey B. "Primary health care in Zimbabwe: Can it survive?" Social Science & Medicine 39, no. 8 (October 1994): 1027–35. http://dx.doi.org/10.1016/0277-9536(94)90374-3.
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Abas, Melanie, O. Lovemore Mbengeranwa, Iris V. Simmons Chagwedera, Patricia Maramba, and Jeremy Broadhead. "Primary Care Services for Depression in Harare, Zimbabwe." Harvard Review of Psychiatry 11, no. 3 (January 2003): 157–65. http://dx.doi.org/10.1080/10673220303952.
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Broadhead, Jeremy, and Melanie Abas. "Depressive Illness — Zimbabwe." Tropical Doctor 24, no. 1 (January 1994): 27–30. http://dx.doi.org/10.1177/004947559402400113.
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Depression is common in the developing world and accounts for 10–20% of attendances at primary care clinics. It is a condition associated with considerable morbidity. This paper considers the characteristics of depressive illness in Zimbabwe and discusses ways to improve detection and management.
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Ferrand, Rashida A., Lucia Munaiwa, John Matsekete, Tsitsi Bandason, Kusum Nathoo, Chiratidzo E. Ndhlovu, Shungu Munyati, Frances M. Cowan, Diana M. Gibb, and Elizabeth L. Corbett. "Undiagnosed HIV Infection among Adolescents Seeking Primary Health Care in Zimbabwe." Clinical Infectious Diseases 51, no. 7 (October 2010): 844–51. http://dx.doi.org/10.1086/656361.
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Chilunjika, Alouis, and Sharon R. T. Muzvidziwa-Chilunjika. "Dynamics surrounding the Implementation of the Primary Health Care Approach in Zimbabwe’s Rural Areas: The Case of Mt Darwin District." International Journal of Clinical Inventions and Medical Science 3, no. 1 (March 10, 2021): 1–17. http://dx.doi.org/10.36079/lamintang.ijcims-0301.162.
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This research studied the implementation of the Primary Health Care approach to health service delivery in Zimbabwe’s rural areas from 2009 to 2012. The approach was launched in response to the Alma-Alta Declaration in 1978 which sought to end the inequalities in health care provision around the globe and was first adopted and implemented in 1982 in Zimbabwe. The approach almost collapsed due to the economic meltdown in the past decade but the period 2009 to 2013 marked a new economic paradigm in Zimbabwe which saw the economy being dollarized which subsequently led to the revival and the resuscitation of the health sector. It is therefore to explore the progress and the dynamics surrounding the implementation of the PHC at Mt Darwin Hospital in light of the dollarized economy. The study explores the dynamics surrounding the implementation of PHC at Mt Darwin District Hospital by particular attention to the following key elements: promotion of nutrition, sanitation, maternal and child care, immunization, treatment of common diseases and provision of essential drugs. Qualitative techniques such as face to face interviews with key informants and documentary research were used to generate data. The research findings revealed that PHC is a powerful tool in delivering health services in Mt Darwin. However, lack of material, financial and human resources have hindered the proper implementation of the PHC approach in Mt Darwin district. The study recommends multi sectoral collaboration in solving health related issues.
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Chibanda, D. "Reducing the treatment gap for mental, neurological and substance use disorders in Africa: lessons from the Friendship Bench in Zimbabwe." Epidemiology and Psychiatric Sciences 26, no. 4 (April 12, 2017): 342–47. http://dx.doi.org/10.1017/s2045796016001128.
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Mental, neurological and substance use disorders (MNS) are a leading cause of disability in Africa. In response to the large treatment gap for MNS, a growing body of evidence-based treatments (EBTs) is emerging from Africa; however, there is a dearth of knowledge on how to scale up EBT. The Friendship Bench intervention is a brief psychological treatment delivered through the primary health care system in Zimbabwe by trained lay health workers. It has contributed significantly towards narrowing the treatment gap for common mental disorders in Zimbabwe where it has been scaled up to over 70 primary health care facilities. A three-pronged approach consisting of community engagement, use of EBTs and a government endorsed scale-up plan is described as part of the key strategy leading to the scale up of the Friendship Bench.
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Patel, V., E. Simunyu, and F. Gwanzura. "The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe." Social Psychiatry and Psychiatric Epidemiology 32, no. 2 (February 1997): 97–103. http://dx.doi.org/10.1007/bf00788927.
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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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Patel, Vikram, Charles Todd, Mark Winston, Essie Simunyu, Fungisai Gwanzura, Wilson Acuda, and Anthony Mann. "Outcome of common mental disorders in Harare, Zimbabwe." British Journal of Psychiatry 172, no. 1 (January 1998): 53–57. http://dx.doi.org/10.1192/bjp.172.1.53.
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BackgroundLittle is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries.MethodTwo and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n=199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness.ResultsThe persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation.ConclusionsA quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.
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Patel, Vikram, Charles Todd, Mark Winston, Fungisai Gwanzura, Essie Simunyu, Wilson Acuda, and Anthony Mann. "Common mental disorders in primary care in Harare, Zimbabwe: Associations and risk factors." British Journal of Psychiatry 171, no. 1 (July 1997): 60–64. http://dx.doi.org/10.1192/bjp.171.1.60.
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BackgroundThis study aimed to investigate the associations for common mental disorders (CMD) among primary care attenders in Harare.MethodThis was an unmatched case-control study of attenders at primary health clinics, general practitioner surgeries and traditional medical practitioner clinics; 199 cases with CMD as identified by an indigenously developed case-finding questionnaire, and 197 controls (non-cases), were interviewed using measures of sociodemographic data, disability, care-giver diagnoses and treatment, explanatory models, life events and alcohol use.ResultsCMD was associated with female gender (.=0.04) and older age (.=0.02). After adjustment for age, gender and site of recruitment, CMD was significantly associated with chronicity of illness; number of presenting complaints; beliefs in “thinking too much” and witchcraft as a causal model; economic impoverishment; infertility; recent unemployment; an unhappy childhood for females; disability; and consultations with traditional medical practitioners and religious priests.ConclusionsMental disorders are associated with female gender, disability, economic deprivation, and indigenous labels of distress states.
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Chirundu, Daniel. "Adherence to Antiretroviral therapy among Clients Utilizing a Primary Health Care Facility Kadoma Zimbabwe (2016)." TEXILA INTERNATIONAL JOURNAL OF NURSING 4, no. 1 (April 28, 2018): 10–22. http://dx.doi.org/10.21522/tijnr.2015.04.01.art002.
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Adamolekun, B., J. Mielke, D. Ball, and T. Mundanda. "An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe." Epilepsy Research 39, no. 3 (May 2000): 177–81. http://dx.doi.org/10.1016/s0920-1211(99)00115-1.
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Adamolekun, Bola, Jens Mielke, Douglas Ball, and Tendai Mundanda. "An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe." Journal of Epilepsy 10, no. 6 (November 1997): 294–97. http://dx.doi.org/10.1016/s0896-6974(97)00069-8.
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Munyati, S. S., T. Dhoba, E. D. Makanza, S. Mungofa, M. Wellington, J. Mutsvangwa, L. Gwanzura, et al. "Chronic Cough in Primary Health Care Attendees, Harare, Zimbabwe: Diagnosis and Impact of HIV Infection." Clinical Infectious Diseases 40, no. 12 (June 15, 2005): 1818–27. http://dx.doi.org/10.1086/429912.
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Williams, H., and A. P. Reeler. "Teaching Zimbabwean Medical Students an Awareness of Hidden Psychological Disorder in an Urban Outpatient Setting." Tropical Doctor 19, no. 2 (April 1989): 52–54. http://dx.doi.org/10.1177/004947558901900203.
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A one-week attachment to an urban primary health care clinic was introduced into the eight-week psychiatric teaching block for fourth (penultimate) year medical students at the University of Zimbabwe. Its objective was to alert students to underlying psychological disorder in patients presenting, at primary health care level, with physical symptomatology. Students were required to screen patients using a 20-item questionnaire, take a psychosocial history of all high-scoring patients, and make one home visit. The attachment proved both popular and valuable, and it is anticipated that this will now become an integral part of the psychiatric teaching block.
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TODD, C., V. PATEL, E. SIMUNYU, F. GWANZURA, W. ACUDA, M. WINSTON, and A. MANN. "The onset of common mental disorders in primary care attenders in Harare, Zimbabwe." Psychological Medicine 29, no. 1 (January 1999): 97–104. http://dx.doi.org/10.1017/s0033291798007661.
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Background. This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe.Method. Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N=197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up.Results. Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points.Conclusions. Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.
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Mharakurwa, S., B. Manyame, and C. J. Shiff. "Trial of the ParaSight-F test for malaria diagnosis in the primary health care system, Zimbabwe." Tropical Medicine & International Health 2, no. 6 (June 1997): 544–50. http://dx.doi.org/10.1046/j.1365-3156.1997.d01-318.x.
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McHugh, G., A. Brunskill, E. Dauya, T. Bandason, T. Bwakura, C. Duri, S. Munyati, and R. A. Ferrand. "A comparison of HIV outpatient care in primary and secondary healthcare-level settings in Zimbabwe." Public Health Action 10, no. 3 (September 21, 2020): 92–96. http://dx.doi.org/10.5588/pha.20.0006.
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Setting: Decentralisation of HIV care to nurse-led primary care services is being implemented across low- and middle-income countries in sub-Saharan Africa.Objective: To compare services offered to clients attending for HIV care at a physician-led and a nurse-led service in Harare, Zimbabwe.Design: A cross-sectional study was performed at Harare Central Hospital (HCH) and Budiriro Primary Care Clinic (PCC) from June to August 2018. An interviewer-administered questionnaire was used to collect sociodemographics, HIV treatment and clinical history from clients attending for routine HIV care. The Mann-Whitney U-test was used to evaluate for differences between groups for continuous variables. For categorical variables, the χ2 test was used.Results: The median age of the 404 participants recruited was 38 years (IQR 28–47); 69% were female. Viral suppression was comparable between sites (HCH, 70% vs. PCC, 80%; P = 0.07); however, screening for comorbidities such as cervical cancer screening (HCH, 61% vs. PCC, 41%; P = 0.001) and provision of referral services (HCH, 23% vs. PCC, 13%; P = 0.01) differed between sites.Conclusion: Efforts to improve service provision in primary care settings are needed to ensure equity for users of health services.
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Patel, Vikram. "A view from the road: experiences in four continents." Psychiatric Bulletin 18, no. 8 (August 1994): 500–502. http://dx.doi.org/10.1192/pb.18.8.500.
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Since graduating from medical school eight years ago, I have had the chance of experiencing clinical psychiatry in four countries on four continents; Bombay and Goa, India, my home, where I trained in medicine and began my psychiatric training; Oxford and London, United Kingdom, where I acquired a taste for academic psychiatry and completed my clinical training; Sydney, Australia, where I worked in a liaison unit in a large general hospital and a community mental health centre; and now, Harare, Zimbabwe, where I am conducting a two year study on traditional concepts of mental illness and the role of traditional healers and other care providers in primary mental health care.
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Olaru, Ioana Diana, Rashida A. Ferrand, Shunmay Yeung, Rudo Chingono, Prosper Chonzi, Kudzai P. E. Masunda, Justin Dixon, and Katharina Kranzer. "Knowledge, attitudes and practices relating to antibiotic use and resistance among prescribers from public primary healthcare facilities in Harare, Zimbabwe." Wellcome Open Research 6 (March 30, 2021): 72. http://dx.doi.org/10.12688/wellcomeopenres.16657.1.
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Background Overuse of antibiotics is one of the main drivers for antimicrobial resistance (AMR). Globally, most antibiotics are prescribed in the outpatient setting. This survey aimed to explore attitudes and practices with regards to microbiology tests, AMR and antibiotic prescribing among healthcare providers at public primary health clinics in Harare, Zimbabwe. Methods This cross-sectional survey was conducted in nine primary health clinics located in low-income suburbs of Harare between October and December 2020. In Zimbabwe, primary health clinics provide nurse-led outpatient care for acute and chronic illnesses. Healthcare providers who independently prescribe antibiotics and order diagnostic tests were invited to participate. The survey used self-administered questionnaires. A five-point Likert scale was used to determined attitudes and beliefs. Results A total of 91 healthcare providers agreed to participate in the survey. The majority of participants (62/91, 68%) had more than 10 years of work experience. Most participants reported that they consider AMR as a global (75/91, 82%) and/or national (81/91, 89%) problem, while 52/91 (57%) considered AMR to be a problem in their healthcare facilities. A fifth of participants (20/91, 22%) were unsure if AMR was a problem in their clinics. Participants felt that availability of national guidelines (89/89, 100%), training sessions on antibiotic prescribing (89/89, 100%) and regular audit and feedback on prescribing (82/88, 93%) were helpful interventions to improve prescribing. Conclusions These findings support the need for increased availability of data on AMR and antibiotic use in primary care. Educational interventions, regular audit and feedback, and access to practice guidelines may be useful to limit overuse of antibiotics.
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Nyagadza, B., N. Kudya, E. Mbofana, S. Masaka, D. Garone, C.-Y. Chen, A. Mulingwa, C. Uzande, P. Isaakidis, and Z. Ndlovu. "Scaling up HIV viral load monitoring in Manicaland, Zimbabwe: challenges and opportunities from the field." Public Health Action 9, no. 4 (December 21, 2019): 177–81. http://dx.doi.org/10.5588/pha.19.0024.
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Background: Demand for viral load (VL) monitoring is expected to increase; however, implementation of the multifaceted VL testing poses numerous challenges. We report experiences from Médecins Sans Frontiéres (MSF) and partners in the scale-up of HIV VL in collaboration with the Ministry of Health and Child Care (MoHCC) of Zimbabwe.Methods: A retrospective data review of routine reports from MSF-supported health facilities in Manicaland Province (Zimbabwe) was conducted. These secondary aggregate data were triangulated, and emerging themes of lessons learnt from VL monitoring were shared.Results: A VL testing coverage of 63% (5966/9456) was achieved among the 40 health facilities, together with a switch rate to second-line antiretroviral therapy (ART) of 46.4% (108/233). The key enablers to scaling-up the VL monitoring were well-equipped and supported VL laboratories, the operationalisation of the on-the-job clinical mentoring and systematic weaning off of better performing health facilities. Concerted efforts from different implementing partners and funders in the HIV programme, and close collaboration with MoHCC were pivotal.Conclusion: Our experience indicates that clinical mentoring is effective, and resulted in high VL testing coverage and up-skilling primary health care workers in VL monitoring. Attention must be focused on innovations for improving VL result utilisation, especially the identification and management of patients who fail ART.
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Madziyire, Mugove Gerald, Chelsea B. Polis, Taylor Riley, Elizabeth A. Sully, Onikepe Owolabi, and Tsungai Chipato. "Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study." BMJ Open 8, no. 2 (February 2018): e019658. http://dx.doi.org/10.1136/bmjopen-2017-019658.
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ObjectivesAbortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe.DesignProspective, facility-based 28 day survey among women seeking PAC and their providers.Setting127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities.Participants1002 women presenting with abortion complications during the study period.Main outcome measuresSeverity of abortion complications and associated factors, delays in care seeking, and clinical management of complications.ResultsOverall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception.ConclusionZimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.
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Munjoma, Marshall W., Munyaradzi P. Mapingure, and Babill Stray-Pedersen. "Risk factors for herpes simplex virus type 2 and its association with HIV among pregnant teenagers in Zimbabwe." Sexual Health 7, no. 1 (2010): 87. http://dx.doi.org/10.1071/sh09106.
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Herpes simplex virus type 2 (HSV-2) causes a chronic infection that is recognised as the leading cause of genital ulcer disease worldwide and is known to increase the risk of HIV infection. In a cross-sectional study we examined risk factors for HSV-2 among 176 pregnant teenagers recruited from three primary health care clinics in Zimbabwe. The prevalence of HSV-2 and HIV were 41.6% and 29.2% respectively. HIV-infected teenagers were more likely to be HSV-2 seropositive compared with the HIV uninfected teenagers, odds ratio (OR) 7.9 (95% confidence interval (CI) 3.7–16.9). In multivariate analysis having an older partner remained independently associated with HSV-2 seropositivity, OR 2.9 (95% CI 1.2–6.9) suggesting that risk factors for HSV-2 seropositivity among pregnant teenagers depend primarily on the behaviour of the male partners.
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Riley, Taylor, Mugove G. Madziyire, Tsungai Chipato, and Elizabeth A. Sully. "Estimating abortion incidence and unintended pregnancy among adolescents in Zimbabwe, 2016: a cross-sectional study." BMJ Open 10, no. 4 (April 2020): e034736. http://dx.doi.org/10.1136/bmjopen-2019-034736.
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ObjectiveTo estimate age-specific abortion incidence and unintended pregnancy in Zimbabwe, and to examine differences among adolescents by marital status and residence.DesignWe used a variant of the Abortion Incidence Complications Methodology, an indirect estimation approach, to estimate age-specific abortion incidence. We used three surveys: the Health Facility Survey, a census of 227 facilities that provide postabortion care (PAC); the Health Professional Survey, a purposive sample of key informants knowledgeable about abortion (n=118) and the Prospective Morbidity Survey of PAC patients (n=1002).SettingPAC-providing health facilities in Zimbabwe.ParticipantsHealthcare providers in PAC-providing facilities and women presenting to facilities with postabortion complications.Primary and secondary outcome measuresThe primary outcome measure was abortion incidence (in rates and ratios). The secondary outcome measure was the proportion of unintended pregnancies that end in abortion.ResultsAdolescent women aged 15–19 years had the lowest abortion rate at five abortions per 1000 women aged 15–19 years compared with other age groups. Adolescents living in urban areas had a higher abortion ratio compared with adolescents in rural areas, and unmarried adolescent women had a higher abortion ratio compared with married adolescents. Unintended pregnancy levels were similar across age groups, and adolescent women had the lowest proportion of unintended pregnancies that ended in induced abortion (9%) compared with other age groups.ConclusionsThis paper provides the first estimates of age-specific abortion and unintended pregnancy in Zimbabwe. Despite similar levels of unintended pregnancy across age groups, these findings suggest that adolescent women have abortions at lower rates and carry a higher proportion of unintended pregnancies to term than older women. Adolescent women are also not a homogeneous group, and youth-focused reproductive health programmes should consider the differences in experiences and barriers to care among young people that affect their ability to decide whether and when to parent.
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Burnette, Denise. "FEASIBILITY OF AN EVIDENCE-BASED MENTAL HEALTH INTERVENTION WITH OLDER ADULTS IN POST-HURRICANE MARIA PUERTO RICO." Innovation in Aging 3, Supplement_1 (November 2019): S542. http://dx.doi.org/10.1093/geroni/igz038.1993.
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Abstract Owing to out-migration, decreased fertility and longer lifespans, 18.5% of Puerto Rico’s population is aged 60+ -- 36% live alone and 40% are below poverty. Out-migration after Hurricane Maria may well raise the proportion of older adults to 30%. Mental health problems are among the most widespread and enduring effects of disasters. Common Mental Disorders (CMD) (anxiety, depression, traumatic stress) are most common. Before Maria, CDC data showed 38 % of persons age 65+ reported fair or poor health and 20% had been told they had a depressive disorder. In the months after Maria, the overall suicide rate rose 29%, while it more than doubled for people aged 65-69 and tripled for those aged 75- 79. This pilot study assesses the feasibility and acceptability of adapting the Friendship Bench, an evidence-based intervention developed in Zimbabwe for CMD, for use with older adults in primary care in Puerto Rico.
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Magwali, Thulani Leslie, Abaden Svisva, Tarryn Bowers, Fishiwe Chiyaka, Jenna-Dawn Conway, Bernard Madzima, Violet Mambo, Alexio Mangwiro, and Andy Elizabeth Carmone. "Applying the RE-AIM framework in a process evaluation of the introduction of the Non-Pneumatic Anti-Shock Garment in a rural district of Zimbabwe." PLOS ONE 16, no. 5 (May 20, 2021): e0251908. http://dx.doi.org/10.1371/journal.pone.0251908.
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The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that can halt and reverse hypovolemic shock secondary to obstetric hemorrhage. The World Health Organization recommended the NASG for use as a temporizing measure in 2012, but uptake of the recommendation has been slow, partially because operational experience is limited. The study is a process evaluation of the introduction of NASG in a public sector health facility network in rural Zimbabwe utilizing an adapted RE-AIM, categorizing observations into the domains of: reach, effectiveness, adoption, implementation and maintenance. The location of the study was Hurungwe district, where staff members of 34 health facilities at primary (31), secondary (2) and tertiary (1) levels of care participated. We found that all facilities became skilled in using the NASG, and that the NASG was used in 10 of 11 instances of severe hemorrhage. In the cases of hypovolemic shock where the NASG was used, there were no maternal deaths and no extreme adverse outcomes related to obstetric hemorrhage in the study period. Among the 10 NASG uses, the garment was used correctly in each case. Fidelity to processes was high, especially in regard to training and cascading skills, but revisions of the NASG rotation and replacement operating procedures were required to keep clean garments stocked. Clinical documentation was also a key challenge. NASG introduction dovetailed very well with pre-existing systems for obstetric emergency response, and improved clinical outcomes. Scale-up of the NASG in the Zimbabwean public health system can be undertaken with careful attention to mentorship, drills, documentation and logistics.
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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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Chidarikire, Sherphard, Merylin Cross, Isabelle Skinner, and Michelle Cleary. "Navigating Nuances of Language and Meaning: Challenges of Cross-Language Ethnography Involving Shona Speakers Living With Schizophrenia." Qualitative Health Research 28, no. 6 (February 22, 2018): 927–38. http://dx.doi.org/10.1177/1049732318758645.
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For people living with schizophrenia, their experience is personal and culturally bound. Focused ethnography enables researchers to understand people’s experiences in-context, a prerequisite to providing person-centered care. Data are gathered through observational fieldwork and in-depth interviews with cultural informants. Regardless of the culture, ethnographic research involves resolving issues of language, communication, and meaning. This article discusses the challenges faced by a bilingual, primary mental health nurse researcher when investigating the experiences of people living with schizophrenia in Zimbabwe. Bilingual understanding influenced the research questions, translation of a validated survey instrument and interview transcripts, analysis of the nuances of dialect and local idioms, and confirmation of cultural understanding. When the researcher is a bilingual cultural insider, the insights gained can be more nuanced and culturally enriched. In cross-language research, translation issues are especially challenging when it involves people with a mental illness and requires researcher experience, ethical sensitivity, and cultural awareness.
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Mbizvo, E. M., E. Msuya Sia, B. Stray-Pedersen, M. Z. Chirenje, M. Munjoma, and A. Hussain. "Association of herpes simplex virus type 2 with the human immunodeficiency virus among urban women in Zimbabwe." International Journal of STD & AIDS 13, no. 5 (May 1, 2002): 343–48. http://dx.doi.org/10.1258/0956462021925171.
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A cross-sectional study at two urban primary health care clinics in Zimbabwe was conducted among 393 consecutive women. The purpose was to determine the seroprevalence of herpes simplex virus type 2 (HSV-2), to identify coinfections and to determine the association between HSV-2, HIV and other sexually transmitted infections (STIs). Sera were tested for HSV-2, HIV and syphilis. Genital specimens were tested for the other STIs. The seroprevalence of ulcerative STIs tested was 42.2% for HSV-2 and 3.9% for syphilis. HSV-2 seropositive women had twice the risk of being HIV infected compared to HSV-2 seronegative women, adjusted OR=2.05 (95% CI=1.29-3.23). HSV-2 seropositivity was also associated with older age, a lower level of education, increase in the number of lifetime sexual partners and history of genital ulcers in the past six or more months. Our data suggest that in this population HSV-2 may contribute more to HIV infection than syphilis because of its high frequency. There is an urgent need for development of an effective HSV-2 vaccine.
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Janca, A., JD Burke, M. Isaac, KC Burke, JA Costa, E. Silva, SW Acuda, et al. "The World Health Organization somatoform disorders schedule. A preliminary report on design and reliability." European Psychiatry 10, no. 8 (1995): 373–78. http://dx.doi.org/10.1016/0924-9338(96)80340-3.
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SummaryThe World Health Organization (WHO) Somatoform Disorders Schedule (SDS) is a highly standardized instrument for the assessment of somatoform disorders according to the tenth revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual (DSM-IV). The SDS was produced in the framework of the WHO International Study of Somatoform Disorders and tested for its reliability in Brazil, India, Italy, the USA and Zimbabwe. A sample of 180 patients from general psychiatry, primary care and general medical settings were interviewed with the SDS within a three-day interval by nonclinician and clinician interviewers. The agreement between the two interviews was tested using the intraclass correlation coefficients (ICC) and kappa statistic. The test-retest reliability of the SDS was found to be very good (the ICC for all the centres was 0.76; overall kappa value for SDS questions was 0.58; one-third of SDS questions had a kappa value of 0.60 or higher). The field test results of the SDS indicated that the instrument may be administered in larger studies by non-clinician interviewers without compromising the ability to document the prevalence of somatoform disorders in different cultures.
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Patel, V., T. Musara, T. Butau, P. Maramba, and S. Fuyane. "Concepts of mental illness and medical pluralism in Harare." Psychological Medicine 25, no. 3 (May 1995): 485–93. http://dx.doi.org/10.1017/s0033291700033407.
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SYNOPSISThe Focus Group Discussions (FGD) described in this paper are the first step of a study aiming to develop an ‘emic’ case-finding instrument. In keeping with the realities of primary care in Zimbabwe, nine FGD were held with 76 care providers including 30 village community workers, 22 traditional and faith healers (collectively referred to as traditional healers in this paper), 15 relatives of patients and 9 community psychiatric nurses. In addition to the general facets of concepts of mental illness, three ‘etic’ case vignettes were also presented.A change in behaviour or ability to care for oneself emerged as the central definition of mental illness. Both the head and the heart were regarded as playing an important role in the mediation of emotions. The types of mental illness described were intimately related to beliefs about spiritual causation. Angered ancestral spirits, evil spirits and witchcraft were seen as potent causes of mental illness. Families not only bore the burden of caring for the patient and all financial expenses involved, but were also ostracized and isolated. Both biomedical and traditional healers could help mentally ill persons by resolving different issues relating to the same illness episode. All case vignettes were recognized by the care providers in their communities though many felt that the descriptions did not reflect ‘illnesses’ but social problems and that accordingly, the treatment for these was social, rather than medical.The data enabled us to develop screening criteria for mental illness to be used by traditional healers and primary care nurses in the next stage of the study in which patients selected by these care providers on the grounds of suspicion of suffering from mental illness will be interviewed to elicit their explanatory models of illness and phenomenology.
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Ouansafi, Ilhame, Dixon Chibanda, Epiphania Munetsi, and Victoria Simms. "Impact of Friendship Bench problem-solving therapy on adherence to ART in young people living with HIV in Zimbabwe: A qualitative study." PLOS ONE 16, no. 4 (April 22, 2021): e0250074. http://dx.doi.org/10.1371/journal.pone.0250074.
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Background Adolescents and young people globally are highly vulnerable to poor mental health especially depression, and they account for 36% of new HIV infections in Eastern and Southern Africa. HIV services remain inadequate for this population and their adherence to ART is low. The Friendship Bench (FB), an evidence-based model developed in Zimbabwe to bridge the mental health gap, is a brief psychological intervention delivered on benches in primary care facilities by lay health workers (“grandmothers”) trained in problem-solving therapy. This study explored the experience of young people living with HIV attending FB, and their perception of how problem-solving therapy impacted their adherence to ART. Methods Semi-structured interviews were conducted in July 2019 with 10 young people living with HIV aged 18–24 years, who had recently completed FB counselling in Harare. Participants were purposively sampled and recruited from three primary care facilities. Interviews were conducted in Shona, audio-recorded, transcribed verbatim and translated into English. Transcripts were analysed in NVivo12 using inductive thematic analysis. Results Study findings revealed a clear emotional denial towards HIV, particularly for young people infected perinatally, and a resulting low adherence to ART. The study also unpacked the issues of internal stigma and how young people living with perinatally acquired HIV are informed of their HIV status. Participants reported that FB had a critical role in helping them accept their HIV status. Grandmothers’ empathic attitude was key during counselling on adherence to ART, to demystify the disease and treatment, normalize the reality of living with HIV, encourage young people to socialize with peers and free them of guilt. Interviewees unanimously reported improved ART adherence following FB counselling, and many described enhanced health and wellbeing. Conclusion Participants saw FB as a strong contributor to their general well-being, evident in decreased symptoms of depression and improved adherence to ART. FB problem-solving therapy should be rolled out to further support young people after post-test counselling or HIV serostatus disclosure for perinatally acquired HIV, for acceptance of HIV status and adherence to ART.
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Olaru, Ioana D., Mutsawashe Chisenga, Shunmay Yeung, David Mabey, Michael Marks, Prosper Chonzi, Kudzai PE Masunda, Anna Machiha, Rashida A. Ferrand, and Katharina Kranzer. "Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study." BMJ Open 11, no. 8 (August 2021): e050407. http://dx.doi.org/10.1136/bmjopen-2021-050407.
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ObjectiveUrinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.DesignCross-sectional study.SettingNine primary health clinics in Harare, Zimbabwe.ParticipantsAdults presenting with symptoms of UTIs between March and July 2020.Primary outcome measuresUrine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.ResultsThe study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen. Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.ConclusionsThis study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.
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Dziva Chikwari, Chido, Victoria Simms, Stefanie Dringus, Katharina Kranzer, Tsitsi Bandason, Arthi Vasantharoopan, Rudo Chikodzore, et al. "Evaluating the effectiveness and cost-effectiveness of health facility-based and community-based index-linked HIV testing strategies for children: protocol for the B-GAP study in Zimbabwe." BMJ Open 9, no. 7 (July 2019): e029428. http://dx.doi.org/10.1136/bmjopen-2019-029428.
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IntroductionThe number of new paediatric infections per year has declined in sub-Saharan Africa due to prevention-of-mother-to-child HIV transmission programmes; many children and adolescents living with HIV remain undiagnosed. In this protocol paper, we describe the methodology for evaluating an index-linked HIV testing approach for children aged 2–18 years in health facility and community settings in Zimbabwe.Methods and analysisIndividuals attending for HIV care at selected primary healthcare clinics (PHCs) will be asked if they have any children aged 2–18 years in their households who have not been tested for HIV. Three options for HIV testing for these children will be offered: testing at the PHC; home-based testing performed by community workers; or an oral mucosal HIV test given to the caregiver to test the children at home. All eligible children will be followed-up to ascertain whether HIV testing occurred. For those who did not test, reasons will be determined, and for those who tested, the HIV test result will be recorded. The primary outcome will be uptake of HIV testing. The secondary outcomes will be preferred HIV testing method, HIV yield, prevalence and proportion of those testing positive linking to care and having an undetectable viral load at 12 months. HIV test results will be stratified by sex and age group, and factors associated with uptake of HIV testing and choice of HIV testing method will be investigated.Ethics and disseminationEthical approval for this study was granted by the Medical Research Council of Zimbabwe, the London School of Hygiene and Tropical Medicine and the Institutional Review Board of the Biomedical Research and Training Institute. Study results will be presented at national policy meetings and national and international research conferences. Results will also be published in international peer-reviewed scientific journals and disseminated to study communities at the end of study.
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Matsena Zingoni, Zvifadzo, Tobias Chirwa, Jim Todd, and Eustasius Musenge. "Competing risk of mortality on loss to follow-up outcome among patients with HIV on ART: a retrospective cohort study from the Zimbabwe national ART programme." BMJ Open 10, no. 10 (October 2020): e036136. http://dx.doi.org/10.1136/bmjopen-2019-036136.
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ObjectiveTo determine the loss to follow-up (LTFU) rates at different healthcare levels after antiretroviral therapy (ART) services decentralisation among ART patients who initiated ART between 2004 and 2017 using the competing risk model in addition to the Kaplan-Meier and Cox regressions analysis.DesignA retrospective cohort study.SettingThe study was done in Zimbabwe using a nationwide routinely collected HIV patient-level data from various health levels of care facilities compiled through the electronic patient management system (ePMS).ParticipantsWe analysed 390 771 participants aged 15 years and above from 538 health facilities.OutcomesThe primary endpoint was LTFU defined as a failure of a patient to report for drug refill for at least 90 days from last appointment date or if the patient missed the next scheduled visit date and never showed up again. Mortality was considered a secondary outcome if a patient was reported to have died.ResultsThe total exposure time contributed was 1 544 468 person-years. LTFU rate was 5.75 (95% CI 5.71 to 5.78) per 100 person-years. Adjustment for the competing event independently increased LTFU rate ratio in provincial and referral (adjusted sub-HRs (AsHR) 1.22; 95% CI 1.18 to 1.26) and district and mission (AsHR 1.47; 95% CI 1.45 to 1.50) hospitals (reference: primary healthcare); in urban sites (AsHR 1.61; 95% CI 1.59 to 1.63) (reference: rural); and among adolescence and young adults (15–24 years) group (AsHR 1.19; 95% CI 1.16 to 1.21) (reference: 35–44 years). We also detected overwhelming association between LTFU and tuberculosis-infected patients (AsHR 1.53; 95% CI 1.45 to 1.62) (reference: no tuberculosis).ConclusionsWe have observed considerable findings that ‘leakages’ (LTFU) within the ART treatment cascade persist even after the decentralisation of health services. Risk factors for LTFU reflect those found in sub-Saharan African studies. Interventions that retain patients in care by minimising any ‘leakages’ along the treatment cascade are essential in attaining the 90–90–90 UNAIDS fast-track targets.
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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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Mebrahtu, Helen, Victoria Simms, Zivai Mupambireyi, Andrea M. Rehman, Rudo Chingono, Edward Matsikire, Rickie Malaba, et al. "Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe." BMJ Global Health 4, no. 5 (September 2019): e001651. http://dx.doi.org/10.1136/bmjgh-2019-001651.
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IntroductionHIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0–2 years in Zimbabwe.MethodsWe conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included: i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat.ResultsThirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI −2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test: intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01).ConclusionThis multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority.Trial registration numberPACTR201701001387209.
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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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Lund, C., A. Alem, M. Schneider, C. Hanlon, J. Ahrens, C. Bandawe, J. Bass, et al. "Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM." Epidemiology and Psychiatric Sciences 24, no. 3 (April 2, 2015): 233–40. http://dx.doi.org/10.1017/s2045796015000281.
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There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
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Chifamba, Ephraim. "Mainstreaming Gender in Pursuit of Millennium Development Goals in Water Resource Governance in Buhera, Zimbabwe." International Journal of Social Sciences and Management 1, no. 1 (January 15, 2014): 10–21. http://dx.doi.org/10.3126/ijssm.v1i1.8946.
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Women have the primary role for the management of household water supply, sanitation and health. Water is necessary for drinking, but also for food production and preparation, personal hygiene, care of the sick, cleaning, washing and waste disposal. Because of their dependence on water resources, women have accumulated considerable knowledge about water resources, including location, quality and storage methods. However, efforts geared towards improving the management of the finite water resources and extending access to safe drinking water and adequate sanitation, have often overlooked the central role that women play in water management. The study used both qualitative and quantitative research methodologies. The research noted that despite increased gender awareness and the availability of much more information on women’s and men’s roles in water management, gender is not yet mainstreamed into this sector. The study revealed that prospects for effective gender mainstreaming in water resource management will hinge on how the main agenda can address the transformation of gender relations and treat water as a human right so as to realize the Millennium Development Goals (MDGs) in Buhera. A gender equity approach within the water sector, should strive for a more balanced division between women and men in access to information, sharing of contribution, the degree of decision making, access to resources and benefits and the control over water resources. Addressing women’s concerns and mainstreaming gender in water governance through a livelihood approach is critical because this generates an understanding of people’s livelihood strategies and their decision making mechanisms and processes. Significant support and capacity development are required to enhance the participation in decision making processes for the success of water management initiatives.DOI: http://dx.doi.org/10.3126/ijssm.v1i1.8946 Int. J. Soc. Sci. Manage. Vol.1(1) 2014 10-21
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Mosler, Gioia, Victoria Oyenuga, Emmanuel Addo-Yobo, Olayinka Olufunke Adeyeye, Refiloe Masekela, Hilda Angela Mujuru, Rebecca Nantanda, Sarah Rylance, Ismail Ticklay, and Jonathan Grigg. "Achieving Control of Asthma in Children in Africa (ACACIA): protocol of an observational study of children’s lung health in six sub-Saharan African countries." BMJ Open 10, no. 3 (March 2020): e035885. http://dx.doi.org/10.1136/bmjopen-2019-035885.
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IntroductionLittle is known about asthma control in the rising number of African children who suffer from this condition. The Achieving Control of Asthma in Children in Africa (ACACIA) study is an observational study collecting evidence about paediatric asthma in urban areas of Ghana, Malawi, Nigeria, South Africa, Uganda and Zimbabwe. The primary objectives are: (1) to identify 3000 children aged between 12 years and 14 years with asthma symptoms; and (2) to assess their asthma control, current treatment, knowledge of and attitudes to asthma and barriers to achieving good control. Secondary objective is to develop interventions addressing identified barriers to good symptom control.Methods and analysisEach centre will undertake screening to identify 500 school children with asthma symptoms using questions from the Global Asthma Network’s questionnaire. Children identified to have asthma symptoms will fill in a digital survey, including: Asthma Control Test, questions on medication usage and adherence, medical care, the Brief-Illness Perception questionnaire and environmental factors. Exhaled nitric oxide testing and prebronchodilator and postbronchodilator spirometry will be performed. A subgroup of children will participate in focus group discussions. Results will be analysed using descriptive statistics and comparative analysis. Informed by these results, we will assess the feasibility of potential interventions, including the adaption of a UK-based theatre performance about asthma attitudes and digital solutions to improve asthma management.Ethics and disseminationThe ACACIA study has been reviewed by the Queen Mary University of London Ethics of Research Committee in the UK. All African centres have received local ethical approval for this study. Study results will be published in academic journals and at conferences. Study outputs will be communicated to the public via newsfeeds on the ACACIA website and Twitter, and through news media outlets and other local dissemination.Trial registration number269211.
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Abi-Dargham, Anissa, Christer Allgulander, O. Gureje, Rachel Jenkins, R. N. Kalaria, Brian Leonard, F. Njenga, et al. "CINP 2005 Regional Meeting, 20-22 April 2005." South African Journal of Psychiatry 11, no. 1 (April 1, 2005): 10. http://dx.doi.org/10.4102/sajpsychiatry.v11i1.92.
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List of abstract titles and authors:1. Antipsychotics across the spectrum: An overview of their mechanisms of actionAnissa Abi-Dargham2. Recent advances in the treatment of common anxiety disordersChrister Allgulander3. Psychiatry in Africa: The myths, the realities and the exoticO Gureje4. Mental Health policy developmet in Kenya and Tanznia - A DFID funded projectRachel Jenkins, David Kima, Joseph Mbatia, Frank Njenga5. Vascular factors in Alzheimer's diseaseR N Kalaria6. Depression as an immunologically based Neurodegenerative disorderBrian Leonard7. Eight years of progress in Arican PsychiatryF Njenga8. Treatment of Depression: Present and futureDr R.M. Pinder9. Imaging the Serotinergic system in impulsive aggressive personality disorder patientsLarry J Siever, Antonia S. New, Mari Goodman, Monte Buchsbaum, Erin Hazlett, Karen O'Flynn, Anissa Abi-argham, Marc Lauelle10. Mode of action of Atypical antipsychotic rugs: Focus on A2 AdrnoceptorsT.H. SvenssonNeuroscience: Selected Abstracts11. Chemical odulato of Fronto-execuitive functions: Neropsychiatric implicationsTrevor W Robbins12. Neural mechanisms of recognition memory and of social atacntProf. G Horn13. Estrogen signling after estrogen receptor ß (ERß)Jan-Ake Gustafsson14. Getting Lost: Hippocampal contributions to agerelated memory dysfunctionCarol BarnesMetals and the brain: Selected abstracts15. Modeling the contributin of iron mismanagement to Neurological disordersProf. J R C Connor16. Aluminium-triggered fibrillogenesis of B-AmyloidsProf. PZ Zatta, Dr D Drago, Mr G Tognon, Dr F RicchelliPsychiatry in Africa:17. Psychosocal aspects of Khat use among the youth of NairobiMs T M Khamis18. PTSD among motor vehicle accident survivors, KenyaDr F A Ongecha19. Psychiatric relities within African context - The Kenyan case StudyProf. D M N Ndetei20. Adolescent-parenta interactions from infancy, Nairobi KenyaDr L K Ksakhala, Prof. D M N Ndetei21. Alcohol use ong young persons: A focus group study in Southwest NigeriaO A Obeijide22. Personality disorders and personality traits among tyoe 2 Diabetic patientsProf. O El Rufaie, Dr M Sabosy, Dr M S Abuzeid23. Association of traumatic experiences with depression among Nigerian adolescentsDr O Omigbodun, Dr K BakareMs O B Yusuf, Dr O Esan24. Prevalence of depression among women attending outpatient clinics in MalawiDr M Tugumisirize, Prof. Agn, Dr Musisi25. Non-fatal suicidalbehaviour at the Johannesburg General HospitalDr M Y H Moosa, Prof. F Y Jeenah, Dr A Pillay, Pof. M Vorstere, Dr R Liebenberg26. Integrating mental health into general primary health care - Uganda's experienceDr N Kigozi27. Depression among Nigerian survivors of stroke:Prevalance and associated factorsDr F.O Fatoye Dr M A Komolafe, Dr A. O Adewuya, Dr B.A. Eegunranti Prof. M.A. Lawal28. NGO Involvement mental health care -The way forwardDr Basangwa29. Prevalen of Attenton Deficit Hyperactivity sorder among African school childrenDr E KashalaProf. T Tylleskar, Dr I Elgen, Dr K Sommerfelt30. Barriers to effective mental health care in NigeriaMs L. Kola31. Quay of life evaluation in patients with HIV-I infection with respect to the impact of Phyttherapy (Traditional Herb in Zimbabwe)M B Sebit, S K Chandiwaa, A S Latif, E Gomo, S W Acuda, F Makoni, J Vushe
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Wilkin, David. "Primary Health Care." Ageing and Society 6, no. 3 (September 1986): 359–61. http://dx.doi.org/10.1017/s0144686x00006024.
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Plant, Paul. "Primary Health Care." Ageing and Society 10, no. 1 (March 1990): 109–12. http://dx.doi.org/10.1017/s0144686x0000790x.
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Wilkin, David. "Primary Health Care." Ageing and Society 5, no. 4 (December 1985): 470–73. http://dx.doi.org/10.1017/s0144686x00012046.
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MCELMURRY, BEVERLY J. "Primary Health Care." Annual Review of Nursing Research 17, no. 1 (January 1999): 241–68. http://dx.doi.org/10.1891/0739-6686.17.1.241.
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Primary Health Care (PHC) has been promulgated for over two decades as a global strategy for ensuring basic health care for all people. PHC is characterized by equity, accessibility, availability of resources, social participation, intersectoral community action, and cultural sensitivity. While PHC can be discussed as philosophy or a process, it is critical that PHC be understood as a community focus in health care that differs from a primary care focus on individuals. Capturing PHC components in community-based interventions in order to advance the development of a rigorous research base requires a shift in thinking about what constitutes acceptable methods and evidence for evaluating changes in health care. To this end, the authors of this review discuss perspectives and available research that inform practice within multidisciplinary teams, highlight the importance of social discourse, and review participatory evaluation issues for achieving a working relationship with communities. Particular attention is focused on education for nurses’ roles in PHC activities within implementation models fostering community mobilization and development. An action plan is suggested as a means for situating discrete research activity within a PHC framework.
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Kar, S. B. "Primary health care." Academic Medicine 65, no. 5 (May 1990): 301–6. http://dx.doi.org/10.1097/00001888-199005000-00006.
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Davidson, Patricia, Judith MacIntosh, Dianne McCormack, and Evelyn Morrison. "Primary Health Care." Holistic Nursing Practice 16, no. 4 (July 2002): 65–74. http://dx.doi.org/10.1097/00004650-200207000-00010.
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Fleetwood, Tony, Vi Wagner, Ben Brazellc, and Bernie Callan. "Primary health care." Nursing Standard 4, no. 23 (February 28, 1990): 41. http://dx.doi.org/10.7748/ns.4.23.41.s47.
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