US White and Black Women Do Not Represent the Bone Mineral Density of Sub-Saharan Black Women.

Reference populations from the United States (US) are often used around the world for representative measures of bone mineral density (BMD) by sex, age, and race. We examined BMD in adult black Zimbabwean women and compared it to that of US women (white and black). In a cross-sectional study, we recruited healthy black Zimbabwean women working at Parirenyatwa Hospital regardless of designation, who were not pregnant and had no diseases or medications known to affect BMD. Dual-energy X-ray absorptiometry scans of the left hip and lumbar spine (L1-L4) were performed for each participant by 1 operator, on 1 dual-energy X-ray absorptiometry machine. Results are presented for 289 participants aged 20-69 years, with a mean weight, height, and body mass index (BMI) of 71.7 ± 15.1 cm, 164.9 ± 6.3 kg, and 26.3 ± 5.3 kg/m(2), respectively. At 5% level of significance, age and BMD were weakly associated for the total lumbar spine (p ≤ 0.001) but not for the total hip (p = 0.890) and femur neck (p = 0.062). BMI and weight were positively correlated with BMD for all 3 sites (p ≤ 0.001). Compared to US white women, mean BMD for black Zimbabwean women in this study was 4.5%-7.4% lower for the lumbar spine but 2.0%-4.8% higher for the total hip and 0.2%-10.2% higher for the femur neck for 20-59 years. Compared to US black women, mean BMD for black Zimbabwean women was 9.1%-11.5% lower for the lumbar spine and 1.4%-8.1% lower for the total hip for 20-59 years. Black Zimbabwean women also had lower mean weight and BMI per decade age group as compared to US women. Differences in weight and BMI offer a possible explanation for the differences in BMD between black Zimbabwean women and US white and black women. Including adjustments for body frame when calculating Z-scores may accurately reflect BMD.

An audit of Zimbabwean public sector diagnostic ultrasound services.

INTRODUCTION: the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. METHODS: utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. RESULTS: of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. CONCLUSION: in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.

An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity.

INTRODUCTION: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. METHODS: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. RESULTS: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. CONCLUSION: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.