Coronavirus disease 2019 (COVID-19) Situation Report – 66

Three new countries/territories/areas from the Region of the Americas [1], and African Region [2] have reported cases of COVID-1

Severe Metabolic Acidosis and “Muti” (traditional herbal medicine) ingestion in young children

Twenty infants ami young children admitted with severe metabolic acidosis and a positive history of ‘muti’ ingestion were investigated. All had accompanying gastroenteritis and significant dehydration. Biochemical data was diagnostic of high anion / gap metabolic acidosis in the majority (70 per cent). Further biochemical data indicated that lactic acidosis and pre-renal azotaemia resulting from severe hypovolaemia were likely causes of the high anion GAP metabolic acidosis. There was no evidence to suggest that the ingested muti per se was associated directly with the acidosis or acute renal failure seen in these childre

Factors influencing dietary patterns in Mt Darwin: a rural population of Zimbabwe, 2013.

Introduction: Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases (CVD) and cancer. CVD are increasing throughout the world and cause 16.7 million deaths each year. In Zimbabwe, hypertension is the top leading cause of outpatient chronic conditions and its proportion to the overall burden is 48.9%. In Mt Darwin hypertension (51.4%) remains the chronic condition with the highest burden. Eating a healthy diet such as high fruits and vegetables, low fat and low salt have been shown to substantially reduce CVD and increase quality of life. This study sought to determine factors influencing dietary patterns in Mt Darwin district. Methods: The study was an Analytic Cross Sectional study and the sample size was 350. Data was collected by an Interviewer Administered Questionnaire targeting people in Mt Darwin that are over the age of 18 years. Multistage sampling was done. Epi info version 3.5.1 was used to create frequencies and proportions were calculated as well as Odds ratios to determine associations. Multivariate Logistic regression analysis was done to identify independent risk factors and to control for confounding variables. Results: Three hundred and fifty (350) participants were included in the study. Being male or female [POR=3.97; 95% CI (2.28-6.89)], preferring fatty foods [POR= 2.1; 95% CI (1.11-3.99)], adding salt to served food [POR=0.42; 95% CI (0.26 -0.67)], boiling food as a method of preparation [POR=1.65; 95% CI (1.05-1.59)], and perceiving that a big body means one is healthy [POR=0.56; 95% CI (0.36-0.96)] were significantly associated with dietary patterns. Being male or female [AOR=0.23; 95% CI (0.13-0.40)], boiling food as a method of preparation [AOR=1.69; 95% CI (1.03-2.76)] and preferring fatty foods [AOR=2.56; 95% CI (1.29-5.06)], remained significant on logistic regression analysis. Conclusion and Recommendations: Unhealthy dietary patterns have been found to be prevalent in Mt Darwin, especially among women. Taste and food preference, and image and body size were factors influencing dietary patterns in this study. Health education messages of diet should encompass all social and cultural context issues around food, including correction of myths

Hypertension in Harare hospital out-patients: drugs prescribed, drugs taken and control achieved.

Patient-retained records supplemented by patieni interviews were used to evaluate hypertension management at Harare Hospital. One hundred and one successive hypertensive out-patients were studied. In over a third of patients diagnosis had been established during medical examination fa an unrelated problem. Only one third of 431 recorded 'on treatment' diastolic blood pressures were less than 100 mm Hg, and one fifth were greater than 119 mm Hg. Thiazides, Methl-dopa and Reserpine were the most commonly prescribed antihypertensives. A step-wise approach to management was evident where two drugs were used, but the choice of a third a fourth drug showed great variation. Thirty percent of patients identified a daily regimen that was different from their recorded prescription. Identification of dosage lower than that prescribed correlated with poor control. Better practitioner-patient interaction and stricter adherence to defined regimens are needed to improve blood pressure control. Patient-retained records can provide useful information for health service evaluation in developing countries

SIDE LAB MANUAL

The laboratory has become more essential in the clinical examination of patients. However there has been a tendency for the clinician to relegate even simple tests to specialist laboratory workers. This has its disadvantages. First, the clinician has less insight into the meaning and potential errors of the test. Second, depending on the main lab the test results may become available later than if the tests were done in a ward side-lab. Finally, the side-lab tests may be the only results available to the clinician during an emergency at night.MEP

The need for peri-operative supplemental oxygen

Molecular oxygen is a colourless and odourless gas which is essential to life. It accounts for 21% of the atmospheric air. Apart from its central role in oxidative phosphorylation to produce biological energy in the form of adenosine triphosphate (ATP), molecular oxygen is used as substrate by two other enzyme systems for the killing of bacteria in the phagocytes and for collagen synthesis by the fibroblast during wound healing.18 In the immediate post operative period atmospheric oxygen might become inadequate for a number of reasons including hypoventilation due to central pharmacological depression, diffusion hypoxia and increased metabolic rate due to shivering (the so called halothane shakes)

Relationship between knowledge levels on malaria prevention and self-care actions in primigravidae aged 18 to 35 years at Harare Maternity Hospital.

Malaria in pregnancy remains an obstetric, social and medical problem despite national control programmes in Zimbabwe. An increase in the number of episodes of malaria is witnessed year after year in Zimbabwe, particularly at Harare Maternity Hospital (H.M.H). Mudambo and SADC Military Malaria Technical Committee, 2009 reported an import of malaria by military into Malaria Free Zones, south of the Zambezi River, which is a threat to malaria elimination in the SADC region. The purpose of this study was to examine the relationship between malaria prevention self-care knowledge and malaria episodes, among primigravidae at H.M.H. self-care model guided this study as a conceptual framework. A descriptive correlational study design was used. Quantitative Data were collected from a systematic sample of 80 participants using face to face interviews. Three questionnaires were developed by the investigator, namely the Demographic Data Questionnaire (DDQ), Malaria Episodes Questionnaire (MEQ) and Malaria Prevention Self-Care Knowledge Questionnaire (MPSCKQ) were used as research instruments. Descriptive inferential statistics were used to analyse data, using the statistical package for Social Sciences. Pearson correlation coefficient was used to determine the self-care actions taken by primigravidae aged 18 to 35 years, if they were related to their knowledge. The findings revealed a positive borderline relationship between knowledge levels and self care actions, (r = .045, p = <.693). The findings showed that the higher the knowledge levels the more the primigravidae exhibited self-care actions in preventing malaria. The study ended with recommendations to empower primigravidae on skills to prevent malaria

Effectiveness of short message services reminder on childhood immunization programme in Kadoma- a randomized control trial, 2013

Introduction: Globally, non-attendance for immunization appointments remains a challenge to healthcare providers. Adoption of short message services has been shown to enhance attendance in medical setting. A review of the 2011 consolidated monthly return form (T5) for Kadoma City reveals that the annual OPV1, Pneumococcal 1, and Pentavalent 1 coverage at 6weeks was 74% and for OPV2, Pneumococcal 2, and Pentavalent 2 was 84% at 10weeks. The coverage for OPV3, Pentavalent3 and Pnemococcal3 was 74% at 14weeks. The immunization coverage was less than the district target of 90% for all the antigens at 6, 10 and 14 weeks. The study was conducted to determine the effectiveness of short message services reminders on immunization programme for Kadoma City. Methods: A Randomized Control Trial was conducted at Kadoma City Clinics. Woman who delivered in Kadoma and are residence of Kadoma City were recruited into the study within 72hours after delivery. In the intervention group Short Message Service reminders were sent at 6, 10 and 14 weeks. In the non-intervention no message reminders were used. Data were collected using a standardized interviewer administered pretested questionnaire. Data were collected in phases that are; soon after delivering, at 6, 10 and 14 weeks. Data were entered and analysed using Epi Info 7TM (CDC August 2012). The data were displayed on frequency tables, the means of continuous data were calculated and also contingency tables were used to analyze categorical data. iii Results: A total of 305 participants were recruited into the study. A total of 152 participants received the short message services as immunization reminders while 153 did not receive the short message reminders. The immunization coverage in the intervention group was 97% and in the non-intervention group was 82% at 6 weeks (p<0.001). At 10 weeks the immunization coverage was 96% and 80% in the intervention and non-intervention group respectively (p<001). Immunization coverage at 14 weeks for OPV3, Penta3 and PCV3 was 95% in the intervention group and 75% in the non-intervention group (p<0.001). The proportion of those who did not delay in receiving OPV1, Penta1 and PCV1 was 82% in the intervention group and 18% in the non-intervention group. The proportion of those who did not delay in receiving OPV3, Penta3 and PCV3 was 81% in the intervention group and only 8% in the non-intervention group. The median delay in the intervention group was 0 days (Q1=0; Q3=0) whilst the median delay in the non-intervention group was 10 days (Q1=6; Q3=17). Conclusion: The immunization coverage in the intervention group was significantly higher than in the non-intervention group. There is a difference on the immunisation coverage among those receiving short message service reminders and routine immunisation health education and those receiving routine immunisation health education only. The overall increase in the immunization coverage can be attributed to the use of short message reminders in this study

The prevalence and morbidity associated with ectopic pregnancies at Harare central and Parirenyatwa hospitals

Introduction Ectopic pregnancy is amongst the top causes of maternal morbidity and mortality in the first trimester of pregnancy. It represents one of the commonest gynaecological surgical emergencies in Zimbabwe and other developing countries because most of the women present to health care facilities after rupture has occurred. Objectives i. To determine the prevalence of ectopic pregnancy at Harare and Parirenyatwa Hospitals. ii. To determine the risk factors associated with ectopic pregnancy at Harare and Parirenyatwa Hospitals. iii. To determine the morbidity and mortality associated with ectopic pregnancy. Design Cross-sectional study. Setting Harare and Parirenyatwa Central Hospitals in Harare, Zimbabwe. Subjects Women attending the two hospitals with suspected ectopic pregnancy from 01 December 2012 to 30 April 2013. Methods All women with a suspected ectopic pregnancy who consented to participate in the study were recruited. They were managed by the attending team in the acute phase of the illness. Face to face interviews were conducted to collect information and probe for risk factors of ectopic pregnancy. The management offered to the patient was then analysed using patient’s notes. An HIV test was done on all consenting subjects after pre-counseling. The mortalities were noted and the morbidity was assessed by checking the pre-operative haemodynamic state of the patient, pre-operative haemoglobin count, use of blood or its products, need for intensive care post-operatively and the mean hospital stay. Results During the study period there were a total of 11239 deliveries attended at the two hospitals. A total of 138 suspected cases of ectopic pregnancy were recruited into the study. Of these, 126 (91.3%) were surgically confirmed as ectopic pregnancies and the remainder (12) were wrongly diagnosed. The overall incidence of ectopic pregnancy was found to be 1.12%. Most women were in the 21-30 year age group and had 2 children or less. The risk factors identified were a reported history of sub-fertility, previous history of STI, previous abdominal or pelvic surgery and a previous ectopic pregnancy. There was one maternal death due to rupture (case fatality rate of 0.8%). The morbidity was significant with 87.3% presenting after rupture, 38.8% being attended with signs of shock, 11.1% requiring intensive care admission and 77% being transfused with blood. The mean hospital stay was 5 days following salpingectomy via laparatomy. The prevalence of HIV amongst those with ectopic pregnancies who were tested was 13.1%. Conclusion The morbidity associated with ectopic pregnancy remains high in young women of low parity as the majority present after rupture. The subsequent impact on future fertility of these women could be improved significantly if health strategists focused on primary prevention and early diagnosis to prevent tubal rupture. This means ensuring universal reproductive health care access thereby working towards achieving Millennium Development Goal 5 (MDG 5) by 2015