Tesis sobre el tema "Health promotion – Zimbabwe – Bulawayo"

Zimbabwe's catastrophic economic decline resulted in a high unemployment rate (95%), declining socioeconomic indicators, pharmacy stores' unprofitability and lower sustainability. Profitable pharmacy stores play a fundamental role in ensuring public access to medication. Lack of pharmacy profitability leads to poor healthcare delivery, resulting in increased morbidity and mortality. A healthy population is panacea to economic growth and prosperity and enhances human dignity, social cohesion, and the quality of life. In this qualitative, descriptive multicase study design, using Porter's business strategies theory and the Deming process of quality assurance as conceptual frameworks, data from 11 pharmacy stores leaders in Bulawayo, Zimbabwe were collected during interviews with open-ended questions. Participants were assumed to have influence, knowledge, and a personal stake in the pharmacy sector and that their views and experiences could address the research question of lack of pharmacy profitability and sustainability. Data were explored, categorized, and tabulated to assist drawing empirical findings and conclusions that could answer the research question. Using software the data were analyzed and themes such as the centrality of strategy in running profitable pharmacies, customer care, reimbursements by medical insurance firms, the role of the legal and regulatory frameworks on pharmacies, and mergers of single-owner pharmacies emerged. Findings from the results might provide strategies for those in the pharmacy retail sector and individuals who intend to explore the sector. Individuals who read results of the study might be influenced to lobby government on behalf of the sector to relax prohibitive regulations.

Within the context of debates concerning the reception and interpretation of media texts by television audiences, this qualitative reception study explores how a sample of Bulawayo students negotiate meanings from Zimbabwe's first health communication soap opera, Studio 263. The study thus examines the reasons behind the popularity of this programme with this target audience. The findings of the study reveal that meaning making is a complex process that is dependent on a variety of factors which include, among others, the socio-cultural context of media consumption, gender, economic disposition and age. It particularly maintains that gender and lived realities influence the interpretation and negotiation of meanings in this particular study.
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Although safe sanitation and hygiene is critical for improving family health, rural communities in Sub Saharan Africa have shown little inclination to change their traditional behaviour, and sanitation coverage has now dropped to 47% (Cairncross 2003). With the Millennium Development Goals seeking to halve the 2.4 billion people without sanitation by the year 2015, there is an urgent need to find cost-effective health promotion strategies that will actively engage rural householders in modifying risky hygiene behaviour. This thesis evaluates an approach, developed over the past ten years in Zimbabwe, in which Community Health Clubs have successfully galvanised rural communities into active behaviour change leading to a strong demand for sanitation. In Tsholotsho District, after six months of weekly hygiene promotion sessions, at the cost of US 35c per beneficiary, good health knowledge of nine different topics was 47% higher in the intervention than for the control, and latrine coverage rose to 43% contrasted to 2% in the control area, with the remaining 57% members without latrines practicing faecal burial, a method previously unknown (p>0.0001). Spot observations of 736 Health Club households in two districts was contrasted to 172 in a control group, and showed highly significant changes in 17 key hygiene practices (p>0.0001) including hand washing. The study demonstrates that if a strong community structure is developed and the norms of a community are altered by peer pressure from a cyclical to linear world view, hygiene behaviour change will ensue and a demand for sanitation can be created. Maslow's Hierarchy of Needs (1954) is adapted to a rural context to analyse the qualitative data, providing some insight into the socio-cultural mechanisms at work. Despite adverse socio-economic conditions in Zimbabwe over the past five years, Health Clubs have flourished, providing a sustainable and cost-effective case study.

This ethnographic study explored factors that facilitate or hinder women's participation in health promotion and HIV prevention in the Mt. Selinda area of rural Zimbabwe. Rates of HIV and AIDS in Zimbabwe are among the highest in the world and increasing most quickly among young females. A purposeful convenience sample of 11 Ndau women (key participants) was interviewed twice. Seventeen key informants and four focus groups offered further perspectives. The resulting narrative presents a picture of Ndau women's existence that is difficult and oppressive. Females are socialized early to be workers and mothers within a context of limited voice, subservience, violence, and economic powerlessness. Application of a health promotion framework reinforced the reality that these women are generally unable to use measures for HIV prevention. Socio-cultural and economic factors of gender inequality were analyzed through an ecological approach, showing that cultural beliefs and practices, along with national and international forces, support and sustain gender inequality. If there is to be change in the AIDS crisis, the study's findings suggest that HIV prevention strategies should be integrated within a participatory community development model that includes opportunities for both men and women to carry out gender analysis. While health professionals must understand and be sensitive to culture and context, existing unjust and inequitable structures at all levels of society must be examined and challenged.

Rapid repeat pregnancy (RRP) is associated with adverse maternal and infant outcomes and a range of undesirable social and economic challenges for the mother, her baby, and society. Although the consequences of RRP are well known, Zimbabwe—a country with some of the poorest maternal health indicators—has not investigated or made efforts to directly address this problem. This is confirmed by the lack of targeted programs to curb RRP, the unavailability of documented evidence regarding RRP significant risk factors, and the lack of understanding of the extent of RRP in the country. Using social cognitive theory as the theoretical framework, an unmatched case-control study was conducted using data from the Zimbabwe Demographic and Health Survey of 2015 to determine the prevalence of RRP and to assess associations between sociodemographic, sexual-relational, women's health, fertility preference, previous birth outcomes, and social factors and having an RRP in Zimbabwe. Logistic regression analysis showed statistically significant associations between all factors except for women's health characteristics. The prevalence of RRP among women of reproductive age (15–49 years) in Zimbabwe was 50.2%. The high prevalence of RRP and the multiple statistically significant associations reported in this study affirm the need for Zimbabwe to make prevention of RRP a public health priority. Zimbabwe must develop targeted interventions that work in context and integrate these into an ongoing comprehensive family planning program. In-depth research is needed to establish and understand the underlying motivations for having an RRP among Zimbabwean women. Such information may help develop targeted interventions to create social change.

A decline in Human Immunodeficiency Virus (HIV) prevalence rates have been observed among females ages 15 to 19 years and 20 to 24 years in Zimbabwe between 2005 and 2010. However, for males 15 to 19 years, rising trends were observed, whereas for males ages 20 to 24 years, rates fluctuated between 2005 and 2011. The purpose of this cross-sectional study was to examine relationships between sexual behaviors and practices and HIV prevalence among young males and females ages 15 to 24 years in Zimbabwe. Guided by constructs of proximate determinants framework, extracted data from two National Demographic Health surveys of 2005/06 and 2010/11 were analyzed using chi square and binary logistic regression. This study revealed that sexual practices, relationship status, and education status increase the odds of being HIV positive differently among 15 to 19-year-olds and 20 to 24-year-olds based on gender and changes through time. Significant relationship existed between HIV positive serostatus and total number of life time partners among females 15 to 19 years and 20 to 24 years; lack of condom use among males 20 to 24 years in 2005/06; early sexual debut and lower education status among females 20 to 24 years; and being widowed, separated, or divorced among males and females 20 to 24 years in 2010/11. The Odds of being HIV positive for males ages 15 to 19 years was not predicted by sexual practice, creating a need for future study. This study can contribute to positive social change by providing information about the associations between HIV serostatus and the assessed risk factors, which may help promote awareness about HIV infection risk, thereby helping develop and implement targeted public health interventions to reduce the burden of HIV.

The study sought to explore and describe the risk behaviour regarding HIV transmission among youth in Bulawayo, their knowledge of HIV transmission and the sources of information on HIV transmission accessible to them. A quantitative, descriptive exploratory design was used and 238 youth from three secondary schools in Bulawayo, the second largest city in Zimbabwe were the respondents. The Health Belief Model (HBM) was used to facilitate and acquire insight into the risk behaviour among the youth. The inferences drawn from the study were that youth have inadequate knowledge about HIV transmission and therefore do not fully understand their risk of infection. Youth also find shyness and fear of rejection serious barriers to communicating openly about sexuality, sexual and HIV/AIDS issues. The findings of the study have implications for programmes to limit HIV transmission among youth and should assist policymakers and educators in developing and implementing such programmes in order to improve the health of youth in Zimbabwe.
Health Studies
M.A. (Health Studies)

Antiretroviral therapy is an important public health strategy to reduce the risk of HIV vertical transmission. Implementation of such therapy depends on the identification of HIV-infected pregnant women. This study investigated how the biographical characteristics of the pregnant women (16-45 years) influenced their health decision-making in Bulawayo clinics. The study was guided by the theories of health behaviour. The study assumed that the respondents’ demographic characteristics will influence their attitudes towards PMTCT programme. Using a structured questionnaire, forty pregnant women who visited the Bulawayo clinics to have prenatal checkups were interviewed. The majority of respondents came from a poor, high-density township. Most of the respondents were married, but about a third were not married at the time data collection and 5% were separated. The survey items were demographic characteristics, knowledge of PMTCT, HIV risk perceptions and service utilisation. The levels of literacy among the respondents were high; more than 80% had completed primary education. Overall the respondents’ demographic characteristics influenced their attitudes towards PMTCT. Majority of the women knew that a mother with HIV can pass the virus to her child, during pregnancy, delivery and breastfeeding. The pregnant women’s health-seeking behaviour and their attitudes toward reproductive health services are influenced by their demographic situation.
Health Studies
(M.A. (Social Behavior Studies in HIV/AIDS))

Employee involvement and participation in HIV-prevention interventions at the workplace remains a barrier to effective programme implementation, which contributes significantly to programme failure and the consequent continued spread of HIV among employees at the workplace. This study explores employee involvement and participation in HIV-prevention interventions at a Bulawayo tyre manufacturing firm. It assesses factors affecting employee involvement and participation in these interventions, and examines the implications of these findings for programme implementation. I used a semi-standardised interview schedule to conduct in-depth, face-to-face qualitative interviews and a self-administered questionnaire to collect quantitative data. The responses showed the nature of employee involvement in HIV-prevention at the firm was at a co-option level, and the type of participation was mere token participation. I recommended that the firm should develop a clear understanding of the importance of stakeholder involvement in HIV-prevention programmes.
Sociology
M.A. (Social Behaviour Studies in HIV/AIDS)

The purpose of the study was to assess the impact of HIV/AIDS programmes at the workplace. The case study used both quantitative and qualitative methods (Triangulation) to determine the level of awareness and evaluate the impact of the programmes implemented at the workplace. The data was collected using a pilot tested structured questionnaire which was distributed to a purposive sample (n=60), involving all the departments at the company. Semi structured interviews involving purposively identified participants (n = 3) were conducted to clarify and explain issues in relation to questionnaire responses. The data from the structured questionnaire was analyzed using a statistical package for social sciences (SPSS).The findings revealed that the organization had achieved 90% awareness and 75% positive impact. The study also revealed that social background, individual values and religion influenced sexual behaviour, hence the recommendation for more preventive oriented programmes to influence positive behavioural change amongst employees
Health Studies
M.A. (Public Health)

Adolescent pregnancies are high risks obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. This study investigated factors influencing pregnant adolescents' utilisation of ANC services in Bulawayo, using the Health Belief Model's major tenets. A quantitative descriptive design was used in four phases: 80 adolescents' ANC records were audited; structured interviews were conducted with 200 adolescents attending ANC and with 80 adolescents who had delivered their babies without attending ANC; and 52 midwives completed questionnaires portraying their perceptions on adolescents' utilisation of ANC services in Bulawayo. Documentation of ANC services provided to adolescents did not meet the expected standards. Poor or non utilisation of ANC services was influenced by socio demographic factors, individual perceptions of adolescents about antenatal care, perceived benefits of and perceived barriers to the utilisation of ANC. Most pregnant adolescents could not access these services because they could not pay the ANC and/or delivery fees charged at government clinics/hospitals. Midwives required more training in providing and recording adequate ANC services. Free ANC and delivery services could enhance adolescents' pregnancy outcomes in Zimbabawe. An information brochure on the importance of ANC attendance for adolescents has been compiled, based on the research results (see Annexure J).
Health Studies
D.Litt. et Phil. (Health Studies)

Landfills have served as the major sites for waste disposal in both developed and developing countries. Upon closure of a landfill site, the surface could be converted to a golf course, recreation park, playground, animal refuge, tennis court and industrial site. Even when closed, landfills still have the potential to contaminate the surrounding environment as a result of the migration of leachate from decomposing waste contained in the site. This study focused on assessing the impacts of a closed landfill on soils and plants at Lumberstewart closed landfill site in Bulawayo, Zimbabwe. Soil samples were collected at three different depths (0-30 cm, 30 - 60 cm and 60-90 cm) at the landfill and a control site. The soil samples were analysed for their texture, pH, electrical conductivity, organic matter content, cation exchange capacity and concentrations of Cd, Cu, Cr, Fe, Ni and Zn. Samples of jimson weed and pigweed growing at the closed landfill and the control site were collected from the same sites where soil samples were collected, and the concentrations of the same set of heavy metals in these weeds determined. Soil samples were digested using EPA method 3050B: Acid Digestion of Sediments, Sludge and soils whereas nitric acid and hydrogen peroxide was used for digestion of plant samples. Both plant and soil digests were analyzed for heavy metals concentrations using Flame Atomic Absorption Spectrometry (AAS). Soils from the landfill as well as the control site had a high content of sand with soil pH values which were alkaline. The electrical conductivity values of the soil samples were relatively low ranging from 0.39 to 1.67 dS/m, indicating low levels of salts in soils at the landfill. The concentrations of heavy metals at the closed landfill site were higher than the control site. Heavy metals concentrations in soils at the closed landfill followed the order Fe>Zn>Cu>Cr>Ni>Cd. Results indicated that Fe was exceptionally higher than the other metals with concentration values averaging 45690±17255 mg/kg. Cadmium on the other hand had the least concentration with values of 0.01±0.00 mg/kg. Values of Enrichment Factors of heavy metals around the soil at different depths indicated that the enrichment of heavy metals increased with depth at the landfill up to 30-60 cm after which a decrease was observed. Values for heavy metal Contamination Factor of soils around the landfill ranged from low concentration (CF<1) to very high concentration (CF>6). The Pollution Load Index (PLI) values for the soil at the Lumberstewart landfill indicated that all sites were polluted (PLI>1). Site 6 had significantly higher mean concentration of heavy metals in soils at the landfill whereas site 11 had the least. The concentrations of Cd and Ni in soils at the landfill were below permissible limits of South African National Norms and Standards (NNS) as prescribed by NEMA (2008) in South Africa whereas Cr, Cu and Zn in soils were above the NNS permissible limits. Heavy metal concentrations in soils at the landfill were above World Health (WHO) permissible limits except for Cd which was equal (0.01 mg/kg) to the permissible values of Cd in the soils at sites 5, 8, 9, 10, 11 and 12. Mean concentrations of heavy metals in jimson weed and pigweed were in the order Fe>Zn>Cu>Cr>Ni>Cd. The concentrations of Cd, Cr, Cu, Fe and Zn in both plants from all sites at the landfill were significantly higher than the control site. Heavy metal transfer coefficient for both plants indicated that heavy metal uptake was more species dependent than soil heavy metal concentration dependent. The results from this research indicate that though the Lumberstewart Landfill has been closed, it is still affecting the soils in the vicinity of the landfill. Plants and water around the Lumberstewart closed landfill could be at risk from heavy metal contamination. High concentrations of heavy metals observed in the soil could present a health risk to communities should they decide to use the landfill site for arable purposes.
Environmental Sciences
M. Sc. (Environmental Science)

Text in English
This qualitative descriptive phenomenological study explored the experiences of HIV positive women utilising PMTCT services at a central hospital in Zimbabwe. Data was collected using in-depth interviews of fifteen participants. The interviews were audio recorded and transcribed verbatim. Using the Interpretive Phenomenological Analysis framework for data analysis, two super-ordinate themes emerged, namely resources for provision of PMTCT services and approaches and nature of PMTCT care. The study revealed challenges experienced by HIV positive women emanating from material, financial and human resource related constraints in the PMTCT setting. The resource challenges negatively affected access and utilisation of PMTCT services. A practice model, whose purpose is to enhance the quality and utilisation of PMTCT services, was developed and described. The model was evaluated using Chin and Krammer (2011) criteria plus a modified form of the Delphi technique. These findings have implications for effective PMTCT service provision. The key lessons learnt for programmatic improvement were that in order to provide quality and accessible PMTCT services the health care system will need to be well resourced. There is need to strengthen the health care system in line with HIV related programmatic changes.
Health Studies
D. L.itt. et Phil. (Health Studies)

Thesis (MPH.) -- University of Limpopo, 2016.
Introduction: Annually, hundred thousands of people worldwide die as a result of second hand smoke (SHS) exposure. There is no safe exposure level to SHS yet in Bulawayo, smokers have been observed smoking without restraint thus exposing non-smokers to SHS. The purpose of this study was to establish the prevalence and contributing factors of SHS exposure among adults in Bulawayo, Zimbabwe. Methods: A cross sectional study was conducted and participants were randomly selected from residents who visited the 13 municipal revenue halls. A structured questionnaire was used to collect data from respondents. Descriptive and multivariate logistic regression analyses were performed. Results: Home SHS exposure prevalence was 22% and females were 2.11 times more likely than males to be exposed at home. Prevalence of SHS exposure in public transportation, health facilities, educational and food premises was 40.9%, 26.3%, 42,9% and 36.8% respectively. Conclusion: SHS exposure in Bulawayo was high and there is need to reduce SHS exposure to non-smoking adults. Keywords: Second hand smoke (SHS), Bulawayo, Prevalence, Exposure, Adult

A distressing consequence of the HIV/AIDS pandemic and of the increasing numbers of orphans and decreasing numbers of caregivers is the emergence in ever larger numbers of child-headed households (CHHs). The complexity of issues affecting CHHs and the lack of research on this subject means that CHHs are not well understood. This sometimes prompts support agencies to provide emotionally driven recommendations suggesting that it is better for a child to be in an orphanage than to live in a CHH. This exploratory study, involving heads of 105 CHHs over a 12 month period and 142 participants in various focus group discussions (FGD) and interviews, suggests the need for a change in perspective. It addresses the question of CHH quality of life, coping strategies and household functioning and attempts to bring this into a productive dialogue with community child care activities, NGO and statutory support and child care and protection policies. Research data suggests that the key determining factor contributing towards the creation of a CHH is `pre-parental illness' family conflict. Another contributing factor is that siblings want to stay together after parental death. Quality of life assessments indicate that despite significant adversities, over 69% of CHHs reported a 'medium' to 'satisfactory' quality of life and demonstrate high levels of resilience. As regards vulnerability to abuse, it is found that while CHH members are more vulnerable to external abuse, they experience little within their household. Contrary to public perceptions about CHHs lacking moral values, CHH behaviour might actually be more responsible than non-CHH peer behaviour as their negative experiences appear to galvanize them into adopting responsible behaviour. Community care and neighbourhood support in older townships are better established compared with newer suburbs. Sufficient community care capacity enables CHHs to function, thus avoiding a situation where households disintegrate and household members end up as street children. CHH coping responses seem to be mainly influenced by individual and community factors, and by social, spiritual and material support. The interplay between these and the CHH's ability to engage in the required coping task impacts on the coping outcome at household level. National and international government and non-governmental child service providers in Southern Africa need to recognize that an adequately supported CHH is an acceptable alternative care arrangement for certain children in communities with high adult AIDS mortality and where adult HIV-prevalence exceeds 10%.
Development Studies
D. Ltt. et Phil. (Development Studies)

MENVSC
Department of Ecology and Resource Management
Solid waste management (SWM) has become an issue of increasing worldwide concern as urban populations continue to rise and consumption patterns change. The health and environmental effects associated with SWM are escalating, predominantly in the perspective of developing countries. The rise in rural-urban migration rates in developing countries has left local authorities overwhelmed and failing to cope with the increase in solid waste. This has led to a shift from conventional systems of solid waste management to contemporary systems such as community based solid waste management (CBSWM). Despite the shift, it seems local authorities in developing countries still fail to manage suburban waste effectively. This study investigated the performance of a CBSWM scheme in Nkulumane, a high-density suburb in Bulawayo. Both quantitative and qualitative data were collected, hence a mixed methods approach employed. The study incorporated systematic sampling and purposive sampling in the selection of research participants. Data was collected through qualitative questionnaires, semi structured interviews and field observations. Thematic content analysis and descriptive statistics from SPSS version 25 were used in data analysis. The study revealed that community members from Nkulumane had sound knowledge on what CBSWM entails, however the community members had negative attitude towards CBSWM and traditional notions on SWM had an influence of their perception of CBSWM concepts. The study also revealed that Bulawayo City Council had managed to create employment for the community through a CBSWM scheme. Furthermore, operating expenses of the city council had decreased over the years. The level of environmental awareness had improved in the study area as well. However, Bulawayo City Council has battled with community participation problems, financial constraints and inter-institutional infighting. This study provides a comprehensive report on the performance of the CBSWM scheme in Nkulumane high density suburb, Bulawayo, Zimbabwe.
NRF

PhD (African Studies)
Department of African Studies
Traditional health practice is an important and often underestimated part of health care. Since time immemorial traditional health ensured and covered all major areas of health promotion, which included preventative, promotive, curative, rehabilitative, and surgical practices. In low- and middle-income countries where the number of practitioners of modern medicine may not be enough to meet the health care needs of the country, traditional health promotion is central. Given that in many societies the practices are done in secret, it therefore makes it difficult for people in general to access proper service from traditional health practitioners. This study explored the role of traditional health practitioners in promoting health in a rural community. The study adopted a qualitative approach which was descriptive, explorative and interpretative, targeting the registered traditional health practitioners in villages of Ward X of the Pfura Rural District Council. A non-probability purposive and snowball sampling method was used to identify twenty-two (22) male and female participants. The participants were registered diviners, herbalists and traditional birth attendants. The data which was collected through in-depth interviews, field notes, audio recordings and observation were thematically analyzed using Tesch’s method of data analysis and presented in categories, themes and subthemes. The study revealed that the traditional health practitioners in Pfura, are playing a vital role in offering primary health care for the people. Traditional health practitioners offer healing through their extensive knowledge of herbal and animal-based medicines and therapeutic actions such as rituals. The study established the use of herbs, traditional ceremonies, taboos, cultural norms as health promotive practices. Traditional healers in Pfura have demonstrated their efficacy and remained a powerful establishment in society through their easy access to the ancestral spirits, which has sustained the healing culture of Kore-kore people. Despite the central role being played by traditional health system in health promotion, impediments were found against the practice and its practitioners. Poor professional development, research and training of the Traditional Health Practitioners as well as the advanced age of practitioners is a setback in the practice as it contributed negatively to the sustainability of the traditional health practice. Guided by both study findings, key action areas of health promotion of the Ottawa Charter and the objectives of the World Health Organization, Traditional Medicine Strategy of 2014-2023 target, a framework/guide was developed and recommended an integrative and sustainable health promotion in a rural setting.
NRF