Antenatal depression: an examination of prevalence and its associated factors among pregnant women attending Harare polyclinics.

BACKGROUND: Antenatal depression is the most prevalent common mental health disorder affecting pregnant women. Here, we report the prevalence of and associated factors for antenatal depression among pregnant women attending antenatal care services in Harare, Zimbabwe. METHODS: From January-April 2018, 375 pregnant women, aged 16-46 years, residing mostly in Harare's high-density suburbs were recruited from two randomly-selected polyclinics. Antenatal depression was measured using the Structured Clinical Interview for DSM-IV. Sociodemographic data including; maternal age, education, marital status, economic status, obstetric history and experiences with violence were also collected. Chi-square tests and multivariate logistic regression analysis were used to determine the association between antenatal depression and participants' characteristics. RESULTS: The prevalence of antenatal depression was 23.47% (95% CI: 19.27-28.09). Multivariate logistic regression analysis revealed intimate partner violence (IPV) [OR 2.45 (95% CI: 1.47-4.19)] and experiencing negative life events [OR 2.02 (95% CI: 1.19-3.42)] as risk factors for antenatal depression, with being married/cohabiting [OR 0.45 (95% CI: 0.25-0.80)] being a protective factor. CONCLUSION: The prevalence of antenatal depression is high with associated factors being interpersonal. Context-specific interventions are therefore needed to address the complexity of the factors associated with antenatal depression.

Human papillomavirus genotype distribution in genital warts among women in Harare-Zimbabwe.

This study aimed to determine the prevalence of HPV genotypes in genital warts among women in Harare, Zimbabwe. Women aged 18-45 years attending gynaecology and genitourinary clinics with a clinical diagnosis of genital-warts were recruited. HPV-DNA was extracted from tissue biopsies. HPV-DNA testing and typing was done by Southern Dot Blot Hybridisation. A hundred samples from 100 women were analysed. Median age of participants was 30.3 years (range 18-45 years). Seventy-eight percent of participants were HIV infected. HPV prevalence was 98%. Low risk genotypes predominated at 86% prevalence. The most prevalent genotypes were 11 (47%), 6 (42%) and 16 (14%). This is the first study on HPV genotype distribution among women with genital warts in Zimbabwe. The high prevalence of HR-HPV 16 in clinically benign lesions shows that warts should have histological analysis to exclude pre-malignancy and malignancy.Impact statementWhat is already known on this subject? Genital warts (GWs), also known as condylomata acuminata (EAC), are a clinical manifestation of persistent infection with 'low risk' or non-oncogenic HPV genotypes. HPV 6 and 11 are examples of low risk genotypes, and both are associated with 90% of GWs. Data on HPV genotypes causing genital warts in the population under study are scarce.What do the results of this study add? A high prevalence (98%) of HPV DNA in genital warts, confirms that the biopsied lesions were HPV related. Over and above the high prevalence of low risk HPV 11 (47%) and HPV 6 (42%), the women had 14% prevalence of HPV 16, an oncogenic genotype, in genital warts. Seventy-eight percent of the participants were HIV infected. The HIV infected women had a 33.3% prevalence of HR-HPV as compared to the 15.8% prevalence in the HIV uninfected women.What are the implications of these findings for clinical practice and/or further research? The population under study will benefit more if an HPV vaccine that includes anti-HPV 6 and 11 is used. The high prevalence of the HR-HPV in apparently benign lesions shows that warts should have histological analysis to exclude vulvar cancer and vulvar intraepithelial neoplasia. All women presenting with genital warts should be offered an HIV test.

Gastrointestinal adenocarcinoma metastasizing to the vulva: a case report.

BACKGROUND: Metastatic vulval adenocarcinoma is a rare occurrence with only a few cases reported to date. They can arise from the breast, gastrointestinal system, or endometrium. CASE PRESENTATION: We present the case of a 55-year-old Black African woman who presented with vulval itching which progressed to warty lesions. Histology revealed a vulval adenocarcinoma which immunohistochemistry suggested was of gastrointestinal origin. Colonoscopy later confirmed an anorectal tumor as the primary site. Despite extensive chest metastases she looked surprisingly well and had no pulmonary symptoms. The major source of symptomatic distress was the itchy extensive warty lesions on her vulva. She has since had a vulvectomy which gave her significant symptomatic relief. CONCLUSIONS: This case was interesting as vulval adenocarcinoma is a rare histological diagnosis found in less than 10% of vulval cancers. Primary vulval adenocarcinoma is rare with most of these cancers being secondary metastases from a distant site. Her symptoms were predominantly vulval with no chest symptoms even though she had extensive pulmonary metastases. She has been clinically well except for the itching suggesting an indolent course.

A cluster randomized controlled trial of the non-pneumatic anti-shock garment for obstetric haemorrhage: sub-analysis of the Zimbabwean Arm.

Objectives: To determine whether earlier application of the Non-pneumatic Anti-Shock Garment (NASG) at clinic level compared to the referral hospital level reduces maternal morbidity and mortality and recovery time from shock due to severe Obstetric Haemorrhage (OH) and to determine the safety of the NASG when applied at clinic level. Design: A cluster Randomized Controlled Trial (RCT) Setting: Harare and Parirenyatwa Referral Hospitals (RH) in Harare and the twelve Harare City Council clinics that offer maternity care. Subjects: Women who had suffered severe OH at clinic level and were being transferred to a Referral Hospital (RH). Iterventions: The clinics were randomized into two groups. In the early NASG group eligible women were given the standard management for OH and had the NASG applied at the clinic level before transport to RH. In the control group, eligible women were given the standard management for OH at the clinic level, transferred to the RH, and received the NASG at the RH. All women received equivalent OH/hypovolemic shock management at the RH. Main Outcome Measures: The main outcome measures were maternal mortality and morbidity, blood loss, recovery from shock and the occurrence of side effects whilst in the NASG. Results: There were few maternal deaths and morbidities, and no statistically significant differences between the two groups were noted. Women in the early NASG group spent a statistically significant shorter time in the NASG at referral hospital level (OR 0.64, 95% CI 0.52 - 0.79, p < 0.001) and had a non-significant 40% faster recovery from shock (HR 1.39; 95% CI 0.98-1.97, p=0.07). There were no differences in reported side effects. Conclusion: Earlier NASG application at the clinic level was associated with faster recovery from shock in women who had suffered severe OH and appears safe to use.

Acute postpartum uterine inversion: a case report.

The case described is that of an African 24 year old and Para 2. She had a normal vaginal delivery at a local clinic and sustained an acute uterine inversion and postpartum haemorrhage. Resuscitative measures were done and she was referred to the central hospital. At the central hospital and under general anaesthesia attempts to manually replace the uterus were unsuccessful. The uterine inversion was successfully corrected at laparotomy after which an area of gangrene and perforation was noted on the uterine fundus. A decision to perform total abdominal hysterectomy was taken. The patient had an uneventful post-operative recovery. A discussion of acute postpartum uterine inversion is presented.

An assessment of the maternal death notification system in Zimbabwe--2006.

OBJECTIVE: To determine the completeness and usefulness of the maternal death notification system in Zimbabwe for the year 2006. METHODS: As part of the Zimbabwe Maternal and Perinatal Mortality Survey (ZMPMS) maternal death notification forms lodged at the national and provincial levels were collected and analyzed. Data was entered into Stata version 6. The forms were also given to two clinician reviewers who assessed the quality of the information on the forms. RESULTS: A total of 364 forms were found at the provincial level. Of these, 56% had had copies forwarded to national level. Information on antenatal booking status was available on 84% of the forms. The forms had been completed by ten different grades of health worker and cause of death was entered on 80% of the forms. Information on whether the death had been potentially avoidable was entered on 68% of the forms. Five different versions of the maternal death notification form were found in the field and a significant proportion of the forms were missing important demographic variables. CONCLUSION: The maternal death notification system for Zimbabwe was found to be incomplete and not standardized.

Heterotopic pregnancy a case report.

A 27 year old patient was admitted with heterotopic pregnancy. Ultrasound scan done by her general practitioner had shown a 14 week viable intra-uterine pregnancy and fluid in the paracolic gutters. An exploratory laparatomy was done and she was found to have a ruptured right-sided ectopic pregnancy. Right partial salpingectomy was done. She had an uneventful post operative course. Ultrasound scan done at 18 weeks showed that the foetus was growing well.

Best practices for post natal care in Zimbabwe.

The purpose of post natal care for the mother is to avert or alleviate significant mortality and morbidity. During the immediate post partum period, the emphasis will be on monitoring to detect complications and assisting the mother to initiate care of the newborn, especially breastfeeding. In the latter post partum period, the aim is to confirm involution and healing of the genital tract, confirm continued good newborn care by the mother and offer protection against pregnancy to the couple.

Best practices for antenatal care in Zimbabwe.

Evidence based recommendations, taken from systematic reviews of available literature form the basis for best practices. The manpower and resources available at health institutions in Zimbabwe have been taken into account in developing these antenatal protocols. Good quality is achieved when all the six visits are undertaken at the recommended times, and the activities are carried out competently by providers displaying a good attitude towards the patients. The providers should assess the quality of antenatal care periodically using indicators of access and the correct performance of procedures.

Acceptance of HIV screening in an antenatal population at a referral teaching hospital in Zimbabwe: a substudy of an operational research in prevention of mother to child HIV vertical transmission.

OBJECTIVE: To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at a tertiary training hospital. Women who accepted testing and were positive received nevirapine. Their babies also received nevirapine within 72 hours of birth. Doctors, nurses and pharmacists were equipped with counselling and management skills for prevention of mother to child HIV vertical transmission. DESIGN: Substudy of a prospective operational research. SETTING: Harare Central Hospital, antenatal clinic. SUBJECT: 863 women were given lectures in a group followed by individualised pre and post test HIV counselling; 767 accepted testing for HIV. MAIN OUTCOME MEASURES: Acceptance rates for HIV testing, number of mothers and babies who received nevirapine as well as the characteristics of HIV positive and negative women were analysed. RESULTS: 89% of the women accepted HIV testing; 44% were positive. Seventy percent of the women who tested positive and their babies received nevirapine. CONCLUSION: Acceptance rates increased when lectures were given to a group of pregnant women followed by individualised pre and post test counselling. The support and encouragement that the women gave each other may explain this observation. Nevirapine should be issued to pregnant women at the time that the HIV test results are available irrespective of the age of gestation, with instructions to take the drug at the onset of labour at their place of delivery. This practice will increase the uptake of the drug by pregnant women. Medical students, nursing and pharmacy students should be equipped with skills for initiating and managing a mother to child HIV prevention programme during their training followed by refresher courses after graduating.

Best practices for intrapartum care in Zimbabwean health facilities.

Evidence-based interventions to ensure a good outcome during childbirth are widely available. Their applicability in various settings depends on local conditions and the resources available. Best practices during normal labour and delivery are described for Zimbabwean health facilities. Practices that have proved value are encouraged and those without benefit are discouraged.

How are condoms used in a family planning setting: evidence from Zimbabwe.

OBJECTIVES: (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.) DESIGN: A prospective cross sectional study. SETTING: The study was carried out at three Zimbabwe National Family Planning Council clinics. SUBJECTS: We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire. MAIN OUTCOME MEASURES: The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/HIV prevention. We measured self-reported condom use during the last 30 days prior to each interview. RESULTS: The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use. CONCLUSIONS: The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use.

Prophylactic augmentin in prelabor preterm rupture of the membranes.

OBJECTIVE: To determine whether the use of prophylactic Augmentin in PPROM prolongs gestation and reduces neonatal and maternal morbidity due to sepsis. METHOD: Study setting was Harare Maternity Hospital, Zimbabwe. Women with PPROM between 26 and 36 weeks' gestation were randomly allocated either to a group given a course of prophylactic oral Augmentin or another receiving no prophylactic antibiotic treatment. The calculated sample size was 72 women per group. Data were analyzed using the EPI INFO program. RESULTS: A total of 171 women were recruited into the study, 84 in the Augmentin group and 87 in the No Treatment group. The group receiving prophylactic Augmentin had a significantly longer latency period between rupture of membranes and delivery. There was a trend towards increased neonatal and maternal morbidity due to sepsis in the No Treatment group although no statistical significance was reached. CONCLUSION: The use of prophylactic Augmentin in PPROM significantly prolongs gestation. It appears to decrease neonatal and maternal morbidity due to sepsis.