RESUMO
BACKGROUND: Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of 'asthma' defined by symptoms is high compared to 'doctor diagnosed asthma'. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? METHODS: The Arksey and O'Malley's framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The 'Preview, Question, Read, Summarise' system was used and a narrative report was used to summarise the findings. RESULTS: A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. CONCLUSION: This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis.
Assuntos
Asma , Asma/diagnóstico , Asma/epidemiologia , Criança , Humanos , Prevalência , Pesquisa Qualitativa , Espirometria , Inquéritos e QuestionáriosRESUMO
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person's knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9-15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.
Assuntos
Comportamento do Adolescente/psicologia , Antirretrovirais/uso terapêutico , Cuidadores/psicologia , Infecções por HIV/tratamento farmacológico , Autoeficácia , Comportamento Sexual , Adolescente , Comportamento do Adolescente/etnologia , Adulto , Criança , Comunicação , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/virologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Prospectivos , Saúde Reprodutiva , Estigma Social , ZimbábueRESUMO
Objective: To determine etiology and risk factors of meningitis in patients admitted a tertiary referral Hospital in Harare. Design: Cross-Sectional Study. Setting: Urban Referral Health Facility. Subjects: Patients suspected of having Meningitis admitted at Parirenyatwa Hospital were consecutively consented and recruited into the study until sample size accrual. Main Outcome Measures: Prevalence of pathogens associated with Meningitis. Risk factors of meningitis. Results: Two Hundred and Ninety Six (296) clinically suspected meningitis patients were recruited into the study, 51.7 %( n=115) were male. Meningitis was confirmed in 20.6% (n=61) cases with the following pathogen proportions, C. neoformans - 45.9 %( n=28), S. pneumoniae 27.9 % (n=17), TBM 4.9 %( n=3), probable viral meningitis 6.6% (n=4 and other bacteria- 14.8% (n=9). Patients from crowded households were also more likely to suffer from meningitis than those from sparsely populated households (p<0.001). Conclusion: The use of Latex agglutination increases the proportion of detected pathogens both fungal and bacterial when used in conjunction with CSF gram stain and culture. Cryptococcus neoformans and S. pneumoniae are the leading causes of meningitis in patients admitted at Parirenyatwa Hospital.
Assuntos
Testes de Fixação do Látex/métodos , Meningites Bacterianas/epidemiologia , Meningite Viral/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningites Bacterianas/etiologia , Meningites Bacterianas/microbiologia , Meningite Viral/etiologia , Meningite Viral/microbiologia , Prevalência , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem , Zimbábue/epidemiologiaRESUMO
Background: Non-adherence reduces the effectiveness of antiretroviral therapy. Knowledge of factors associated with non-adherence would assist clinicians and program planners to design and implement interventions to improve adherence and therefore treatment outcomes. Objective: To determine the prevalence and factors associated with non-adherence to Highly Active Antiretroviral Therapy (HAART) in children less than 10 years of age. Methods: A cross-sectional study of 216 caregivers and children less than 10 years of age who had received HAART for at least 60 days prior to this study. Non-adherence was defined as taking less than 95% of prescribed doses. Caregiver self-reports of missed doses in the 30 days preceding a clinic visit, and clinic based pill counts were used to determine non-adherence. Results: Of the 228 children selected, 216 (94.7%) study participants were assessed using the self-report method. Pill count assessment was done on only 96 (44%) participants who produced unused pills on their review dates. Caregiver self-reports (n=216) estimated the prevalence of non-adherence to be 7.4% (95%: CI 3.90 10.90) whereas clinic-based pill counts (n=96) yielded a higher estimate of 18.8% (95% CI 10.94 26.56). In a regression analysis based on pill count, two or fewer siblings (OR=6.26, 95% CI 1.64-23.95) or adults (OR=3.73, 95% CI: 1.01-13.78) in the household were independently associated with non-adherence to HAART. Of the 16 participants who were non adherent by pill count the reasons for missing doses were, attending gatherings (funeral, church), caregiver forgetting to give dose, medication running out, not understanding dosing instructions, concurrently taking other medicines such as anti tuberculosis drugs and cotrimoxazole, child visiting relatives during school vacation, and inconsistent supply of drugs in the hospital. Conclusion: The prevalence of non adherence using pill count method was high at this clinic. Caregiver reports of missed doses underestimated the prevalence of non-adherence to HAART. Having fewer siblings or adults in the household to assist with dosing are strongly associated with non-adherence to HAART in this population of children.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Adulto , Cuidadores , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem , ZimbábueRESUMO
OBJECTIVE: To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to reach parts of the country where the conventional visual acuity charts are not available. DESIGN: Aperformance evaluation of counting fingers (LLTT) in screening for blindness against the standard test (Snellen chart). SETTING: Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Zimbabwe. SUBJECTS: Patients presenting to the Eye Outpatient Department at Sekuru Kaguvi Eye Unit with various eye problems. MAIN OUTCOME MEASURE: Sensitivity of low level technology tool (LLTT) in identifying blind people. RESULTS: Sensitivity and specificity of LLTT in detecting blindness in all age groups combined was 100% and 88.5% respectively. Although sensitivity was not affected by patient age, specificity decreased with increasing age. The overall positive predictive value for the test was 53.3% and the prevalence of blindness among outpatient attendees was 11.6%. CONCLUSION: Finger counting is an effective tool that can be employed in screening for blindness in communities which are hard to reach, have low literacy rate and when conventional methods of testing visual acuity are not available.
Assuntos
Cegueira/diagnóstico , Países em Desenvolvimento , Seleção Visual/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem , ZimbábueRESUMO
INTRODUCTION: Anecdotal and published reports suggest that ocular tumours are on the increase in Zimbabwe. OBJECTIVES: To determine the trends in incidence rates of common malignant ocular tumours registered with the Zimbabwe Cancer Registry during the last decade (1990 to 1999). DESIGN: Retrospective study. SETTING: Data were collected from the Zimbabwe National Cancer Registry, the Zimbabwe National Census 1992 and 2002 Reports, and patient records from hospitals. SUBJECTS: All cases of malignant ocular tumours registered with the Zimbabwe National Cancer Registry between 1 January 1990 and 31 December 1999. MAIN OUTCOME MEASURES: Age standardized annual incidence rates for registered cases of common ocular tumours. RESULTS: The age-adjusted annual incidence rates of squamous cell carcinoma of the conjunctiva had a more than 10-fold increase from 0.17 to 1.8 per 100,000 people during periods 1990 and 1999 respectively. Retinoblastoma dropped by more than half from 0.8 to 0.34 per 100,000 during the same period. The annual age standardised incidence rates for all ocular tumours showed a significant upward linear trend (chi2: 362.78, df=9 and p < 0.001). There was no significant gender difference in the distribution of these tumours amongst the study population. CONCLUSION: The increasing trend in the age-adjusted annual incidence rates of ocular surface squamous neoplasms could be attributed to the worsening HIV and AIDS pandemic in Zimbabwe or improved access/utilization of health services by the public.
Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Oculares/epidemiologia , Infecções por HIV/epidemiologia , Sistema de Registros , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Zimbábue/epidemiologiaRESUMO
The objective of this study was to describe trends over time in HIV prevalence, sexually transmitted infections (STIs) and sexual behaviour among women in Moshi urban, Tanzania. Two cross-sectional studies were conducted in 1999 and in 2002-04 among women attending three primary health-care clinics. They were interviewed and screened for HIV and STIs. There was a significant decrease in HIV prevalence (11.5-6.9%). The decline was greatest among women aged 15-24 years. Syphilis, trichomoniasis, bacterial vaginosis, genital ulcers and reported STI symptoms also decreased significantly over the three-year inter-survey period. The proportion of women reporting casual sex decreased and knowledge of STI symptoms and health-care seeking behaviour improved. Herpes simplex virus type 2, genital warts, age at sexual debut, age at first pregnancy and condom use remained unchanged. In conclusion, decline in curable STIs and casual sex partners may partly explain the observed decline in HIV seroprevalence. Both STIs and sexual behaviour should be monitored in HIV sentinel surveillance. There remains a gap between knowledge of preventive behaviour and actual preventive practices.
Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , Fatores Etários , Condiloma Acuminado/epidemiologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Soroepidemiológicos , Comportamento Sexual , Sífilis/epidemiologia , Tanzânia/epidemiologia , Vaginite por Trichomonas/epidemiologia , População Urbana , Vaginose Bacteriana/epidemiologiaRESUMO
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.
Assuntos
Infecções por HIV/epidemiologia , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Controle de Infecções/métodos , Cooperação do Paciente , Complicações Infecciosas na Gravidez/epidemiologia , Avaliação de Programas e Projetos de Saúde , Feminino , Seguimentos , Infecções por HIV/transmissão , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Prevalência , Estudos Retrospectivos , Zimbábue/epidemiologiaRESUMO
SETTING: Twenty-two urban factories in Harare. OBJECTIVE: To determine the relationship between the human immunodeficiency virus (HIV), smoking and self-rated health in a high HIV prevalence urban workforce. DESIGN: Cross-sectional survey. RESULTS: Of 7482 employees, 6111 (82%) consented to interview and anonymous HIV serology; 88% were male; median age was 34 years. HIV prevalence was 19%. Current (median 6 cigarettes per day) and former smoking were reported by 17% and 7%, respectively. Smoking (current or former) was more common among HIV-positive (27%) than -negative participants (17%; P < 0.001). Factors significantly associated with being a smoker on multivariate analysis were being HIV-infected (OR 1.5, 95% CI 1.4-1.7), older age (P < 0.001), non-Christian (OR 1.6, 95% CI 1.2-2.2) and manual job (OR 1.4, 95% CI 1.2-1.6). Women (OR 0.05, 95% CI 0.03-0.11) and the better educated (OR 0.7, 95% CI 0.5-0.9) were significantly less likely to smoke. HIV-positive smokers had the highest risk of reporting poor health (adjusted OR compared to HIV-negative non-smokers 3.4, 95% CI 2.3-5.0). CONCLUSIONS: Smoking was significantly more common among HIV-positive than -negative employees in this predominantly male workforce. There was evidence of a combined effect on self-rated poor health, a variable shown to be a strong independent predictor of mortality in industrialised countries. Interventions to encourage smoking cessation may be an important component of HIV care in Southern Africa.
Assuntos
Infecções por HIV/epidemiologia , HIV , Nível de Saúde , Fumar/epidemiologia , População Urbana , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Zimbábue/epidemiologiaRESUMO
OBJECTIVE: To determine the extent of association and relative risk of developing ocular surface squamous neoplasia (OSSN) among HIV positive patients seen in July 2004 at Sekuru Kaguvi Eye Unit, in Harare, Zimbabwe. DESIGN: Prospective study. SETTING: Sekuru Kaguvi Eye Unit. SUBJECTS: All patients who presented with conjunctival growths in July 2004. MAIN OUTCOME MEASURE: Relative risk. RESULTS: The relative risk of being HIV positive among patients with ocular surface squamous neoplasia was 3.6 with 95% CI 1.5 to 8.6. The mean CD4 cell count level was significantly lower among OSSN patients when compared to patients with non-ocular surface squamous neoplasia. RECOMMENDATIONS: 1. HIV related malignancies can be used as an indicator of when to commence patients on anti-retroviral (ARVs) when CD4 counts are not accessible; 2. Medical practitioners in resource-poor settings should conduct meaningful operational research as part and parcel of their routine clinical work using available resources, since funding is not readily available.
Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias da Túnica Conjuntiva/patologia , Neoplasias Oculares/epidemiologia , Infecções por HIV/fisiopatologia , Adulto , Contagem de Linfócito CD4 , Carcinoma de Células Escamosas/fisiopatologia , Neoplasias Oculares/etiologia , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Risco , Fatores de Risco , Zimbábue/epidemiologiaRESUMO
OBJECTIVE: A pilot study to assess effectiveness of generic Nevirapine (NVP)+Zidovudine (AZT)+Lamivudine (3TC) as potent antiretroviral therapy (ART) in women exposed to either SD NVP or short course (SC) AZT through participation in prevention of mother-to-child transmission of HIV-1 (pMTCT) interventions, and their spouses. DESIGN: A pilot study of antiretroviral treatment of adults with AIDS. SETTING: Primary health care clinics; Seke North and St Mary's in Chitungwiza, Zimbabwe. SUBJECTS: Women with pre-exposure to SD NVP or SC AZT and their spouses with CD4 count < 200 cells/ INTERVENTIONS: Generic AZT/3TC twice daily plus NVP daily for the first 14 days and then twice a day thereafter, administered to the cohort. MAIN OUTCOME MEASURES: The baseline median CD4 count for women and men was 128.5 and 119.0 cells/ microL respectively. The geomean virus load was similar for the women and men. At weeks 16, 24 and 48, 82.8%, 85.1% and 73.8% had < 400 copies/ml of HIV RNA respectively. Only at 16 weeks, was the proportion of women (75.9%) with undetectable virus significantly lower than that for men (93.9%), p = 0.031. Median CD4 count for both men and women increased significantly, p < 0.001. There were no significant differences in virologic responses between the women with pre-exposure to SD NVP and SC AZT. The mean adherence for women and men was similar, > 98%. CONCLUSION: Women showed a significantly reduced response top ART relative to men only at 16. However, prior exposure to SD NVP for PMTCT was no more likely to negatively influence responses to ART than use of SC AZT.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , HIV-1 , Lamivudina/administração & dosagem , Nevirapina/administração & dosagem , Zidovudina/administração & dosagem , Adulto , Análise de Variância , Terapia Antirretroviral de Alta Atividade , Distribuição de Qui-Quadrado , Medicamentos Genéricos/administração & dosagem , Feminino , Humanos , Masculino , Projetos Piloto , Cônjuges , Estatísticas não Paramétricas , Resultado do Tratamento , ZimbábueRESUMO
BACKGROUND: There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe. METHODS: A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up. RESULTS: Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up. CONCLUSION: Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.
RESUMO
Unwanted teenage pregnancy and the attendant morbidity and mortality necessitate an understanding of the factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge and reproductive behaviour. A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline followed by a health education intervention, except for control schools. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents. There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored correctly on practice relating to menstruation. Pupils from intervention schools were more likely (P < 0.001) to know that a boy experiencing wet dreams could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Knowledge of family planning was low in both groups at baseline but was high at five months follow-up in the intervention schools. The findings point to the need for early school-based reproductive health education programmes, incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Educação Sexual/normas , Adolescente , Intervalos de Confiança , Feminino , Educação em Saúde/normas , Humanos , Masculino , Menstruação/etnologia , Menstruação/psicologia , Razão de Chances , Gravidez , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/psicologia , Avaliação de Programas e Projetos de Saúde , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , ZimbábueRESUMO
OBJECTIVES: To determine whether low-dose aspirin reduces the incidence of pre-eclampsia, reduces perinatal mortality and improves birth weights in pregnant women considered at high risk of developing pre-eclampsia. METHOD: Two-hundred fifty subjects were recruited from the antenatal clinics at Harare Central Hospital with either a previous history of pregnancy-induced hypertension or pre-existing chronic hypertension and were randomized to receive either 75 mg of aspirin (ASA) or placebo (PLA). RESULTS: Two-hundred thirty subjects (ASA, n = 113; PLA, n = 117) completed the trial. The odds of developing pre-eclampsia for those on aspirin was 0.72 times those on placebo (95% CI, 0.34-1.52). The mean birth weight was 2774 g for those on aspirin and 2694 g for those on placebo (P = 0.80). No difference was noted in the perinatal deaths (OR = 0.38; 95% CI, 0.10-1.20). CONCLUSION: Prophylactic use of aspirin was not associated with a significant effect on the major pregnancy outcomes assessed in this study.
Assuntos
Aspirina/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Pré-Eclâmpsia/prevenção & controle , Resultado da Gravidez , Adulto , Peso ao Nascer , Intervalos de Confiança , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Incidência , Mortalidade Infantil , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/fisiopatologia , Razão de Chances , Pré-Eclâmpsia/epidemiologia , Gravidez , Fatores de RiscoRESUMO
OBJECTIVES: A double blind randomized controlled trial was performed at the tertiary hospital in Harare, Zimbabwe to compare oral misoprostol with intramuscular oxytocin in the management of third stage of labor. METHODS: A total of 499 women were randomized to receive either 400 microg misoprostol orally or 10 IU oxytocin intramuscularly. The incidences of postpartum hemorrhage and side effects were examined. RESULTS: The demographic and labor characteristics were comparable. Postpartum hemorrhage occurred in 15.2% of women given misoprostol and in 13.3% of those given oxytocin (P=0.534). Measured blood loss of more than 1000 ml occurred in 3.7% of the misoprostol group compared with 2% in the oxytocin group (P=0.237). There was no significant difference in the need for additional oxytocic drugs or blood transfusion in women given misoprostol (P values 0.137 and 0.600, respectively). Significant side effects of misoprostol were shivering [RR=1.32 (95% CI 1.11-1.58); P=0.002) and a rise in temperature [RR=2.02 (95% CI 1.75-2.33); P<0.001]. CONCLUSIONS: Oral misoprostol is as effective as intramuscular oxytocin in the prevention of PPH. Shivering and transient pyrexia were specific side effects of misoprostol. Misoprostol has potential in reducing the high incidence of PPH in developing countries.
Assuntos
Terceira Fase do Trabalho de Parto/efeitos dos fármacos , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Administração Oral , Adulto , Volume Sanguíneo/efeitos dos fármacos , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Injeções Intramusculares , Idade Materna , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Paridade , Gravidez , Resultado da GravidezRESUMO
OBJECTIVE: To compare the effectiveness of extra-amniotic saline infusion versus extra-amniotic prostaglandin F2alpha for cervical ripening, induction of labor and achievement of vaginal delivery in patients with unfavorable cervices. METHOD: A randomized trial of extra-amniotic saline infusion versus extra-amniotic prostaglandin F2alpha performed at Harare Central Hospital Maternity Unit, Zimbabwe. One hundred and sixty-four patients were recruited from those referred to Harare Central Hospital Maternity Unit who required induction of labor for either maternal or fetal indications. RESULTS: 162 patients (extra-amniotic PgF2alpha group, N = 81; extra-amniotic saline infusion group, N = 81) had complete information. Two patients (one from each group) were lost to follow up. The demographic characteristics of the patients and the indications for induction were not statistically different. There was a marginally statistically significant difference in the change of Bishop Score in favor of the extra-amniotic saline infusion (4.0, S.D. = 1.4) as compared to (4.5, S.D. = 1.5) for extra-amniotic PgF2alpha (P value = 0.047). All other parameters showed no statistically significant differences. Maternal and fetal complications were minimal and not significantly different. Extra-amniotic saline infusion was however almost six times cheaper than PgF2alpha. CONCLUSION: Extra-amniotic saline infusion is as effective as PgF2alpha, safe, but much cheaper than PgF2alpha and should be seriously considered as a method of first choice in resource-poor settings.
Assuntos
Abortivos não Esteroides/farmacologia , Maturidade Cervical/efeitos dos fármacos , Dinoprosta/farmacologia , Trabalho de Parto Induzido , Cloreto de Sódio/farmacologia , Abortivos não Esteroides/economia , Adulto , Âmnio , Dinoprosta/economia , Feminino , Humanos , Injeções , Trabalho de Parto Induzido/métodos , Gravidez , Resultado da Gravidez , Cloreto de Sódio/economia , ZimbábueRESUMO
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.
Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Infecções Bacterianas/prevenção & controle , Ruptura Prematura de Membranas Fetais/complicações , Resultado da Gravidez , Administração Oral , Adulto , Infecções Bacterianas/etiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Terceiro Trimestre da Gravidez , Valores de Referência , Resultado do TratamentoRESUMO
OBJECTIVE: To examine the level of reported quality of condom use by young adult Zimbabwean males at higher learning institutions. DESIGN: A cross sectional descriptive survey. SETTING: Two technical colleges in Harare, Zimbabwe. SUBJECTS: A sample of 400 subjects (200 from each of the higher learning centres). MAIN OUTCOME MEASURES: Reported quality of condom use. RESULTS: All participants were males who had at least completed 'O' levels, or the equivalent of high school. The majority of the participants were single (78.2%), while a fifth (20.2%) were married and the remaining few were separated or living with a partner. Among those who were married about one fifth had children. The majority 136 (36.8%) were Roman Catholic. The mean age of students surveyed was 24 (SD 3.5) years. The reported quality of condom use in the last 12 months in this sample was measured by four items: 24.6% reported using condoms every time; 27.7% put the condom on every time before the penis entered the vagina for the first time; 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. In this study the results indicated that behaviour specific influences i.e. attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the reported quality of condom use. CONCLUSION: Using the health promotion model the results indicated that marital status, having been shown how to use condoms, attitudes towards condom use and use of marijuana were all independently predictive of the reported quality of condom use.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Adulto , Estudos Transversais , Humanos , Masculino , Inquéritos e Questionários , Zimbábue/epidemiologiaRESUMO
OBJECTIVE: To conduct a situation analysis of obstetric services in a rural district of Zimbabwe. DESIGN: Observational study. SETTING: 13 primary health care centres in Murewa district in Zimbabwe. MAIN OUTCOME MEASURES: Number of maternity beds, antenatal attendance, deliveries per month, availability of antenatal, intrapartum and neonatal care equipment, intrapartum monitoring and neonatal resuscitation skills. RESULTS: 13 of 15 primary health care clinics providing obstetric care in Murewa district were surveyed in 1995. Median number of maternity beds were nine (Q1 = 0, Q3 = 11) per clinic, median number of first ANC attenders per month was 15 (Q1 = 3, Q3 = 18), median number of deliveries per clinic per month were eight (Q1 = 0, Q3 = 16). While all clinics had laboratory facilities, 6/13 could estimate haemoglobin, 5/13 syphilis serology, none of the clinics sent blood to district hospitals for blood grouping and there were no microscopes at clinics for malaria parasite determination. Only 6/13 clinics used partographs for monitoring labour, 10/13 had suction machines for neonatal resuscitation while only 3/13 had ambu bags, 3/13 had oxygen and 2/13 had heaters. Correct methods for neonatal resuscitation were used in 3/13 clinics. Clean water supply, reliable power supply and the referral system were not optimal. CONCLUSION: Basic equipment for antenatal, intrapartum and neonatal care was inadequate. Essential laboratory facilities for obstetric care were lacking. Skills for intrapartum monitoring and neonatal resuscitation were inadequate. The referral system was poor. There is need for more strategic planning at primary health care level in this district which is known to have high perinatal and neonatal death rates. More emphasis should be placed on strengthening basic laboratory back up service for obstetric care, strengthening infrastructural and referral systems as well as training in areas of lost or no skills.
Assuntos
Obstetrícia/normas , Assistência Perinatal/métodos , Atenção Primária à Saúde/normas , Serviços de Saúde Rural/normas , Adulto , Atenção à Saúde , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Monitorização Fisiológica/métodos , Obstetrícia/instrumentação , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , ZimbábueRESUMO
OBJECTIVE: To describe perinatal practices from a community perspective and identify factors associated with perinatal death. DESIGN: Cross sectional community based survey. SETTING: Murewa and Madziwa rural areas, Zimbabwe. SUBJECTS: Women aged 15 to 50 years who had been pregnant within the 24 months preceding the survey. MAIN OUTCOME MEASURES: Where delivered, where preferred to deliver, model of delivery, use of herbs in labour, duration of labour, assistant at delivery, time of delivery, condition of baby at birth, resuscitation methods, birth weight, initiation of breast feeding, illness in the first week and outcome of pregnancy. RESULTS: 644 women were interviewed; 581/644 stated where they would have liked to deliver and 505/644 stated where they actually delivered their last baby. The majority 369/581 (62.4%) preferred to delivery at a government hospital and 240/505 (47.5%) actually delivered at a government hospital. Of the home deliveries only 27/581 (4.6%) preferred to deliver at home and yet 123/505 (24.4%) actually delivered at home. Primary care clinics were less preferred 151/581 (25.5%) as a place for delivery and 89/505 (17.6%) actually delivered there. Labour lasting more than 12 hours occurred in 20.4% of deliveries. Nurses were the commonest attendants at delivery 309/508 (60.4%) and morbidity following delivery was noted in 72/495 (14.5%). Resuscitation was carried out in 61/72 infants. Beating/shaking 36/61 (58.0%) and pouring cold water over the baby 11/61 (18.0%) were the commonest methods of resuscitation. Being delivered by a doctor compared to a nurse and being in Murewa district were statistically significant risk factors for mortality with Odds Ratio (OR) 5.21 (95% CI 2.86 to 9.51) and 3.90 (95% CI 1.51 to 10.09) respectively. The odds of dying when delivered by breech extraction were high, but not statistically significant OR 3.73 (95% CI 0.92 to 13.97) when compared to being delivered by vertex delivery. Labour more than 12 hours, use of herbs in pregnancy and time of delivery were not significantly associated with mortality with OR (95% CI) of 1.02 (0.40 to 2.19), 0.92 (0.00 to 4.38), 1.05 (0.56 to 1.97) respectively. On logistic regression analysis only being delivered in Murewa district remained significant. CONCLUSION: The utilisation of primary health care centres for delivery was unexpectedly low and home deliveries were unacceptably high. Increased mortality when delivered by a doctor and high early neonatal morbidity suggest poor monitoring and delayed intervention in labour. Infant morbidity following delivery was high and methods for neonatal resuscitation inappropriate. There is a need for more studies looking into health worker skills particularly in the areas of partogram use and neonatal resuscitation in these districts.