24 hour movement behaviours and the health and development of pre-school children from Zimbabwean settings: the SUNRISE pilot study.

Background: In 2019, the World Health Organization (WHO) released global guidelines for physical activity, sedentary behaviour and sleep for the early years. The International Study of Movement Behaviours in the Early Years, SUNRISE, aimed to assess the extent to which children aged three and four years meet the WHO global guidelines and its association with health and development. Objectives: To assess movement behaviours in pre-school children from low-income settings in Zimbabwe and to establish associations between these movement behaviours and adiposity, motor skills and executive function. Methods: Pre-school children/caregivers were recruited from two urban and two rural public schools respectively in Zimbabwe. The caregivers answered questions on the children's physical activity, screen time, sedentary behaviour and sleep patterns. Children's movement behaviours were objectively measured using accelerometers. Gross and fine motor skills and executive function were assessed using the Ages and Stages Questionnaire-3 and Early Years Toolbox, respectively. Focus group discussions were carried out with caregivers and teachers on the acceptability and feasibility of the study. Results: Eighty-one children participated in the study. The proportions of children meeting the guidelines were physical activity 92%, sedentary behaviour 70%, and sleep 86%, and all guidelines combined 24%. Boys and girls were similar (p>0.05 for all variables) for all executive function variables, but rural children had significantly lower inhibition scores (p=0.026) than urban children. Conclusion: The study adds to the growing literature on movement behaviours and associated risk factors in low-resourced settings. Further investigations of movement behaviours in this age group in Zimbabwe are recommended.

Factors contributing to defaulting scheduled therapy sessions by caregivers of children with congenital disabilities.

BACKGROUND: Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers' defaulting scheduled rehabilitation therapy sessions. METHODS: A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13. RESULTS: Factors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors(58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important. CONCLUSIONS: A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.

Occupational therapy needs of adolescents and young adults with cerebral palsy in Zimbabwe: caregivers' perspectives.

Objectives: To determine occupational therapy needs of adolescents and young adults with cerebral palsy living in an urban setting, to identify participation levels in activities of daily living and social activities, to identify factors influencing participation and to determine the contribution of occupational therapy in participating in these activities. Design: Descriptive cross-sectional. Setting: Community rehabilitation outreach points in Epworth, Mufakose, Glenview, Dzivarasekwa, Mabvuku and Norton. Participants: Thirty-five randomly selected primary caregivers of adolescents and young adults with cerebral palsy. Data analysis: Data collected on the questionnaires was analysed using SPSS/16.0 for frequencies and means. Results: Fourteen (41%) of the adolescents and young adults were independent in self-care activities such as toileting, grooming, dressing, mobility and bathing. Twenty-one (59%) were totally dependent or needed some assistance in performing activities of daily living. Factors reported to influence participation included upper and lower limb contractures, transport challenges, financial constraints and the home environment. Occupational therapy needs of adolescents and young adults as reported by their caregivers included further training in activities of daily living (74%), home adaptations (66%), vocational skills training (20%) and provision of appropriate assistive devices (6%). Conclusion: In light of these findings performance areas that still needed occupational therapy interventions included activities of daily living, vocational skills training, use of assistive devices and home adaptations. Therefore adolescents and young adults with cerebral palsy living in Zimbabwe still have functional performance deficits that can be addressed by provision of follow-up community occupational therapy interventions.

Prevalence and the correlates of postnatal depression in an urban high density suburb of Harare.

Introduction: Postnatal depression is a common cause of morbidity but is rarely diagnosed or managed in busy primary care settings in most resource limited countries like Zimbabwe. Objectives: This study sought to determine the prevalence of postnatal depression and establish factors associated with postnatal depression. Methods: The study utilized a cross-sectional descriptive design where 295 consenting women (mean age=25.4 years; SD= 5.6 years) attending post natal care services at Mbare Polyclinic were recruited. Data were collected using the validated Shona version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Associations between variables were computed using the chi-square test statistic and where appropriate the Fisher's exact statistic. Results: Prevalence for postnatal depression was 34.2% among women in the study. Univariate analysis revealed that there were no statistically significant associations between mother's age (p=0.120), parity (p=0.396), marital status (p=0.523), level of education (p=0.805), and age of child (p=0.489) and postnatal depression. Conclusion: Findings from this study indicate that there is a high prevalence of postnatal depression in women in Mbare, Zimbabwe. This therefore calls for further studies to identify and address the causes of postnatal depression among women attending postnatal care in Zimbabwe.

Work related musculoskeletal disorders among farm workers: a case study of an agricultural college in Zimbabwe.

INTRODUCTION: Farming is a physically laborious occupation and farm workers are at risk of developing musculoskeletal complaints. OBJECTIVE: To determine the work related musculoskeletal complaints among farm workers at an agricultural college in Zimbabwe. METHODS: A descriptive cross-sectional study was conducted using a sample size of 30 farm workers. Convenience sampling was used to select participants. Interviewer-administered questionnaires were used to assess the occupational hazards and the occurrence of musculoskeletal symptoms among farm workers. STATA version 13 was used for data analysis. Fishers' exact test was used to determine associations between agricultural activities and reported occurrence of musculoskeletal complaints. RESULTS: The lower back was the most frequently affected body site. Commonly performed activities included working prolonged periods in the same posture and working prolonged periods squatting or kneeling. There were significant associations between performing overhead activities (p = 0.029), working with the back bent (p = 0.007) and pushing or pulling heavy objects (p=0.014) with the occurrence of musculoskeletal complaints. CONCLUSION: Farm workers at Chibero College of Agriculture are exposed to a variety of occupational hazards, therefore a need for intervention to protect them from musculoskeletal complaints. Improvement in farm work practices through ergonomic training might help reduce musculoskeletal complaints.

Application of the International Classification of Functioning, Disability and Health (ICF) framework in record keeping by occupational therapists and physiotherapists at central hospitals in Harare.

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) is a framework that provides a detailed outline of the information that should be included in patient records. Whilst the World Federation of occupational therapists and the World Confederation of Physiotherapists have recommended use of this framework in clinical practice, the extent to which Zimbabwean therapists are applying this framework in patients' assessment and treatment is unknown. OBJECTIVE: This study was conducted to determine the extent to which the ICF framework is being applied in recording information on patient assessment and treatment by occupational therapists and physiotherapists in Zimbabwe. METHODS: A descriptive cross sectional study was carried out in rehabilitation departments at three central hospitals in Harare. Thirty therapists were interviewed on their record keeping practices. Sixty randomly selected records for in-patients receiving rehabilitation services were also evaluated for completeness using a checklist developed using ICF guidelines. Data were analysed using Microsoft excel and Epi info. RESULTS: Forty-three percent (12) of the records were rated as good and another (43%) as satisfactory. None of the records reviewed were 100% complete according to the ICF guidelines. Personal factors were the most recorded (82%) component and the least recorded were environmental factors (18%) affecting patient functioning. There were no statistically significant associations between application of the ICF framework and profession (p = 0.680), ICF application and years in clinical practice (p = 0.557) and training and record keeping practices (p = 1.000). CONCLUSION: Standard guidelines for evaluating patients with different conditions derived from the ICF checklist should be designed for occupational therapists and physiotherapists to standardise information recorded during management of patients seeking rehabilitation services.