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.

Knowledge, attitudes, and practices of cervical Cancer screening among HIV-positive and HIV-negative women participating in human papillomavirus screening in rural Zimbabwe.

BACKGROUND: Women in low- and middle-income countries are at the highest risk of cervical cancer yet have limited access to and participation in cervical cancer screening programs. Integrating self-collected, community-based screening offers a potential primary screening method in areas of limited resources. In this paper, we present a study evaluating knowledge, attitudes, and practices of cervical cancer and Human Papilloma Virus (HPV) in rural Zimbabwe. METHODS: We performed a community-based cross-sectional knowledge, attitudes and practices of HPV and cervical cancer study in rural Zimbabwe from January 2017-May 2017. Women were selected for the study via random number generation from complete lists of inhabitants in the study area if they satisfied the inclusion criteria (≥30-years-old, ≤65-years-old, not pregnant, intact uterus). If selected, they participated in a 19-question structured knowledge, attitudes and practices survey. The questionnaire included questions on demographics, education, knowledge of HPV, cervical cancer, and risk factors. Chi-squared tests were evaluated comparing knowledge, attitudes and practices relating to HPV and cervical cancer screening with actual infection with HPV. Women were also offered a voluntary HIV and self-collected HPV screening. RESULTS: Six hundred seventy-nine women were included in the knowledge, attitudes and practices survey. Most women (81%) had heard of cervical cancer while the majority had not heard of HPV (12%). The number of women that had been screened previously for cervical cancer was low (5%). There were no significant differences between and within groups regarding knowledge of cervical cancer and actual overall infection with HR-HPV, HPV 16, and HPV 18/45 test results. CONCLUSIONS: Most women in rural Zimbabwe have heard of cervical cancer, but the number that had been screened was low. Extending existing outreach services to include cervical cancer screening, potentially including HPV screening, should include cervical cancer/HPV education and screening triage. This approach would serve to bridge the gap between knowledge and screening availability to address some of the barriers to cervical cancer care still affecting women in many regions of the world.

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.

Tenofovir Gel for Prevention of Herpes Simplex Virus Type 2 Acquisition: Findings From the VOICE Trial.

BACKGROUND: Genital infection with herpes simplex virus type 2 (HSV-2) is common and increases risk of human immunodeficiency virus (HIV) transmission and acquisition. Pericoital use of tenofovir (TFV) gel provided protection from HSV-2 acquisition in the CAPRISA 004 study. METHODS: We measured estimate of effect of vaginal TFV 1% gel in preventing HSV-2 acquisition among women in VOICE, randomized, double-blinded, placebo-controlled trial assessing daily use of oral and vaginal TFV for HIV-1 preexposure prophylaxis. The TFV level in plasma at the first quarterly visit was used as a measure of gel use. RESULTS: Of 566 participants at risk for HSV-2 acquisition, 532 (94%) had first-quarter plasma TFV and end-of-study HSV-2 serologic data available. Over a follow-up period of 501 person-years, 92 incident cases of HSV-2 acquisition occurred: 77 were in women with no TFV detected in plasma, and 15 occurred in women with TFV detected in plasma (incidence, 20.6 cases/100 person-years [95% confidence interval [CI], 16.2-25.7] vs 11.9 cases/100 person-years [95% CI, 6.6-19.6], respectively). TFV detection in plasma was associated with a trend toward a reduced risk of HSV-2 seroconversion, with an unadjusted hazard ratio (HR) of 0.59 (95% CI, .34-1.02; P = .060) and a HR adjusted for site, age, having ≥2 male sex partners in the past 3 months, use of hormonal contraception, having anal sex in the past 3 months, and HIV status of 0.60 (95% CI, .33-1.08; P = .086). CONCLUSIONS: Detection of TFV in plasma among TFV gel users was associated with a trend toward a reduced risk of HSV-2 acquisition, after controlling for sexual behavior and HIV-1 acquisition.

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991-2010.

Incidence rates of different cancers have been calculated for the black population of Harare, Zimbabwe for a 20-year period (1991-2010) coinciding with continuing social and lifestyle changes, and the peak, and subsequent wane, of the HIV-AIDS epidemic. The overall risk of cancer increased during the period in both sexes, with rates of cervix and prostate cancers showing particularly dramatic increases (3.3% and 6.4% annually, respectively). By 2004, prostate cancer had become the most common cancer of men. The incidence of cancer of the esophagus, formerly the most common cancer of men, has remained relatively constant, whereas rates of breast and cervix cancers, the most common malignancies of women, have shown significant increases (4.9% and 3.3% annually, respectively). The incidence of Kaposi sarcoma increased to a maximum around 1998-2000 and then declined in all age groups, and in both sexes The incidence of squamous cell cancers of the conjunctiva is relatively high, with temporal trends similar to those of Kaposi sarcoma. Non-Hodgkin lymphoma, the fifth most common cancer of men and fourth of women, showed a steady increase in incidence throughout the period (6.7-6.9% annually), although rates in young adults (15-39) have decreased since 2001. Cancer control in Zimbabwe, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate), while the incidence of cancers associated with poverty and infection (liver, cervix and esophagus) shows little decline, and the residual burden of the AIDS-associated cancers remains significant.

Compliance and loss to follow up of HIV negative and positive mothers recruited from a PMTCT programme in Zimbabwe.

OBJECTIVE: To describe the methodological challenges of a nine months follow up study of mothers recruited from a national Prevention of Mother To Child Transmission (PMTCT) programme with regards to defaulters, drop outs and compliance. DESIGN: Nested case control study. SETTING: Three peri-urban clinics in Zimbabwe namely: Epworth, St Mary's, Seke North. METHOD: Pregnant women who enrolled at 36 weeks of gestation were recruited for a follow up of mother and child from delivery, six weeks, four and nine months post partum. Follow up trend of these women was compared between the HIV positive and negative mothers with regards to defaulting, drop outs, full and partial compliance. Statistical significance was computed using the Chi-square test. RESULTS: Of the enrolled 1050 pregnant women with a known HIV status (594 HIV negative and 456 HIV positive) 851 (457 HIV negative and 394 HIV positive) showed up at one or more visits scheduled up to nine months. The denominator was dropping at each point and time. The overall dropout rate was 19% without a significant difference between the HIV positive and negative women at delivery. At six weeks the drop out rate was 35 (7.7%) for the HIV positive versus 75 (12.9%) p=0.010 and at four months 12 (2.9%) versus 39 (7.7%) p=0.002 respectively. However, at nine months the drop out rate was not different (p=0.747). The defaulter rate was significantly different at every stage between the HIV positive and negative mothers from delivery to six weeks, becoming even more significant at the four and nine months visit (p=<0.001). The overall full compliance at nine months was 46.1% with a significant difference between the HIV positive (55.6%) versus (37.9%) for the HIV negative (p=<0.001). CONCLUSION: Drop out is highest among the HIV negative as opposed to the HIV positive with the peak period being at "six weeks". There is high defaulting among the HIV negative compared to the HIV positive with the peak being at "four months". The study has shown that the HIV negative women are more likely to drop out whereas the HIV positive were twice as likely to fully comply. It is surprising that the peak drop out period, "six weeks visit" is a cardinal existing national scheduled visit where both mother and baby undergo a full medical examination with the mother having a pap smear taken.

HIV and cancer of the cervix.

Cancer of the cervix is the second most common cause of cancer-related death in women worldwide, and in some low resource countries accounts for the highest cancer mortality in women. The highest burden of the HIV/AIDS epidemic is currently in sub-Saharan Africa, where more than half of the people infected are women who have no access to cervical cancer screening. The association between HIV and invasive cervical cancer is complex, with several studies now clearly demonstrating an increased risk of pre-invasive cervical lesions among HIV-infected women. However, there have not been significantly higher incidence rates of invasive cervical cancer associated with the HIV epidemic. The highest numbers of HIV-infected women are in poorly-resourced countries, where the natural progression of HIV disease in the absence of highly active antiretroviral treatment sometimes results in deaths from opportunistic infections before the onset of invasive cervical cancer. This chapter will discuss the association of HIV and cervical intraepithelial neoplasia, the treatment of pre-invasive lesions, and invasive cervical cancer in HIV-infected women. The role of screening and the impact of antiretroviral treatment on the progression of pre-invasive and invasive cancer will also be discussed.

Association of cervical SIL and HIV-1 infection among Zimbabwean women in an HIV/STI prevention study.

A cross-sectional study was conducted on women attending family planning clinics in Harare, Zimbabwe to determine the prevalence of cervical neoplasia among HIV-1 positive women relative to an HIV-1 negative control group. Five hundred and fifty four women were recruited and the prevalence of HIV-1 was 36.8%. Cervical cytology was abnormal in 25.6% of HIV-infected women compared to only 6.7% HIV-1 seronegative women. Cervical neoplasia was significantly associated with HIV infection (chi(2)=42.4, P<0.001). Cellular changes typical of HPV infection (koilocytocis) were recorded in 6.4% of HIV infected women compared with 1.7% of HIV-1-uninfected women (chi(2)=8.43, P=0.004). HIV-1-positive women had twice the risk of having abnormal cervical cells than HIV-negative women (relative risk 2.47, odds ratio 10.14, P<0.001). Therefore the introduction of national cervical screening programme in HIV-1 endemic countries like Zimbabwe where the highest burden of pre-malignant lesions is among HIV-1-infected women needs careful planning because these women have other competing health needs including high rates of opportunistic infections.

Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear.

OBJECTIVE: To test whether the performance of visual inspection using acetic acid (VIA) could be improved through adjunctive testing and to determine whether the combination of visual inspection of the cervix and HPV testing could prove useful for identifying those at highest risk of cervical precancer. METHODS: Between October 1995 and August 1997, 2199 women willing to be screened for cervical cancer in peri-urban clinics in Harare, Zimbabwe received VIA, Pap smear and HPV as screening tests. The presence or absence of (pre)cancer was confirmed via colposcopy with biopsy as indicated for >97% of all women. Computerized simulations of sequential testing scenarios provided estimates of the joint (net) test qualities of different paired combinations of the three tests and allowed for comparisons with the individual test qualities. RESULTS: Using HGSIL/CIN II-III as the reference threshold of disease, the net sensitivity and specificity of VIA and HPV when used sequentially were 63.6 and 81.9%, respectively, compared to 43.3 and 91%, respectively, when Pap smears were followed by HPV testing. VIA followed by the Pap smear yielded a net sensitivity of 37.5% and net specificity of 94.3%. CONCLUSIONS: For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.

Situational analysis for diagnosis and treatment of cervical cancer in mainland Tanzania.

OBJECTIVE: To determine factors influencing early diagnosis and treatment of cervical cancer in Tanzania women. DESIGN: A cross-sectional study. SETTING: Forty primary health care facilities, twenty district/regional and four referral (tertiary) hospitals in mainland Tanzania. RESULTS: The most basic equipment for cytology-based cervical cancer were available at all health care facilities. However, screening against cervical cancer was appallingly inadequate at all levels of health care delivery system. Apart from medical doctors at tertiary level, other medical personnel including nurses were poorly or hardly utilised for cervical cancer screening. Treatment facilities for pre-cancerous lesions in most district, regional and even tertiary hospitals were inadequate or non-existent despite being very simple, cheap and yet very effective. There was total lack of organised institutional or national policy guidelines on cervical cancer screening in Tanzania. CONCLUSION: There is an urgent need to introduce systematic screening against cervical cancer and treatment of precursor lesions at all levels of health care delivery system in Tanzania. A national policy guideline should be urgently drawn addressing specifically frequency of screening and at what age to start screening.

Management of the patient with an abnormal Papanicolaou smear.

The aim of this article is to outline management of a woman with an abnormal Papanicolaou smear. Current knowledge of progression cervical intra-epithelial neoplasm (CIN) and justification for treatment is discussed.

Cervical cancer screening in a rural population of Zimbabwe.

OBJECTIVE: To review cervical cancer screening since its introduction to a rural district hospital in Zimbabwe. DESIGN: Retrospective, descriptive. SETTING: Rural district hospital. SUBJECTS: Data from 419 cervical smears performed on women who had cervical cancer screening as part of a routine post partum visit from 1994 to 1996 was available for analysis. MAIN OUTCOME MEASURE: Rates of abnormal cervical smears. RESULTS: The majority of the patients were of age 20 to 29 years (47.2%) and of low gravidity (Zero to three children) 62.6%). A total of 173 slides (41.3%) were normal. Of the abnormal smears, 158 (37%) had inflammation, and 65 cases (15.5%) demonstrated abnormal cytology of which 50 (12%) were low grade squamous epithelial lesions (atypia/CINI), and the remaining 15 (3.6%) high grade squamous intra-epithelial lesions (CIN II/III and carcinoma in situ). CONCLUSION: There was a high frequency of abnormal smears at this rural district hospital. Furthermore, there were problems in sampling the population at highest risk, shortages of supplies, technical problems in sampling and interpretation, and difficulties in follow up of patients. These problems are discussed including the confounding effect of the Human Immunodeficiency Virus.

PIP: In Zimbabwe, where cervical cancer is the leading female malignancy, no systematic cervical screening program has been introduced. However, selective or opportunistic screening has been performed since the late 1980s at family planning clinics, various central and district government hospitals, and in private practice. The initial results of a cervical cancer screening program introduced in a district hospital (Salvation Army Howard Hospital) in the Chiweshe rural community in 1994 were investigated. The aim is for every mother to receive a Pap smear at her 6-week postpartum visit. By May 1996, a total of 419 Pap smears--representing less than 20% of the hospital's postnatal population--had been performed at this facility. If all postnatal visits included a Pap smear, there would have been 2500 screenings. 58.7% of smears were classified as inadequate, primarily because of the coexistence of sexually transmitted infections. A total of 173 slides (41.3%) were normal. Of the abnormal smears, 158 (37.7%) had inflammation. Abnormal cytology was reported in 65 cases (15.5%); 15 of these cases (3.6%) were high-grade squamous intraepithelial lesions. Factors contributing to the low number of Pap smears actually performed included a high default rate for the postpartum visit, shortages of test-related supplies, and the rapid turnover of trained staff. Cervical cancer screening efforts in Zimbabwe require physical resources to perform smears, well-trained personnel, transport and laboratory services, and adequate patient follow up and treatment. Finally, since cervical cancer primarily affects older women, young women of reproductive age may not be the most appropriate target population for screening efforts.

Screening for cervical cancer: experience from the Colposcopy Clinic at Harare Hospital.

A study was carried out to determine the prevalence of cervical intra-epithelial neoplasia (CIN) among women referred to Harare Hospital Colposcopy Clinic with a history of an abnormal smear. During the period, 132 patients were seen and 79 (60 pc) had colposcopic findings suggestive of CIN and 17 (13 pc) had inflammatory changes and 36 (27 pc) had normal findings. Electrocautery was used to treat low grade CIN lesions, cone biopsy was performed for higher grades of CIN and a selected group underwent hysterectomy.

Cancer of the cervix: knowledge, beliefs and screening behaviours of health workers in Mudzi District in Mashonaland East Province, Zimbabwe.

OBJECTIVE: To assess the knowledge, beliefs and screening behaviours on cervical cancer among health workers in Mudzi District. DESIGN: Cross sectional survey. SETTINGS: Mudzi District Hospital and all the 20 rural health centres in Mudzi District of Mashonaland East. SUBJECTS: Sixty health workers in Mudzi District. MAIN OUTCOME MEASURES: Knowledge of cervical cancer risk factors, screening methods and treatment options. Beliefs and screening behaviours. RESULTS: The knowledge levels were lower for many of the predisposing factors of cervical cancer except for the use of vaginal herbs or chemicals, which 85% of the health workers knew. Though 50% of the respondents knew of the Pap smear as a screening method for cervical cancer, 86.6% did not know the human papiloma virus screening and 90% did not know of the visual inspection of the cervix using acetic acid. There were also very low knowledge levels for most of the treatment options for pre-cancer with all health workers not knowing the leep and the Laser options. The majority 73.3% believed that they where not at risk of developing cervical cancer. Most of the respondents, 81.7%, had not undergone any form of cervical cancer screening. However, the main reason for non screening was that there were no cervical cancer screening facilities in Mudzi District. CONCLUSION: The study revealed low knowledge levels, negative beliefs about the risk of developing cervical cancer and poor screening behaviours among health workers in Mudzi District. Training in cervical cancer is, therefore, recommended for the health workers. However, the training should be combined with setting up facilities for cervical cancer screening.

A review of cervical cancer patients presenting in Harare and Parirenyatwa Hospitals in 1998.

OBJECTIVE: To document the socio-demographic profile, presenting symptoms, disease stage and treatment modality offered to all women attending Harare and Parirenyatwa Hospitals with a histological diagnosis of invasive cervical cancer in 1998. DESIGN: A cross sectional study. SETTING: Parirenyatwa Hospital and Harare Central Hospital. SUBJECTS: All women with a histological diagnosis of cervical cancer admitted between 11 January 1998 and 14 December 1998 were recruited into the study. RESULTS: A total of 196 patients, with a median age of 47 years (range 24 to 80 years) were recruited into the study. A high proportion (63.3%) of the women were from rural areas. The mean age at first pregnancy was 17.9 years (SD 2.8) and 112 (63.3%) first sought treatment at the primary health care centre. Persistent vaginal discharge was the most frequent (69.4%) presenting complaint. One hundred and ninety five patients (99.5%) had histological confirmation of invasive cervical cancer (91.8% squamous cell carcinoma, 7.7% adenocarcinoma). Clinical staging by The International Federation of Gynaecology and Obstetrics (FIGO) classification confirmed that the majority (80.3%) of the cancers had spread from the cervix into the parametrium and beyond (stage 2b and above) at the time of presentation. Radiation therapy was the most commonly used (77.0%) treatment modality. CONCLUSION: This study demonstrates that the burden of cervical cancer occurs around the peak age of 47 years and that the majority of women present with advanced disease. None of the women had ever been screened for cervical cancer. The planned introduction of a cervical cancer screening programme by visual inspection of the cervix with acetic acid (VIA), together with a health education campaign may result in a shift towards more women presenting with early curable cervical cancer cases.

Visual inspection of the cervix as a primary means of cervical cancer screening: results of a pilot study.

OBJECTIVE: To measure the effectiveness of unaided visual inspection (UVI) of the cervix as a primary means of cervical cancer screening. DESIGN: A cross sectional study. SETTING: Five primary health care clinics in Mashonaland Province, Zimbabwe. SUBJECTS: 1,000 women aged between 25 and 55 years. MAIN OUTCOME MEASURES: Sensitivity and specificity of UVI. METHODS: 1,000 women attending primary health care clinics were screened for cervical cancer by six qualified nurses. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix and a cervical cytology specimen was obtained followed by visual inspection of the cervix stained by 4% acetic acid. All women found to have abnormal cervices by visual inspection and/or by cervical cytology report were scheduled for colposcopy examination at Harare Central Hospital. RESULTS: 236 (23.6%) women had an abnormal cervical appearance after application with 4% acetic acid, out of which 157 (15.7%) were reported abnormal by cytology. True disease as defined by positive colposcopy and positive cytology was confirmed in 38 (3.8%) women. The sensitivity of UVI using colposcopy and cytology as a reference standard was 68.4%, specificity was 3.4%. CONCLUSION: The results of this study suggest that naked eye inspection of the cervix after application of acetic acid is a practical alternative to cervical cytology in screening for cervical cancer in countries with few resources like Zimbabwe.

Determinants of reproductive tract infections among asymptomatic women in Harare, Zimbabwe.

OBJECTIVES: To determine the prevalence of and risk factors for reproductive tract infections (RTI) among asymptomatic women attending primary health care clinics in Harare, Zimbabwe. DESIGN: A cross sectional study. MAIN OUTCOME MEASURES: Prevalent RTI, HIV and socio-demographic data. SETTING: Two primary health care clinics in Harare. SUBJECTS: 393 consecutive, consenting women aged 15 to 49 years, presenting at the clinics for antenatal care, family planning, or bringing their children to attend preventive care clinics. RESULTS: More than half of the women had at least one ongoing RTI. Voluntary reporting of symptoms was almost non-existent. Prevalence of HIV was 29.3% and that of classical STIs was 15.4% Trichomoniasis vaginalis, 3.9% syphilis, 3.9% Chlamydia trachomatis and 1.8% Neisseria gonorrhoea. Bacteria vaginosis was diagnosed in 30.3% of the women and candidiasis in 25.4%. Presence of any RTI was significantly associated with lower level of education, sexual debut < 20 years, a non-monogamous partner, and use of a condom during the last sexual encounter. Independent factors associated with cervical infections were young age (< 20 years), being unmarried, current dysuria, warts, clinical signs of purulent or yellowish discharge, lower abdominal pain and cervical friability. Vaginitis was associated with sexual debut or marriage < 20 years, a partner who was a frequent traveller, history of STI, and presence of abnormal vaginal discharge. CONCLUSION: In view of the high prevalence of RTI and HIV and the low reporting of symptoms by infected women, it is recommended that strategies that improve women's awareness of urogenital symptoms be adopted, along with pro-active inquiry of genital symptoms by the health care workers, and treatment of RTIs, in order to reduce the unnecessary burden of RTIs.

Situation analysis for cervical cancer diagnosis and treatment in Zimbabwe.

OBJECTIVE: To establish factors influencing early diagnosis and treatment of cervical cancer in Zimbabwean women. DESIGN: A cross sectional study. SETTING: A random selection of 29 primary health care facilities, 11 district/provincial and four tertiary hospitals in Zimbabwe. RESULTS: All the institutions at primary health care, district, provincial and tertiary levels had the basic infrastructure to perform exfoliative cytology screening (Pap. smear). An average of only nine pap. smears per month were performed at primary health clinics and at district/provincial and tertiary levels seven and 23 Pap. smears per week were done respectively. Infrequent supplies of consumable materials and lack of policy guidelines were the most common reasons for not screening women. Surgical treatment for cervical cancer was offered in all tertiary hospitals but only 22% of provincial hospital had facilities to perform hysterectomy. CONCLUSION AND RECOMMENDATIONS: There is an urgent need to improve screening for cervical pre-cancer in Zimbabwean women with emphasis to provide adequate treatment facilities especially at district and provincial Hospitals. A national policy guideline should be drawn to address specific ages and frequency of screening for cervical cancer.

Cancer survival in Harare, Zimbabwe, 1993-1997.

The Zimbabwe national cancer registry was established in 1985 as a population-based cancer registry covering Harare city. Cancer is not a notifiable disease, and registration of cases is done by active methods. The registry contributed data on randomly drawn sub-samples of Harare resident cases among 17 common cancer sites or types registered during 1993-1997 from black and white populations. Follow-up was carried out predominantly by active methods with median follow-up ranging from 1-54 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged from 20-100%; death certificate only (DCO) cases comprised 0-34%; 58-97% of total registered cases were included for survival analysis. Complete follow-up at five years ranged from 94-100%. Five-year age-standardized relative survival rates of selected cancers among both races combined were cervix (42%), breast (68%), Kaposi sarcoma (4%), liver (3%), oesophagus (12%), stomach (20%) and lung (14%). Survival was markedly higher among white than black populations for most cancers with adequate cases. Five-year relative survival by age group was fluctuating, with no definite pattern or trend.