Depression in Zimbabwe: a community approach to prevention and treatment

A position paper on primary health care for the management of mental health in Zimbabwe.This paper reports on a process whereby research findings, generated by a collaborative project between primary health care workers and a University team, were utilized by a community to formulate local plans for the prevention and management of depression. Action-oriented research, with a high level of community participation, follows on directly from the Declaration of Alma-Ata1 and has been called Health Systems Research (HSR). The principle of HSR is that it should be useful and have a direct focus on solving practical and relevant problems.2 Priorities should be generated by health workers and by the community rather than purely by academics and as much as possible of the research should be carried out by those already working at ground level. Results should lead to implementable recommendations and the research is not complete until those recommendations are underway

Prevalence and correlates of alcohol dependence disorder among TB and HIV infected patients in Zambia.

OBJECTIVES: To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. METHODS: 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. RESULTS: The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). CONCLUSIONS: Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population

Cultural orientation and use of cannabis and inhalants among secondary school children in Zimbabwe

A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted in 1994. In the present paper, the relationships between cultural and social factors and use of inhalants and cannabis are explored. Respondents were selected by means of a two-stage sample design, first based on a complete list of schools in the four provinces and subsequently on lists of students at the randomly selected schools. Stratification was based on the identification of four different sociocultural groups. Data collection followed standardised procedures and was conducted by a research team from University of Zimbabwe. Cultural orientation was operationalised by means of a Likert-type 14-item scale on choice of media, language and music. Exploratory principal component analysis revealed a two-factor solution, representing a global or Western cultural orientation and a local or Zimbabwean cultural orientation. Drug use by older siblings and best friends represented social factors. A combined model of cultural and social variables was subject to a multiple logistic regression analysis. Results revealed that the social variables and global cultural orientation were significantly associated with increased use of both drugs, whereas a local cultural orientation was found not to be associated with use of these substances. Findings are discussed in the light of historical and cultural factors.cannabis inhalants culture adolescents Zimbabwe

Adolescent drug use in Zimbabwe assessed by their teachers

No Abstract. Central African Journal of Medicine Vol. 45 (4) 1999: pp. 80-8

Use of alcohol and tobacco among secondary school teachers in Zimbabwe

No Abstract. Central African Journal of Medicine Vol. 45 (3) 1999: pp. 60-6

Prevalence of major depression in deliberate self- harm individuals in Harare, Zimbabwe

Objective: To investigate the prevalence of major depression in deliberate self-harm individuals. Design. A cross sectional descriptive study. Setting. Three tertiary health care centres in Harare, Zimbabwe. Subjects: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose. Main outcome measures: The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals. Results: The prevalence of major depression was 20.7% (n=80, 95% CI= 16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI= 57.2-66.8) of the subjects with DSH were age

Alcolhol consumption in HIV-1 infected persons: a study of immunological markers, Harare, Zimbabwe

No Abstract. Central African Journal of Medicine Vol. 45 (11) 1999: pp. 303-30

Improving adherence to ante-retroviral treatment for people with harmful alcohol use in Kariobangi, Kenya through participatory research and action

<p>Abstract</p> <p>Background</p> <p>Harmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya.</p> <p>Methods</p> <p>Entry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants’ understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress.</p> <p>Results</p> <p>By the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement.</p> <p>Conclusion</p> <p>We propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary health care (PHC) would be important not only to PLWHA but also to other diseases in the PHC setting . Longer term follow up is needed to determine the sustained impact of the interventions. Problems encountered in the PRA work included great expectations at all levels fostered by handouts from other donors and cognitive impairment that interfered with constructive engagement in some of the PLWHA.</p