The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study

Background: Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Method: Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Results: Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (p < .001) as compared to recipients of institution-based services. Conclusion: Long term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance

Psychometric evaluation of the Shona version of the Multidimensional Scale of Perceived Social Support Scale (MSPSS–Shona) in adult informal caregivers of patients with cancer in Harare, Zimbabwe

Background: Providing care for a patient with cancer can negatively affect the health and psychosocial well-being of informal caregivers. However, social support has been enlisted as an essential buffer to stressful life events. There is now a greater call to routinely measure and provide support for caregivers and this is only feasible through use of validated outcome measures. The multidimensional scale of perceived social support (MSPSS) is one of the most commonly used social support outcome measure. Consequently, the MSPSS has been translated into several languages and validated across several populations. The aim of the present study was to translate the MPSS to Shona (Zimbabwean native language) and validate it in caregivers of patients with cancer.Methods: The MSPSS was translated to Shona using a backward-forward translation method, pretested on a group of caregivers (n = 10) before being administered to large sample (N = 126) at Parirenyatwa Group of Hospitals. Both exploratory and confirmatory factor analysis were performed to assess the structural validity of the MSPSS-Shona version. Reliability was assessed using the Cronbach’s alpha.Results: Data for 120 caregivers were analysed. Most were females (69.2%), had attained at least secondary education (81.7%) and married (75%). There was moderate evidence for structural validity for the 2-factor model and excellent evidence for internal consistency as the scale yielded α = 0.905.Conclusions: Despite moderate evidence for structural validity, the translation of MSPSS into native languages (e.g. MSPSS-Shona) in low resource settings can be deemed as “steps in the right direction” for evidence based practise in management of cancer. There is also need for further psychometric evaluation of the MSPSS-Shona

Does an educational workshop have an impact on caregivers’ levels of knowledge about cerebral palsy? A comparative, descriptive cross-sectional survey of Zimbabwean caregivers

BackgroundThe diagnosis of a child with a life-long disability, such as cerebral palsy (CP), can be catastrophic to parents. It is often accompanied by feelings of despair, anxiety, hopelessness, and the fear of the unknown. Knowledge about CP is thus essential for caregiver adjustment and preparation for the caregiving role. However, there is a paucity of empirical evidence regarding the best method for educating caregivers. The aim of this study was therefore to evaluate the impact of an educational intervention on caregivers’ knowledge about cerebral palsy.MethodsThis cross-sectional survey included 49 caregivers of children with cerebral palsy. Convenience sampling was used to select participants from two central hospitals in Harare, Zimbabwe. The caregivers were divided into two groups based on whether or not they had attended an educational workshop. The knowledge of cerebral palsy questionnaire (KCPQ) was administered once to assess the caregivers’ CP knowledge.ResultsThe caregivers were comparable in terms of sociodemographic characteristics. The mean KCPQ scores for caregivers who attended workshops was 17.4 (SD 1.5), versus 13.8 (SD 2.5) for those without exposure to workshops. The differences between the two groups was statistically significant (U =77.0, Z = -4.45, and P &lt; 0.001).ConclusionsOur findings suggest that educational workshops may lead to improved CP  knowledge among caregivers. This may better equip parents and guardians to meet the extra caregiving demands associated with CP, leading to improved health  outcomes for children with CP and their caregivers

Correlates of social support on report of probable common mental disorders in Zimbabwean informal caregivers of patients with stroke: a cross-sectional survey

Abstract Objective Stroke is a major global public health burden. Unfortunately, stroke invariably leads to functional limitations, consequently, most stroke survivors are hugely dependent on family members/informal caregivers in carrying out essential daily activities. The increased demands of caregiving negatively impact caregivers’ mental health. Nevertheless, caregivers who receive an adequate amount of social support are likely to adjust better to the caregiving role. We sought to determine the impact of social support on the mental wellbeing of 71 caregivers of patients with stroke in Zimbabwe, a low-resourced country. Results The mean caregiver age was 41.5 (SD 13.8) years. Patients had a mean age of 65.2 (SD 15.3) years with most being functionally dependent (93.2%). 45.1% of the caregivers showed excessive psychiatric morbidity. The mean Multidimensional Scale of Perceived Social Support (MSPSS) score was 44 (SD 9.4), denoting high levels of social support. Caregivers who received an adequate amount of social support were likely to report of lower psychiatric morbidity (Rho = − 0.285, p = 0.016). Furthermore, caregiver who were; poorer, were caring for more functionally-dependent patients, and did not receive additional assistance were likely to report of poor mental health functioning. There is therefore a strong need to implement context-specific caregivers wellness programs

The impact of social support on the health-related quality of life of adult patients with tuberculosis in Harare, Zimbabwe: a cross-sectional survey

Objective Tuberculosis (TB) is the second prime cause of mortality in Sub-Saharan Africa and remains a major worldwide public health problem. Unfortunately, patients with TB are at risk of poor mental health. However, patients who receive an adequate amount of social support are likely to have improved health outcomes. The study was done to establish how social support influences the health-related quality of life (HRQoL) of patients with TB in Harare, Zimbabwe. Data were collected from 332 TB patients and were analysed through structural equation modelling. Results The mean age of the participants was 40.1 (SD 12.5) years and most were; males (53%), married (57.8%), educated (97.3%), unemployed (40.7%), stayed with family (74.4%), and reported of less than average levels of income (51.5%). Patients received the most significant amount of social support from the family. Patients also presented with lower HRQoL as they considerably reported of pain, anxiety and depression. The final model accounted for 68.8% of the variance. Despite methodological limitations, the study findings suggest that social support optimises patients’ HRQoL. Based on the patients’ responses, it was noted that patients presented with lower mental health, therefore, there is a need to develop and implement patient wellness interventions

Absolute and relative reliability of SCRuM test battery components assembled for schoolboy rugby players playing competitive rugby in low-resource settings: A pragmatic in-season test-retest approach

Background: Schoolboy rugby is a popular sport which forms the bedrock of rugby development in many African countries, including Zimbabwe. With burgeoning talent identification programmes, the development of multi-dimensional, logically- validated, and reliable test batteries is essential to inform the objective selection of potentially talented young rugby athletes. Objectives: This study sought evidence on the absolute and relative test-retest reliability of the component test items in the newly-assembled SCRuM test battery. Methods: Utilising a pragmatic test-retest experimental design, a sample of 41 Under-19 schoolboy players playing competitive rugby in the elite Super Eight Schools Rugby League in Harare, Zimbabwe, participated in the study. Results: Physiological and game-specific skills tests which showed good to excellent relative reliability and acceptable absolute reliability, included: 20 m and 40 m speed, L-run, Vertical Jump (VJ), 60 s Push-Up, 2 kg Medicine Ball Chest Throw test (2 kg MBCT), Wall Sit Leg Strength test (WSLS), Repeated High Intensity Exercise test (RHIE), One Repetition Maximum Back Squat (1-RM BS) and Bench Press tests (1-RM BP), Yo-Yo Intermittent Recovery Level 1 test (Yo-Yo IRT L1), Tackling Proficiency test, Passing Ability Skill test and Running and Catching Ability skill test. Conclusion: All these tests are reliable and warrant inclusion in the SCRuM test battery for possible profiling of U19 schoolboy rugby players during the ‘in-season’ phase provided there is adequate participant familiarisation and test standardisation. The test-retest ICCs and measurement errors are generalisable to other young athletes in this population, making the tests useful for the evaluation of training and developmental effects of the measured constructs

A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period

Objective Globally, 13–20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. Results The mothers’ mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2–8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = − 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions

Conceptualisation and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV:a mixed scoping and systematic review protocol

Introduction Sub-Saharan Africa bears the greatest burden of HIV. Concomitant mental disorders are common, necessitating the integration of mental healthcare into routine HIV care. Consequently, it is necessary to holistically evaluate the mental health of adolescents and young adults living with HIV (AYALHIV, 10–24 years old) by measuring negative and positive psychological constructs (eg, anxiety and self-acceptance, respectively). There has been a proliferation of positive psychological outcome measures, but the evidence of their psychometric robustness is fragmented. This review, therefore, seeks to (1) identify positive psychological outcomes used in AYALHIV in sub-Saharan Africa and map the constructs onto corresponding measures and (2) critically appraise the psychometrics of the identified outcomes Methods and analysis This mixed review will be done in two parts. First, a scoping review will identify positive psychological outcomes and map them onto corresponding outcome measures. Subsequently, we will systematically evaluate the psychometric properties of the outcomes identified from the scoping review. Independent and blinded reviewers will search articles in PubMed, Scopus, Web of Science, Africa-Wide Information, CINAHL, PsychINFO and Google Scholar from inception through 30 September 2022. Thereafter, separate independent reviewers will screen the retrieved articles. We will apply a narrative synthesis to map the key constructs emerging from the scoping review. For the systematic review, the risk of bias across studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The quality of the psychometric properties will be rated using the COSMIN checklist and qualitatively synthesised using the modified Grading of Recommendations Assessment, Development and Evaluation checklist. Ethics and dissemination No ethical approvals are needed. The mixed-review outputs will collectively inform the development, implementation and evaluation of bespoke interventions for AYALHIV. Review outcomes will be disseminated in a peer-reviewed journal, on social media and through policy briefs

Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses.

BACKGROUND: Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe. METHODS: In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational analysis of NCDs care in Zimbabwe and views from patients with lived experiences. RESULTS: Saturation was reached after interviewing 10 participants from five busy urban clinics. For all three NCDs, we identified four cross-cutting barriers, a) poor access to medication and functional equipment such as blood pressure machines, urinalysis strips; b) high cost of private care; c)poor working conditions; and d) poor awareness from both patients and the community which often resulted in the use of alternative potentially harmful remedies. Participants indicated that empowering communities could be an effective and low-cost approach to positive lifestyle changes and health-seeking behaviours. Participants indicated that the Friendship bench, a task-shifting programme working with trained community grandmothers, could provide a platform to introduce NCDs care at the community level. Also, creating community awareness and initiating screening at a community level through community health workers (CHWs) could reduce the workload on the clinic nursing staff. CONCLUSION: Our findings reflect those from other LMICs, with poor work conditions and resources shortages being salient barriers to optimal NCDs care at the facility level. Zimbabwe's primary health care system faces several challenges that call for exploring ways to alleviate worker fatigue through strengthened community-led care for NCDs. Empowering communities could improve awareness and positive lifestyle changes, thus optimising NCD care. Further, there is a need to optimise NCD care in urban Zimbabwe through a holistic and multisectoral approach to improve working conditions, basic clinical supplies and essential drugs, which are the significant challenges facing the country's health care sector. The Friendship Bench could be an ideal entry point for providing an integrated NCD care package for diabetes, hypertension and depression

An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol

Background: Cerebral palsy (CP) is the most common, life-long paediatric disability. Taking care of a child with CP often results in caregiver burden/strain in the long run. As caregivers play an essential role in the rehabilitation of these children, it is therefore important to routinely screen for health outcomes in informal caregivers. Consequently, a plethora of caregiver burden outcome measures have been developed; however, there is a dearth of evidence of the most psychometrically sound tools. Therefore, the broad objective of this systematic review is to evaluate the psychometrical properties and clinical utility of tools used to measure caregiver burden in caregivers of children with CP. Methods/design: This is a systematic review for the evaluation of the psychometric properties of caregiver burden outcome tools. Two independent and blinded reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, PsychINFO and Africa-Wide Google Scholar. Information will be analysed using predefined criteria. Thereafter, three independent reviewers will then screen the retrieved articles. The methodological quality of studies on the development and validation of the identified tools will be evaluated using the four point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Finally, the psychometric properties of the tools which were developed and validated from methodological sound studies will then be analysed using predefined criteria. Discussion: The proposed systematic review will give an extensive review of the psychometrical properties of tools used to measure caregiver burden in caregivers of children with CP. We hope to identify tools that can be used to accurately screen for caregiver burden both in clinical setting and for research purposes