Patterns and determinants of health care utilization : an assessment of high density urban areas in Harare, Zimbabwe

Includes bibliographical references (leaves 114-123).Zimbabwe has been well known, since independence in 1980, to have one of the best health care systems in Sub-Saharan Africa regardless of a low economic growth pattern. The gains in health status that have been reaped in the 1980s and early 1990s have now been reversed due to the combination of the effects of structural adjustments policies, intermittent drought, a decline in the quality of health care services and severe economic decline. The current economc environment places pressure on households, especially the poorest, to meet the rising costs of individual medical care. The study focused on the evaluation of the patterns and determinants of health care utilization, which can aid in understanding the responsiveness of individuals to the current health care system in light of the economc climate. A detailed assessment of health seeking behaviour and health care utilization was performed using a cross-sectional household community survey comprising of 527 households (2302 individuals) that were randomly selected in three high density suburbs in Harare, Zimbabwe. Information pertaining to demographics, socio-economic status, and health status in addtion to the experiences in the use of health care services or health care providers was collected using a questionnaire

Sinister unilateral tonsillar enlargement

A CAJM article.Tonsillectomy is one of those routine simple and safe procedures that can be delegated to juniors. The procedure is now even being done as day surgery. Tonsillectomy is commonly bilateral, but unilateral tonsillar enlargement can occur especially in the presence of an infective process. This case report, however, serves to highlight the hazards that could occur with tonsillectomy

Prevalence and associated factors of smoking among secondary school students in Harare Zimbabwe

<p>Abstract</p> <p>Background</p> <p>There is a growing epidemic of tobacco use among adolescents in the developing world. However, there is no up to date information on smoking among adolescents. Although in the developing world concerted efforts are being made to control tobacco use, Zimbabwe does not have any documented tobacco control programmes. We estimated the prevalence of smoking among school going secondary school students in Harare, Zimbabwe.</p> <p>Methods</p> <p>A 3-stage stratified random sampling was employed to select six participating schools and students. A descriptive analysis was conducted to describe the demographic characteristics of the participants. The prevalence of smoking was estimated and the comparison of prevalence was performed according to its associated factors. Logistic regression analysis was used to identify risk factors for smoking.</p> <p>Results</p> <p>650 students with a mean age 16 years and 47% of them female participated. Prevalence of ever-smoked was 28.8% (95% CI 25.3 to 32.3). Prevalence of ever-smoked among males (37.8%) was significantly (p < 0.001) much higher than among females (18.5%). In the multivariate analysis, smoking was found to be statistically associated with having friends that smoke (OR 2.8), getting involved in physical fights (OR 2.3), alcohol use (OR 5.7), marijuana use (OR 8.1) and having had sexual intercourse (OR 4.4).</p> <p>Conclusions</p> <p>The study provides recent estimates of prevalence of smoking, and indicates that there is still a high prevalence of smoking among urban secondary school students. Exposure to friends who smoke, risky behaviour like substance abuse, premarital sex and physical fights are significantly associated with smoking. Interventions to stop or reduce the habit should be implemented now and future studies should monitor and evaluate the impact of the interventions.</p

Comparison of deltamethrin as indoor residual spray or on insecticide treated nets for mosquito control in Lake Chilwa

We conducted a study on the control of mosquitos on Chisi Island in Lake Chilwa from August to November, 2006. The aim was to compare the cost and efficacy of deltamethrin, a pyrethroid based insecticide, when used in insecticide treated nets (ITN) and when used in indoor residual spray (IRS). Thirty village huts were enrolled in the study. Fifteen were systematically selected in a stratified manner and sprayed with deltamethrin following manufacturers' standard application procedures of 0.02g/m2. The remaining fifteen were provided with ITNs. In both groups deltamethrin KO tabs were used. Pyrethroid knockdown (PKD) spray was used for indoor rest captures in the houses monthly for three months. Houses treated with IRS had significantly reduced number of mosquitoes resting indoors than houses provided with nets (

ZENITH Adolescent HIV prevalence survey dataset

The ZENITH study sought to determine whether a package of services at primary care level would adequately meet the needs of vertically HIV-infected children and adolescents in Zimbabwe, or whether further decentralisation is needed to provide community-level HIV testing and/or treatment support. This dataset contains results of a adolescent HIV prevalence survey conducted in Harare

Determining and analysing the emergent behaviour from context-aware devices

With the continued miniaturization of technology and the incorporation of Moore’s law, smartphones are more powerful. These mobile devices contain technologies that add other functionalities to them. Technologies such as sensors constantly provide information to the device. The constant stream of information from these sensors often leads to information overload of relevant and irrelevant information. To work towards solving this problem context-aware computing was introduced. Our major concern is that context information in context aware computing is not completely being utilized. The aggregation of context information could unlock more possibilities. This research seeks to aggregate the context of multiple devices such that, through analysis, some emergent behaviour can be observed. In this research context information from the sensors of devices is collected using an Android application and a central Server. The context information is used for pattern analysis. A pattern analysis algorithm is designed and used to observe patterns throughout the data set. It shows patterns that are similar within the dataset. In the case that the pattern observed has no similar pattern or few similar patterns this behaviour can be stated as emergent in the dataset. Further study of this emergent behaviour can be performed were a classifier can be used to give the exact activities that were being performed at that time. The research found this was possible and has many uses. One of these is in disaster prevention were the behaviour of a group of individuals may be monitored to observe any random changes such as masses running at the same time. This could be used as a first warning to natural disasters

Hydro-Physicochemical Changes in Domasi River Associated with Outbreak of Blackflies (Diptera; Simuliidae) in Zomba, Malawi

Blackflies impact human and animal health due to their biting nuisance and transmission of Ochocerca volvulus. This study presents an attempt to analyze hydro physicochemical changes associated with outbreak of black flies in Zomba, Malawi. The study compared historical data of hydro physicochemical parameters before (1985-2002) and after (2008) the outbreak to deduce the changes associated with mass occurrence of these flies. Changes in water quality between these two periods were assessed using T-tests. To establish the relationship between the black fly larval densities and water quality parameters data was subjected to both principal component and correlation analysis. Three principal components before the outbreak and two principal components during the outbreak (both dry and wet season) accounted for most of the variation in water quality in this river system. Nutrient load, increases in Total Suspended Solids (TSS) and Total Hardness (TH) were the main factors that had high loadings on these principal components over the years. A significant correlation was established between black fly larval densities and total hardness (r=0.86, p&lt;0.05) as well as total suspended solids (r = 0.755, p&lt;0.02). The potential role of anthropogenic influences on water quality and its cascading effect on black fly population dynamics is discussed

Provider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status.

OBJECTIVE: To assess the diagnostic value of provider-initiated symptom screening for tuberculosis (TB) and how HIV status affects it. METHODS: We performed a secondary analysis of randomly selected participants in a community-based TB-HIV prevalence survey in Harare, Zimbabwe. All completed a five-symptom questionnaire and underwent sputum TB culture and HIV testing. We calculated the sensitivity, specificity, and positive and negative predictive values of various symptoms and used regression analysis to investigate the relationship between symptoms and TB disease. FINDINGS: We found one or more symptoms of TB in 21.2% of 1858 HIV-positive (HIV+) and 9.9% of 7121 HIV-negative (HIV-) participants (P or = 2 weeks' duration, any symptom and a positive sputum culture had sensitivities of 48%, 81% and 65%, respectively; in HIV- participants, the sensitivities were 45%, 71% and 74%, respectively. Symptoms had a similar sensitivity and specificity in HIV+ and HIV- participants, but in HIV+ participants they had a higher positive and a lower negative predictive value. CONCLUSION: Even smear-positive TB may be missed by provider-initiated symptom screening, especially in HIV+ individuals. Symptom screening is useful for ruling out TB, but better TB diagnostics are urgently needed for resource-poor settings

"It is not possible to go inside and have a discussion": how fear of stigma affects delivery of community-based support for children's HIV care.

Caregivers mediate children's access to HIV care and their adherence to treatment. Support for caregivers may improve health outcomes in children, but fear of HIV stigma and discrimination can affect both uptake and delivery of support services. Within a trial evaluating community-based support for caregivers of newly HIV diagnosed children in Harare, Zimbabwe, we conducted a longitudinal qualitative study to explore how stigma affected delivery and acceptance of the intervention. We conducted semi-structured interviews with 36 caregivers, 15 children, and 20 community health workers (CHWs). Children and caregivers described experiencing or witnessing stigma and discrimination, causing some to resist home visits by CHWs. Anxiety around stigma made it difficult for CHWs to promote key messages. In response, CHWs adapted the intervention by meeting caregivers outside the home, pretending to be friends or relatives, and proactively counteracting stigmatising beliefs. As members of local communities, some CHWs shared concerns about discrimination. HIV stigma can hinder "getting a foot over the threshold" in community-based programmes, particularly for households most affected by discrimination and thus least likely to engage with services. For community support programmes to be effective, stigma-related resistance should be addressed from the outset, including CHWs' own concerns regarding HIV stigma