RESUMEN
PURPOSE: Stigma is an understudied barrier to health care acceptance in pediatric oncology. We sought to explore the stigma experience, including its impact on cancer treatment decision making, and identify strategies to mitigate stigma for patients with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe. METHODS: Participants included caregivers, adolescent patients (age 12-19 years), and health care clinicians. A semistructured interview guide based on The Health Stigma and Discrimination Framework (HSDF) was adapted for use at each site. Interviews were conducted in English, Spanish, Arabic, or Shona, audio-recorded, translated, and transcribed. Thematic analysis focused on stigma practices, experiences, outcomes, drivers, mitigators, and interventions. RESULTS: We conducted 56 interviews (28 caregivers, 19 health care clinicians, nine patients; 20 in Guatemala, 21 in Jordan, 15 in Zimbabwe). Major themes were organized into categories used to adapt the HSDF to global pediatric cancer care. Themes were described similarly across all sites, ages, and diagnoses, with specific cultural nuances noted. Pediatric cancer stigma was depicted as an isolating and emotional experience beginning at diagnosis and including internalized and associative stigma. Stigma affected decision making and contributed to negative outcomes including delayed diagnosis, treatment abandonment, regret, and psychosocial fragility. Overcoming stigma led to positive outcomes including resilience, treatment adherence, pride, and advocacy. Identified stigma drivers and mitigators were linked to potential interventions. CONCLUSION: Participants describe a shared stigma experience that transcends geography, cultural context, age, and diagnosis. Stigma manifestations have the potential to impact medical decision making and affect long-term psychological outcomes. Stigma assessment tools and interventions aimed at stigma mitigation including educational initiatives and support groups specific to pediatric cancer should be the focus of future research.
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Osteosarcoma , Retinoblastoma , Estigma Social , Humanos , Adolescente , Guatemala , Niño , Femenino , Masculino , Zimbabwe , Retinoblastoma/psicología , Adulto Joven , Osteosarcoma/psicología , Adulto , Cuidadores/psicologíaRESUMEN
The present review was aimed at documenting medicinal uses of species of the Euphorbiaceae family in Zimbabwe. Literature was collected from online databases such as BioMed Central, W eb of Science, Springerlink, Google Scholar, Scielo, PubMed, Science Direct, ACS Publications, Scopus and JSTOR. This study showed that 29 species are used to manage human and animal diseases in Zimbabwe. These species are used against 49 medical condition s, mainly as ethnoveterinary medicine (21 use reports), and traditional medicine against respiratory (23 use reports), gastro - intestinal (14 use reports), male reproductive (11 use reports), antenatal and postpartum (10 use reports each) and sexually trans mitted infections (9 use reports). Acalypha brachiata , Bridelia cathartica , B. mollis , Croton megalobotrys , Euphorbia ingens , E. matabelensis , Flueggea virosa , Monadenium lugardiae , Pseudolachnostylis maprouneifolia , Ricinus communis and Spirostachys afric ana have the highest number of medicinal uses. There is need to unravel the therapeutic potential of the family through further ethnopharmacological research.
La p resente revisión tuvo como objetivo documentar los usos medicinales de especies de la familia Euphorbiaceae en Zimbabwe. La literatura se recopiló de bases de datos en línea como BioMed Central, Web of Science, Springerlink, Google Scholar, Scielo, PubMed, Science Direct, ACS Publications, Scopus y JSTOR. Este estudio mostró que se utilizan 29 especies para el tratamiento de enfermedades humanas y animales en Zimbabwe. Estas especies se utilizan para tratar 49 condiciones médicas, principalmente como medici na etnoveterinaria (21 informes de uso), y medicina tradicional para enfermedades respiratorias (23 informes de uso), gastrointestinales (14 informes de uso), reproductivas masculinas (11 informes de uso), prenatales y posparto (10 informes de uso cada una ) e infecciones de transmisión sexual (9 informes de uso). Acalypha brachiata , Bridelia cathartica , B. mollis , Croton megalobotrys , Euphorbia ingens , E. matabelensis , Flueggea virosa , Monadenium lugardiae , Pseudolachnostylis maprouneifolia , Ricinus communi s y Spirostachys africana son las especies con mayor número de usos medicinales. Es necesario desvelar el potencial terapéutico de esta familia a través de futuras investigaciones etnofarmacológicas.
Asunto(s)
Plantas Medicinales , Euphorbiaceae , Zimbabwe , Etnobotánica , Euphorbia , FitoquímicosRESUMEN
BACKGROUND: Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM: The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS: A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS: A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS: A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.
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Desarrollo Infantil , Responsabilidad Parental , Niño , Femenino , Humanos , Preescolar , Lactante , Zimbabwe , Madres/educaciónRESUMEN
Use of herbal, complementary and alternative medicines during pregnancy, labour and delivery is common in Zimbabwe. This study aimed at documenting herbal, complementary and alternative medicines used during pregnancy in Makoni District in Zimbabwe. Snowballing was used to select 66 participants which included herbalists (45.5%), traditional birth attendants (18.2%), traditional healers (15.2%), and assistant traditional healers and herbal medicine vendors (10.6% each). Pregnant women in the study areaused a total of 47 plant species from 27 families, and 14 non-plant products as herbal, complementary and alternative medicines by. A total of 26 medical cases were treated with the majority of medicinal plants and non-plant products, used to dilate or widen the birth canal (55.3%) and to augment labour or speed up the delivery process (46.8%). This study showed that herbal, complementary and alternative medicinesplay an important role in the provision of basic health care in Zimbabwe.
El uso de medicinas a base de hierbas, complementarias y alternativas durante el embarazo, el trabajo de parto y el parto es común en Zimbabwe. Este estudio tuvo como objetivo documentar las medicinas a base de hierbas, complementarias y alternativas utilizadas durante el embarazo en el distrito de Makoni en Zimbabwe. Se utilizó bola de nieve para seleccionar a 66 participantes que incluían herbolarios (45,5%), parteras tradicionales (18,2%), curanderos tradicionales (15,2%) y asistentes de curanderos tradicionales y vendedores de hierbas medicinales (10,6% cada uno). Las mujeres embarazadas en el área de estudio utilizaron un total de 47 especies de plantas de 27 familias y 14 productos no vegetales como medicinas a base de hierbas, complementarias y alternativas. Un total de 26 casos médicos fueron tratados con la mayoría de plantas medicinales y productos no vegetales, utilizados para dilatar o ensanchar el canal del parto (55,3%) y para aumentar el parto o acelerar el proceso de parto (46,8%). Este estudio mostró que las medicinas a base de hierbas, complementarias y alternativas desempeñan un papel importante en la prestación de atención médica básica en Zimbabwe.
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Humanos , Femenino , Embarazo , Plantas Medicinales , Terapias Complementarias , Parto , Medicina Tradicional , Zimbabwe , FitoterapiaRESUMEN
INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.
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Salud Mental , Cobertura Universal del Seguro de Salud , Bangladesh , Humanos , Jordania , Paraguay , Filipinas , Ucrania , Organización Mundial de la Salud , ZimbabweRESUMEN
O objetivo deste artigo é analisar a dinâmica das migrações internacionais sul-sul a partir do estudo de caso da recente imigração de zimbabweanos para a província de Tete, Moçambique, historicamente uma região de emigração. Nesse sentido, examinamos as características sociodemográficas desses novos imigrantes, assim como as condições e motivações individuais, familiares e estruturais subjacentes ao fluxo migratório. Para tanto, combinamos dados quantitativos provenientes do Censo moçambicano de 2007 e dos registros de trabalhadores imigrantes da Direção Provincial de Trabalho, Emprego e Segurança Social, com entrevistas semiestruturadas junto aos imigrantes zimbabweanos em Tete. Os resultados indicam uma multiplicidade de fatores que contribuíram para a recente onda de imigração em Tete, com destaque, além das motivações econômicas e de subsistência familiares, para aspectos sociais e culturais relacionados à longa tradição da mobilidade intrarregional na África Austral, facilitada por fronteiras relativamente porosas e fortes laços culturais, linguísticos e de parentesco. Discutimos, também, como a instalação de megaprojetos de mineração com capital brasileiro, em Tete, contribuiu para torná-la atrativa como destino migratório, num contexto em que se assistiam violentas ondas de xenofobia contra imigrantes na África do Sul, principal destino das migrações na região.
This article analyses the dynamics of international South-South migration through the case study of the recent immigration of Zimbabweans to the province of Tete, Mozambique, historically a region of emigration. We examine immigrants' socio-demographic characteristics, as well as the individual, family and structural conditions and motivations underlying this new migration flow. The analysis combines quantitative data from the 2007 Mozambican Census and administrative records for immigrant workers from the Provincial Directorate of Labour, Employment and Social Security, with semi-structured interviews with Zimbabwean immigrants in Tete. The results indicate a multiplicity of factors that contributed to the recent wave of immigration in Tete. In addition to economic and subsistence motivations, social and cultural aspects related to the long tradition of intra-regional mobility in Southern Africa, facilitated by relatively porous borders and strong cultural, linguistic and kinship ties, seem to be important. We also discussed how the installation of mining megaprojects with Brazilian capital in Tete, contributed to its appeal as a migrant destination, in a context in which violent waves of xenophobia against immigrants were occurring in South Africa, the main destination for migrants in the region.
El objetivo de este artículo es analizar la dinámica de la migración internacional sur-sur a partir del estudio de caso de la reciente inmigración de zimbabuenses a la provincia de Tete, Mozambique, históricamente una región de emigración. En este sentido, examinamos las características sociodemográficas de estos nuevos inmigrantes, así como las condiciones y motivaciones individuales, familiares y estructurales inherentes a este flujo migratorio. Para este fin, combinamos datos cuantitativos del censo de Mozambique de 2007 y registros de trabajadores inmigrantes de la Dirección Provincial de Trabajo, Empleo y Seguridad Social, con entrevistas semiestructuradas con inmigrantes zimbabuenses en Tete. Los resultados indican una multiplicidad de factores que contribuyeron a la reciente ola de inmigración en Tete, entre los que se destacan, además de las motivaciones económicas y de subsistencia familiar, aspectos sociales y culturales relacionados con la larga tradición de movilidad intrarregional en el sur de África, facilitada por fronteras relativamente porosas y por fuertes lazos culturales, lingüísticos y de parentesco. También discutimos cómo la instalación de megaproyectos mineros con capital brasileño en Tete contribuyó con su atractivo como destino migratorio, en un contexto en el que se asistía a violentas oleadas de xenofobia contra inmigrantes en Sudáfrica, el principal destino de las migraciones en la región.
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Humanos , Zimbabwe , Dinámica Poblacional , Emigración e Inmigración , Mozambique , Censos , Distribución por Edad y Sexo , Xenofobia , MineríaRESUMEN
BACKGROUND: Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks. METHODOLOGY/PRINCIPLE FINDINGS: We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 12 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied. CONCLUSIONS/SIGNIFICANCE: CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks.
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Cólera/epidemiología , Cólera/prevención & control , Cólera/transmisión , Congo/epidemiología , Composición Familiar , Haití/epidemiología , Humanos , Higiene , Estudios Retrospectivos , Saneamiento , Yemen/epidemiología , Zimbabwe/epidemiologíaRESUMEN
BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.
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Comparación Transcultural , Conocimientos, Actitudes y Práctica en Salud/etnología , Preeclampsia/etnología , Condicionamiento Psicológico , Etiopía/etnología , Femenino , Haití/etnología , Modelo de Creencias sobre la Salud , Humanos , Embarazo , Investigación Cualitativa , Características de la Residencia , Zimbabwe/etnologíaRESUMEN
The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefit having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.
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COVID-19 , Pandemias , Cuba , Humanos , Rwanda/epidemiología , SARS-CoV-2 , Sudáfrica/epidemiología , Zimbabwe/epidemiologíaRESUMEN
BACKGROUND: Cervical cancer is an important global health problem. In this study we aimed to analyze trends in cervical cancer at the global, regional, and national levels from 1990 to 2019, to inform health service decision-making. METHODS: Data on cervical cancer was extracted from the Global Burden of Disease study, 2019. Trends in cervical cancer burden were assessed based on estimated annual percentage change (EAPC) and age-standardized rate (ASR). RESULTS: Globally, decreasing trends were observed in incidence, death, and disability adjusted life years (DALYs) of cervical cancer from 1990 to 2019, with respective EAPCs of - 0.38 (95% confidence interval [CI]: - 0.41 to - 0.34), - 0.93 (95%CI: - 0.98 to - 0.88), and - 0.95 (95 CI%: - 1.00 to - 0.90). Meanwhile, decreasing trends were detected in most sociodemographic index (SDI) areas and geographic regions, particularly death and DALYs in Central Latin America, with respective EAPCs of - 2.61 (95% CI: - 2.76 to - 2.46) and - 2.48 (95% CI: - 2.63 to - 2.32); hhowever, a pronounced increasing trend in incidence occurred in East Asia (EAPC = 1.33; 95% CI: 1.12 to 1.55). At the national level, decreasing trends in cervical cancer were observed in most countries/territories, particularly DALYs in the Maldives (EAPC = - 5.06; 95% CI: - 5.40 to - 4.72), Whereas increasing trends were detected in Lesotho, Zimbabwe, and Bulgaria. CONCLUSIONS: Slowly decreasing trends in cervical cancer were detected worldwide from 1990 to 2019. Cervical cancer remains a substantial health problem for women globally, requiring more effective prevention and control strategies.
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Carga Global de Enfermedades , Neoplasias del Cuello Uterino , Bulgaria , América Central , Femenino , Salud Global , Humanos , Incidencia , Lesotho , Años de Vida Ajustados por Calidad de Vida , Neoplasias del Cuello Uterino/epidemiología , ZimbabweRESUMEN
In order to determine the population allele frequencies of autosomal STR markers of forensic interest in the Zimbabwean population, we analyzed a sample of 478 individuals from 19 different ethnic groups using the PowerPlex® Fusion 6C Kit (Promega Corp, Madison, Wisconsin). The data obtained were compared among the different Zimbabwean ethnic groups as well as with several African populations to establish whether significant differences exist among them. No significant differences were found among the ethnic groups in Zimbabwe. Statistically significant differences were observed between allele frequencies in Zimbabwe and some other African populations, although FST with neighboring Bantu populations from South and Southeast regions were low (below 0.005 in most single locus comparisons).
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Población Negra/genética , Etnicidad/genética , Frecuencia de los Genes , Repeticiones de Microsatélite , Análisis de Secuencia de ADN , Femenino , Genética de Población , Humanos , Masculino , Zimbabwe/etnologíaRESUMEN
INTRODUCTION: Obesity is a major and challenging public health problem. The aim of this substudy is to evaluate the effect of calcium supplementation on body weight in women recruited in the Calcium and Preeclampsia trial. METHODS: Women were recruited before pregnancy and randomized to receive a calcium supplement containing 500 mg of elemental calcium or placebo until 20 weeks' gestation; all women received 1.5 g from 20 weeks until delivery. RESULTS: A total of 630 women conceived during the study, 322 allocated to calcium and 308 to placebo. Among these, 230 allocated to calcium and 227 allocated to placebo had information on body weight at baseline and at 8 weeks' gestation. During the study period, women allocated to calcium had a mean weight increase of 1.1 (SD ±5.5) kg, whereas those allocated to placebo had a mean increase of 1.5 (SD ±6.1) kg, a mean difference of 0.4 kg (95% -0.4 (-1.4 to 0.6); P = .408). Women classified as obese at the start of the trial had a lower body weight gain at 8 weeks' gestation (1.0 kg; 95% CI: -3.2 to 1.2; P = .330) and at 32 weeks' gestation (2.1 kg; 95% CI: 5.6-1.3; P = .225) if they received calcium as compared to placebo. However, none of these differences were statistically significant. CONCLUSION: The smaller increase in body weight found in women supplemented with 500 mg elemental calcium daily is quantitatively consistent with previous studies. However, in this study, the difference was not statistically significant.
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Calcio de la Dieta/administración & dosificación , Preeclampsia/prevención & control , Atención Preconceptiva , Atención Prenatal , Adulto , Argentina , Suplementos Dietéticos , Femenino , Humanos , Fenómenos Fisiologicos Nutricionales Maternos , Embarazo , Sudáfrica , Resultado del Tratamiento , Aumento de Peso , Organización Mundial de la Salud , ZimbabweRESUMEN
BACKGROUND: Despite a growing body of literature on HIV service costs in sub-Saharan Africa, only a few studies have estimated the facility-level cost of prevention of Mother-to-Child Transmission (PMTCT) services, and even fewer provide insights into the variation of PMTCT costs across facilities. In this study, we present the first empirical costs estimation of the accelerated program for the prevention of mother-to-child transmission of HIV in Zimbabwe and investigate the determinants of heterogeneity of the facility-level average cost per service. To understand such variation, we explored the association between average costs per service and supply-and demand-side characteristics, and quality of services. One aspect of the supply-side we explore carefully is the scale of production-which we define as the annual number of women tested or the yearly number of HIV-positive women on prophylaxis. METHODS: We collected rich data on the costs and PMTCT services provided by 157 health facilities out of 699 catchment areas in five provinces in Zimbabwe for 2013. In each health facility, we measured total costs and the number of women covered with PMTCT services and estimated the average cost per woman tested and the average cost per woman on either ARV prophylaxis or ART. We refer to these facility-level average costs per service as unitary costs. We also collected information on potential determinants of the variation of unitary costs. On the supply-side, we gathered data on the scale of production, staff composition and on the types of antenatal and family planning services provided. On the demand side, we measured the total population at the catchment area and surveyed eligible pairs of mothers and infants about previous use of HIV testing and prenatal care, and on the HIV status of both mothers and infants. We explored the determinants of unitary cost variation using a two-stage linear regression strategy. RESULTS: The average annual total cost of the PMTCT program per facility was US$16,821 (median US$8,920). The average cost per pregnant woman tested was US$80 (median US$47), and the average cost per HIV-positive pregnant woman initiated on ARV prophylaxis or treatment was US$786 annually (median US$420). We found substantial heterogeneity of unitary costs across facilities regardless of facility type. The scale of production was a strong predictor of unitary costs variation across facilities, with a negative and statistically significant correlation between the two variables (p<0.01). CONCLUSIONS: These findings are the first empirical estimations of PMTCT costs in Zimbabwe. Unitary costs were found to be heterogeneous across health facilities, with evidence consistent with economies of scale.
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Costos y Análisis de Costo , Infecciones por VIH/transmisión , Instituciones de Salud/economía , Transmisión Vertical de Enfermedad Infecciosa/economía , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo/economía , Atención Prenatal/economía , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/uso terapéutico , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Humanos , Lactante , Embarazo , ZimbabweRESUMEN
The collapse of a country's economy can have significant impacts on the health and healthcare infrastructure of the country. This paper compares the collapse of three national economies from widely separated regions: Venezuela, Zimbabwe, and the countries of the former Soviet Union. Despite significant differences in the environments and cultures of these countries, there are some common variables and outcomes shared by most of the countries including effects on healthcare workforce, disproportionate effects on marginalized populations, and resurgence of certain infectious diseases.
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Enfermedades Transmisibles/epidemiología , Atención a la Salud/economía , Recesión Económica , Fuerza Laboral en Salud/economía , Humanos , U.R.S.S. , Venezuela , Poblaciones Vulnerables , ZimbabweRESUMEN
Reports of simultaneous infections and neoplasms in patients with acquired immune deficiency syndrome (AIDS) are occasionally seen in the literature. However, coexistent lymphoma with tuberculosis, and Kaposi sarcoma (KS) with tuberculosis occurring in the same lymph node is rare. Coexistent lesions pose diagnostic difficulties. In this article, we report two HIV-positive patients from Zimbabwe who displayed KS and tuberculosis; KS and diffuse large B-cell lymphoma in the same lymph node. We found only one similar case presentation in the literature, which was reported in India.
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Infecciones por VIH/complicaciones , Ganglios Linfáticos/patología , Linfoma de Células B Grandes Difuso/complicaciones , Sarcoma de Kaposi/complicaciones , Tuberculosis/complicaciones , Adulto , Femenino , Infecciones por VIH/patología , Humanos , Linfoma de Células B Grandes Difuso/patología , Masculino , Sarcoma de Kaposi/patología , Tuberculosis/patología , ZimbabweRESUMEN
BACKGROUND: Dual human immunodeficiency virus (HIV)/syphilis rapid, point-of-care testing may enhance syphilis screening among high-risk populations, increase case finding, reduce time to treatment, and prevent complications. We assessed the laboratory-based performance of a rapid dual HIV/syphilis test using serum collected from patients enrolled in the Zimbabwe Sexually Transmitted Infections (STI) Etiology study. METHODS: Blood specimens were collected from patients presenting with STI syndromes in 6, predominantly urban STI clinics in different regions of Zimbabwe. All specimens were tested at a central research laboratory using the Standard Diagnostics Bioline HIV/Syphilis Duo test. The treponemal syphilis component of the dual rapid test was compared with the Treponema pallidum hemagglutination assay (TPHA) as a gold standard comparator, both alone or in combination with a nontreponemal test, the rapid plasma reagin test. The HIV component of the dual test was compared with a combination of HIV rapid tests conducted at the research laboratory following the Zimbabwe national HIV testing algorithm. RESULTS: Of 600 men and women enrolled in the study, 436 consented to serological syphilis and HIV testing and had specimens successfully tested by all assays. The treponemal component of the dual test had a sensitivity of 66.2% (95% confidence interval [CI], 55.2%-77.2%) and a specificity of 96.4% (95% CI, 94.5%-98.3%) when compared with TPHA; the sensitivity increased to 91.7% (95% CI, 82.6%-99.9%) when both TPHA and rapid plasma reagin were positive. The HIV component of the dual test had a sensitivity of 99.4% (95% CI, 98.4%-99.9%) and a specificity of 100% (95% CI, 99.9%-100%) when compared with the HIV testing algorithm. CONCLUSIONS: Laboratory performance of the SD Bioline HIV/Syphilis Duo test was high for the HIV component of the test. Sensitivity of the treponemal component was lower than reported from most laboratory-based evaluations in the literature. However, sensitivity of the test increased substantially among patients more likely to have active syphilis for which results of both standard treponemal and nontreponemal tests were positive.
Asunto(s)
Técnicas de Laboratorio Clínico/normas , Infecciones por VIH/diagnóstico , Pruebas en el Punto de Atención/normas , Pruebas Serológicas/normas , Serodiagnóstico de la Sífilis/normas , Sífilis/diagnóstico , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Técnicas de Laboratorio Clínico/métodos , Femenino , VIH , Infecciones por VIH/sangre , Humanos , Masculino , Persona de Mediana Edad , Juego de Reactivos para Diagnóstico/normas , Sensibilidad y Especificidad , Sífilis/sangre , Serodiagnóstico de la Sífilis/métodos , Treponema pallidum , Adulto Joven , ZimbabweRESUMEN
BACKGROUND: Syphilis prevalence in sub-Saharan Africa appears to be stable or declining but is still the highest globally. Ongoing sentinel surveillance in high-risk populations is necessary to inform management and detect changes in syphilis trends. We assessed serological syphilis markers among persons with sexually transmitted infections in Zimbabwe. METHODS: We studied a predominantly urban, regionally diverse group of women and men presenting with genital ulcer disease (GUD), women with vaginal discharge and men with urethral discharge at clinics in Zimbabwe. Syphilis tests included rapid plasma reagin and the Treponema pallidum hemagglutination assay. RESULTS: Among 436 evaluable study participants, 36 (8.3%) tested positive for both rapid plasma reagin and Treponema pallidum hemagglutination assay: women with GUD: 19.2%, men with GUD: 12.6%, women with vaginal discharge: 5.7% and men with urethral discharge: 1.5% (P < 0.0001). CONCLUSIONS: Syphilis rates in Zimbabwe are high in sentinel populations, especially men and women with GUD.
Asunto(s)
Enfermedades de Transmisión Sexual/microbiología , Sífilis/sangre , Sífilis/diagnóstico , Adolescente , Adulto , Biomarcadores/sangre , Femenino , Genitales/patología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Vigilancia de Guardia , Enfermedades de Transmisión Sexual/epidemiología , Sífilis/epidemiología , Treponema pallidum , Úlcera/microbiología , Población Urbana/estadística & datos numéricos , Excreción Vaginal/microbiología , Adulto Joven , Zimbabwe/epidemiologíaRESUMEN
BACKGROUND: Reducing deaths from hypertensive disorders of pregnancy is a global priority. Low dietary calcium might account for the high prevalence of pre-eclampsia and eclampsia in low-income countries. Calcium supplementation in the second half of pregnancy is known to reduce the serious consequences of pre-eclampsia; however, the effect of calcium supplementation during placentation is not known. We aimed to test the hypothesis that calcium supplementation before and in early pregnancy (up to 20 weeks' gestation) prevents the development of pre-eclampsia METHODS: We did a multicountry, parallel arm, double-blind, randomised, placebo-controlled trial in South Africa, Zimbabwe, and Argentina. Participants with previous pre-eclampsia and eclampsia received 500 mg calcium or placebo daily from enrolment prepregnancy until 20 weeks' gestation. Participants were parous women whose most recent pregnancy had been complicated by pre-eclampsia or eclampsia and who were intending to become pregnant. All participants received unblinded calcium 1·5 g daily after 20 weeks' gestation. The allocation sequence (1:1 ratio) used computer-generated random numbers in balanced blocks of variable size. The primary outcome was pre-eclampsia, defined as gestational hypertension and proteinuria. The trial is registered with the Pan-African Clinical Trials Registry, number PACTR201105000267371. The trial closed on Oct 31, 2017. FINDINGS: Between July 12, 2011, and Sept 8, 2016, we randomly allocated 1355 women to receive calcium or placebo; 331 of 678 participants in the calcium group versus 320 of 677 in the placebo group became pregnant, and 298 of 678 versus 283 of 677 had pregnancies beyond 20 weeks' gestation. Pre-eclampsia occurred in 69 (23%) of 296 participants in the calcium group versus 82 (29%) of 283 participants in the placebo group with pregnancies beyond 20 weeks' gestation (risk ratio [RR] 0·80, 95% CI 0·61-1·06; p=0·121). For participants with compliance of more than 80% from the last visit before pregnancy to 20 weeks' gestation, the pre-eclampsia risk was 30 (21%) of 144 versus 47 (32%) of 149 (RR 0·66, CI 0·44-0·98; p=0·037). There were no serious adverse effects of calcium reported. INTERPRETATION: Calcium supplementation that commenced before pregnancy until 20 weeks' gestation, compared with placebo, did not show a significant reduction in recurrent pre-eclampsia. As the trial was powered to detect a large effect size, we cannot rule out a small to moderate effect of this intervention. FUNDING: The University of British Columbia, a grantee of the Bill & Melinda Gates Foundation; UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO; the Argentina Fund for Horizontal Cooperation of the Argentinean Ministry of Foreign Affairs; and the Centre for Intervention Science in Maternal and Child Health.
Asunto(s)
Calcio/administración & dosificación , Suplementos Dietéticos , Preeclampsia/prevención & control , Atención Prenatal/métodos , Adulto , Argentina , Países en Desarrollo , Método Doble Ciego , Femenino , Edad Gestacional , Salud Global , Humanos , Embarazo , Factores de Riesgo , Sudáfrica , Adulto Joven , ZimbabweRESUMEN
BACKGROUND: Xpert MTB/RIF, the most widely used automated nucleic acid amplification test for tuberculosis, is available in more than 130 countries. Although diagnostic accuracy is well documented, anticipated improvements in patient outcomes have not been clearly identified. We performed an individual patient data meta-analysis to examine improvements in patient outcomes associated with Xpert MTB/RIF. METHODS: We searched PubMed, Embase, ClinicalTrials.gov, and the Pan African Clinical Trials Registry from inception to Feb 1, 2018, for randomised controlled trials (RCTs) comparing the use of Xpert MTB/RIF with sputum smear microscopy as tests for tuberculosis diagnosis in adults (aged 18 years or older). We excluded studies of patients with extrapulmonary tuberculosis, and studies in which mortality was not assessed. We used a two-stage approach for our primary analysis and a one-stage approach for the sensitivity analysis. To assess the primary outcome of cumulative 6-month all-cause mortality, we first performed logistic regression models (random effects for cluster randomised trials, with robust SEs for multicentre studies) for each trial, and then pooled the odds ratio (OR) estimates by a fixed-effects (inverse variance) or random-effects (Der Simonian Laird) meta-analysis. We adjusted for age and gender, and stratified by HIV status and previous tuberculosis-treatment history. The study protocol has been registered with PROSPERO, number CRD42014013394. FINDINGS: Our search identified 387 studies, of which five RCTs were eligible for analysis. 8567 adult clinic attendees (4490 [63·5%] of 7074 participants for whom data were available were HIV-positive) were tested for tuberculosis with Xpert MTB/RIF (Xpert group) versus sputum smear microscopy (sputum smear group), across five low-income and middle-income countries (South Africa, Brazil, Zimbabwe, Zambia, and Tanzania). The primary outcome (reported in three studies) occurred in 182 (4·5%) of 4050 patients in the Xpert group and 217 (5·3%) of 4093 patients in the smear group (pooled adjusted OR 0·88, 95% CI 0·68-1·14 [p=0·34]; for HIV-positive individuals OR 0·83, 0·65-1·05 [p=0·12]). Kaplan-Meier estimates showed a lower rate of death (12·73 per 100 person-years in the Xpert group vs 16·38 per 100 person-years in the sputum smear group) for HIV-positive patients (hazard ratio 0·76, 95% CI 0·60-0·97; p=0·03). The risk of bias was assessed as reasonable and the statistical heterogeneity across studies was low (I2<20% for the primary outcome). INTERPRETATION: Despite individual patient data analysis from five RCTs, we were unable to confidently rule in nor rule out an Xpert MTB/RIF-associated reduction in mortality among outpatients tested for tuberculosis. Reduction in mortality among HIV-positive patients in a secondary analysis suggests the possibility of population-level impact. FUNDING: US National Institutes of Health.
Asunto(s)
Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Brasil/epidemiología , Causas de Muerte , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Mycobacterium tuberculosis/aislamiento & purificación , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud , Modelos de Riesgos Proporcionales , Sudáfrica/epidemiología , Tanzanía/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/mortalidad , Zambia/epidemiología , Zimbabwe/epidemiologíaRESUMEN
PURPOSE: Identification of trends in the ability of young single women to protect themselves from unwelcome pregnancy is essential for evaluation and development of policies and programs. We document trends over a 15-year period in sexual activity, contraceptive use, and reproductive outcomes in four countries for single women aged 15-24 years. METHODS: Using retrospective month-by-month reproductive and contraceptive calendars, we constructed annual sexual, contraceptive, and reproductive profiles. The analysis was applied to all four countries (Colombia, Kenya, Peru, and Zimbabwe) that had collected complete reproductive calendars in three consecutive Demographic and Health Surveys. Women-years were classified as sexually inexperienced (i.e., virgin), sexually experienced but using contraception, and sexually experienced without contraception. Conception rates were calculated and those ending in live births were classified as wanted or unwanted. RESULTS: While virginity decreased over time in the Latin American countries, it increased in the African settings. The contribution of condom to the sexually active time protected by contraception use increased in all countries. While the percentage of conceptions ending in spontaneous or induced abortion increased in Colombia and Peru to around 15% of the total pregnancy outcomes, it decreased in the African countries to less than 6%. CONCLUSIONS: Delayed sexual debut remains the major restraint on pregnancy in these four countries with the result that conception rates are very low. Condoms remain the most common method of contraception even in the two countries without severe HIV risks and efforts to displace condoms by nonbarrier methods should be pursued with caution.