Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study.

BACKGROUND: Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe. METHODS: This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom's cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05. RESULTS: This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50-56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1-2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1-0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05). CONCLUSION: This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.

Health professions faculty's perceptions of online teaching and learning during the COVID-19 pandemic.

The global societal impact of the COVID-19 pandemic is incalculable with profound social suffering, deep economic hardships and enforced closure of schools, businesses, and higher learning institutions through the imposition of lockdown and social distancing in mitigation of the spread of the SARS-Cov-2 infection. Institutions have had to hastily migrate teaching, learning and assessment to online domains, at times with ill-prepared academics, students and institutions and with unwelcome and disorienting consequences. Our study surveyed perspectives of faculty at the University of Zimbabwe Faculty of Medicine and Health Sciences (UZFMHS) towards the hastily adopted online teaching, learning and assessment implemented in response to the mitigation of the COVID-19 pandemic. Twenty nine (29) faculty in all the major disciplines and career hierarchy. There were mixed responses regarding the use of this modality for teaching, learning and assessment: training before online teaching, learning and assessment, advantages and disadvantages, cost effectiveness, effectiveness for teaching, learning and assessment, effect on student feedback, disruptions from internet connectivity issues, interaction with students, suitability for practical training, and barriers to online teaching, learning and assessment. These results would enable the UZFMHS develop institutional and personalised approaches that would enable execution of online teaching, learning and assessment under the current and post COVID-19 pandemic.

Needs assessment of diabetic foot services in Zimbabwe.

INTRODUCTION: Due to the increasing incidence of diabetes in Zimbabwe, complications such as diabetic foot (DF) are anticipated. Establishing local gaps and needs in DF healthcare is paramount for tailoring management strategies. AIMS: To determine the status of DF services in the healthcare system and explore awareness of DF management and practices among registered general nurses (RGNs) in Zimbabwe. METHODS: A mixed-methods approach was applied. Thirty-one RGNs from 16 public health facilities in Harare, Zimbabwe attending a DF workshop were administered with a cross-sectional survey instrument and a semi-structured questionnaire. Data collected included presence/absence of DF services and podiatrists in healthcare facilities, healthcare system approaches in DF care and availability of DF training/education programs for RGNs. Analysis was performed using Stata and Nvivo software. RESULTS: No respondents reported availability of podiatrists. Only 1 (3%) of RGNs reported DF screening in primary care. Sixty percent (18) did not know or had never screened for DF. The RGNs reported inadequate DF educational programs/modules in primary care settings. CONCLUSION: This data highlights a need to improve DF education for RGNs at the frontline of managing PLWD. Understanding the needs for DF services may guide interventions to improve education and awareness programs that are appropriately tailored to local constraints in the health system. The non-communicable diseases director is encouraged to develop DF educational programmes for frontline health care workers.

Intersection of HIV and Anemia in women of reproductive age: a 10-year analysis of three Zimbabwe demographic health surveys, 2005-2015.

BACKGROUND: Women of reproductive age 15-49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015. METHODS: DHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia. RESULTS: Prevalence (95% confidence interval (CI)) of anemia was 37.8(35.9-39.7), 28.2(26.9-29.5), 27.8(26.5-29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7-9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03-2.74), 2010: 2.35(1.99-2.77), and 2015: 2.48(2.18-2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08-1.65), 2010: 1.26(1.03-1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16-1.47), 2010: 1.23(1.09-1.34)]; not taking iron supplementation [2005: 1.17(1.03-1.33), 2010: 1.23(1.09-1.40), and2015: 1.24(1.08-1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden. CONCLUSION: The prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women's health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.

The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study.

BACKGROUND: Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. METHODS: A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. RESULTS: Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2-4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was 'unexplained' in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. CONCLUSION: Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.

Investigations and treatment offered to women presenting for infertility care in Harare, Zimbabwe: a cross sectional study.

INTRODUCTION: clinical infertility is failure to conceive within a year of regular sexual intercourse by a non contracepting couple. Infertility care is costly and result in investigations being incomplete and inconclusive. It is therefore important to streamline investigations offered to infertile couples such that only the most cost effective tests are done. This paper explores the adequacy of investigations and treatments offered to women presenting for infertility care. METHODS: the data used in this analysis was obtained from a cross sectional sample of 216 women who presented with infertility in public and private gynaecological clinics in Harare, Zimbabwe. Information on investigations and treatment offered to women presenting for care was extracted from hospital cards, case notes, laboratory and radiological reports. Data was analysed using STATA SE/15. RESULTS: of the 178 (82.4%) who had ultrasound scan evaluation (USS) 50 (28.1%) had fibroids and 22 (12.4%) had polycystic ovaries. Tubal patency tests were done in 118 participants using (hystero-salpingogram) HSG alone in 62.7%, laparoscope and dye alone in 21.2% and both in 16.1% of them. Of the 97 (44.9%) men who had semen analysis 61 (62.9%) had abnormal parameters. CONCLUSION: this study reveals that evaluation for tubal patency and USS to rule out reproductive organ pathology are not being offered to all women with a diagnosis of infertility. Likewise, male partner semen evaluation is not being done in all male partners. There is a high prevalence of abnormal semen parameters. Studies should be done to understand why some male partners are not forthcoming in providing semen for analysis. It is important for protocols to be produced by professional bodies which prescribe the minimum basic investigations in couples with infertility.

Oral rehydration solution coverage in under 5 children with diarrhea: a tri-country, subnational, cross-sectional comparative analysis of two demographic health surveys cycles.

BACKGROUND: More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals. METHODS: The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007-2010 (1st Period), and 2013-2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage. RESULTS: Crude ORS coverage increased from 21.0% (95% CI: 17.4-24.9) in 1st Period to 40.5% (36.5-44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1-65.3) to 64.7% (61.8-67.5) in Zambia; and decreased from 72.3% (68.4-75.9) to 64.6% (60.9-68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from - 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from - 16.5% in the Northern Province to - 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66-5.86) for Zimbabwe, 2.83 (2.35-3.40) for Zambia, and, 0.71(0.59-0.87) for Malawi. CONCLUSION: ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society (GILES) initiative.

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprising urban, peri-urban and rural areas. Emerging findings indicates a need for updating guidelines and policies for addressing ELSI in biobanking and genomics research in Zimbabwe. Emerging terminologies such as biobanking and genomics lack clarity suggesting a need for increased awareness and educational tools for health professionals, research scientists and community members. Common concerns relating to consent processes, sample and data use and sharing, particularly where there is trans-national flow of biospecimens and data, call for nationally tailored ELSI frameworks aligned to regional and international initiatives. This paper describes the strategy undertaken for the development and implementation of the GILES project and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa. Conducting this explorative study among a wide range of stakeholders over a countrywide geographical regions, established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa.

Evaluation of transcutaneous bilirubinometer (DRAEGER JM 103) use in Zimbabwean newborn babies.

BACKGROUND: Acute Bilirubin Encephalopathy in the neonatal period is a major cause of permanent disability. Effective screening and surveillance are essential in the newborn period to enable timely management. Noninvasive transcutaneous bilirubin devices have been successfully used for screening in many settings. We evaluated the accuracy of the Draeger JM 103 (Medical Systems, USA) for estimating serum bilirubin in Zimbabwean newborns. METHODS: Paired transcutaneous (forehead and sternum) and serum bilirubin measurements were compared on 283 infants consecutively recruited between 01 August and 30 November 2015 at Harare Hospital Neonatal Unit. Using serum bilirubin as gold standard, Pearson Correlation Coefficient (r) was calculated for the two transcutaneous measurement sites. Linear regression plots of transcutaneous versus serum estimates were performed. Comparison was made between preterm and term babies. Specificity, sensitivity, positive predictive value and negative predictive value of the JM103 were calculated including ROC curves to assess the accuracy of the diagnostic tests. RESULTS: Fifty-five percent of the babies were male. Median gestational age was 38 weeks (range 28-42). One hundred and fifteen (41%) were preterm. Median postnatal age was 3 days (range 0-10). Serum bilirubin ranged 85-408 µmol/l, transcutaneous bilirubin sternum; 170-544 µmol/l and forehead; 119-510 µmol/l. Correlation between serum and transcutaneous bilirubin (sternum) was 0.77 and between serum and transcutaneous (forehead) was 0.72. Preterm babies correlation for sternum was 0.77 and forehead was 0.75. Term babies correlation for sternum was 0.76 and forehead was 0.70. The sensitivity for the sternum site was 76%, specificity 90%, Positive Predictive Value of 70 and Negative Predictive Value 92. Sensitivity for forehead site was 62%, specificity 95% with a Positive Predictive Value of 80 and Negative Predictive Value of 90. Bland-Altman plot of serum versus transcutaneous measurements showed agreement between the tests. The ROC curves showed that the accuracy of the two diagnostic tests were good with no significant difference between the two, p = 0.2954. CONCLUSION: The study demonstrated a strong positive correlation for both sternum and forehead sites with serum bilirubin in this Zimbabwean population of African origin. However, the sternum is a better site for identifying babies with jaundice compared to forehead. The Draeger JM-103 can be used to screening for neonatal jaundice in this population.

Factors associated with hospital arrival time after the onset of stroke symptoms: A cross-sectional study at two teaching hospitals in Harare, Zimbabwe.

BACKGROUND: Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. METHODS: A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. RESULTS: Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05-21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78-5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71-7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15-1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18-1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08-2.72); p=0.389). CONCLUSIONS: Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.

Clinical characteristics and outcomes of patients with stroke admitted to three tertiary hospitals in Zimbabwe: A retrospective one-year study.

BACKGROUND: Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date. METHODS: A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside with comorbidities and outcomes. Scoping over a period of one year using records of patients admitted for stroke helped to quantify and qualify the stroke problem. Descriptive analysis was done using STATA version 13.0. RESULTS: A total of 450 stroke cases, (63% women) were included in the final analysis. The proportion of stroke cases among the admissions was 0.61%. Mean age of the stroke patients was 61.6±16.8 years (95% CI=60.1; 63.2). Risk factors were hypertension (58.5%), diabetes (18%) and HIV, (14%)). Diagnosis was clinical and 39.4% had a CT scan. Mean length of hospital stay was 8.1±5.6 days with a significance difference noted among hospitals (p<0.001). In-hospital mortality was 24.9%, 95% CI (20.9; 29.0%). Mortality was associated with place of admission (p<0.001). Gender and side of stroke were significantly associated (p<0.001). CONCLUSIONS: The sociodemographic characteristics mirrored findings from elsewhere. Mean age was higher than reported for Zimbabwe in the nineties and lately for Malawi. Majority of patients were female, elderly and hypertensive in line with findings from other countries. Presence of HIV is supported by recent studies from Malawi and South Africa. The relationship between gender and side affected needs further research. There is need to standardise acute care through proper diagnosis to reduce mortality. There is need to support caregivers post-discharge. Data-handling is poor and there is limited capacity for Sub Saharan Africa hospitals to provide optimal stroke care. This may have long term implications on the outcome of survivors and caregivers. There is need of vigilance in acute stroke care.

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study.

BACKGROUND: The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors. METHODS: A retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present. RESULTS: Out of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%. CONCLUSION: PPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

Prevalence of and Factors Associated with Nephropathy in Diabetic Patients Attending an Outpatient Clinic in Harare, Zimbabwe.

There is limited information on the burden of diabetic nephropathy in developing countries. This study aimed to determine the prevalence of and factors associated with nephropathy among diabetic patients attending an outpatient clinic in Harare, Zimbabwe. In an analytical cross-sectional study, diabetic patients were consecutively enrolled and a questionnaire administered, clinical assessment conducted, and blood samples collected for human immunodeficiency virus testing and measurement of lipids, creatinine, fructosamine, and glycosylated hemoglobin levels. Urine samples were collected for determination of albumin and creatinine levels, which were used to categorize albuminuria. A total of 344 diabetic patients were enrolled. Overall, just over a third (35.8%) of patients had moderately increased albuminuria and 9.0% had severely increased albuminuria giving an overall prevalence of nephropathy of 44.8%. Prevalence of moderately increased albuminuria was slightly higher (36.5% versus 33.3%) and severely increased albuminuria slightly lower (8.8% versus 9.5%) in type 2 than type 1 diabetes patients, but the difference was not statistically significant (P = 0.866). Higher fructosamine and retinopathy were associated with nephropathy in both univariate and multivariate analysis {higher fructosamine (odds ratio [OR] = 1.00, confidence interval [CI] = 1.00-1.01), and retinopathy (OR = 2.80, CI = 1.64-4.97)}. We report a higher prevalence of moderately increased albuminuria and a lower prevalence of severely increased albuminuria compared with findings reported a decade ago among type 1 and type 2 diabetes mellitus patients attending the same clinic. High fructosamine and retinopathy were independent predictors of nephropathy.

Hypoalbuminaemia in haemodialysis patients at Parirenyatwa group of hospitals and Chitungwiza central hospital.

INTRODUCTION: Haemodialysis is one of the widely used methods in end stage renal disease. However it has a negative impact on the quality of life of the renal patients. Hypoalbuminaemia occur in haemodialysis patients and it correlates strongly with mortality and morbidity. We sought out to determine the prevalence of hypoalbuminaemia among haemodialysis patients at Parirenyatwa group of hospitals and Chitungwiza central hospital. METHODS: A questionnaire was administered on haemodialysis patients at Parirenyatwa Group of Hospitals and Chitungwiza Central Hospital who consented to participate in the study. Pre dialysis serum samples collected from the patients were used for albumin analysis. The serum from the patients was analysed for serum albumin levels using the Mindray BS120 chemistry analyser using the bromocresol green method. RESULTS: A total of 60 patients were recruited from the two hospitals. The Mean albumin concentration for the entire group was 33.6g/L SD (6.1 g/L). The mean albumin in males was 33.6 g/L, SD (5.9) and in female 33.6, SD (6.6 g/L) and this was not statistically significantly different (p = 0.988). The prevalence of hypoalbuminaemia was 76.7%. CONCLUSION: Hypoalbuminaemia in 76.7% of haemodialysis patients studied is a cause of concern thus monitoring of haemodialysis patients albumin is necessary since its decreased levels has been associated with increased morbidity and mortality.

PIMA Point of Care CD4+ Cell Count Machines in Remote MNCH Settings: Lessons Learned from Seven Districts in Zimbabwe.

An evaluation was commissioned to generate evidence on the impact of PIMA point-of-care CD4+ count machines in maternal and new-born child health settings in Zimbabwe; document best practices, lessons learned, challenges, and recommendations related to scale up of this new technology. A mixed methodology approach that included 31 in-depth interviews with stakeholders involved in procurement, distribution, and use of the POC machines was employed. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4+ count machines and 10 other comparative sites without the machine. A clearer training strategy was found to be necessary. The average time taken to initiate clients on antiretroviral treatment (ART) was substantially less, 15 days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. There was general satisfaction because of the presence of the PIMA POC CD4+ count machine at sites that also initiated ART.

Clinical predictors of low CD4 count among HIV infected pulmonary tuberculosis clients: a health facility-based survey.

OBJECTIVES: The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/microl) in HIV-infected patients with pulmonary tuberculosis (PTB). DESIGN AND SETTING: A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe. PARTICIPANTS: Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART. INTERVENTIONS: Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done. RESULTS: Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/microl (intraquartile range (IQR) 41-213 cells/microl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03-0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells /microl: BMI<18 kg/m2 (OR 3.8; CI 1.2-12), KPS<54.4 (OR 3; CI 1.1-12) and haemoglobin concentration<8 g/dl (OR 13; CI 1.8 - 533). CONCLUSIONS: HIV-infected sputum-positive PTB patients presenting with a BMI<18, KPS<54.4% and haemoglobin concentration<8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.