A multilevel analysis of the determinants of HIV testing in Zimbabwe: evidence from the demographic and health surveys

Introduction Zimbabwe is still burdened with HIV epidemic and the government has an ambitious aim in the post-2015 era to end the AIDS epidemic by 2030. To achieve this, the government has set up the 90-90-90 strategic milestones to be achieved by 2020. It is daunting task to increase HIV testing uptake from current estimate of 56%to 90% to meet these targets. The current government’s initiative requires an understanding of determinants of HIV testing. Objectives The specific objectives of this study are to: (i) identify the individual and community-level determinants of HIV testing, focussing on predisposing, enabling and perceived need factors (PREP); and (ii) establish gender differences. Material and Methods We applied multilevel logistic regression models to nationally-representative samples of 17,797women and 14,587 men from the 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys to examine the determinants of HIV testing. Results HIV testing uptake increased significantly between 2005/6 and 2010/11, especially for women (females OR=5.60; males OR=2.57). Most PREP factors associated with HIV testing are largely consistent with patterns in Southern Africa (e.g. higher uptake by women and those who are wealthier), but unique patterns have also emerged. In particular, results reveal important gender differences: rural residence is associated with lower uptake of HIV testing for women (OR=0.74) but higher for men (OR=1.16); community wealth is a more important factor in enabling HIV testing than household wealth for women, but the converse is true for men; and individual-level, rather than community-level stigma is important for women, while for men, it is community-level stigma that is important. Conclusion Observed gender disparities in determinants of HIV testing calls for gender specific response. Couple-oriented HIV counselling and testing services where men accompany their spouse to HIV screening during pregnancy may help increase HIV testing uptake for males and reduce gender disparities

Reinsurance and dividend management

Includes bibliographical references.In this dissertation we set to find the dual optimal policy of a dividend payout scheme for shareholders with a risk-averse utility function and the retention level of received premiums for an insurance company with the option of reinsurance. We set the problem as a stochastic control problem. We then solve the resulting second-order partial differential equation known as Hamilton-Jacobi-Bellman equation. We find out that the optimal retention level is linear with the current reserve up to a point whereupon it is optimal for the insurance company to retain all business. As for the optimal dividend payout scheme, we find out that it is optimal for the company not to declare dividends and we make further explorations of this result

The changing age ecology of measles and its implications on measles control

A clinical report on the changing age ecology of measles and its management in Zimbabwe.World-wide an estimated two million children die from measles and its complications every year.1 Severe measles is limited geographically to developing countries where it is unquestionably one of the most prevalent and serious infectious diseases of childhood/ This gruesome epidemiological picture has provided a strong priori case for measles prevention through immunisation. In the City of Gweru in Zimbabwe, vaccination against measles was commenced in 1971, gained momentum in the late seventies and was accelerated and consolidated with the advent of the Expanded Programme on Immunisation (EPI) in 1982-83. In this paper we shall examine how, despite aggressive efforts aimed at controlling measles through vaccination, it would not be possible to interrupt measles transmission with the single nine months of age vaccination regime, due to the changing age epidemiology of the disease

Integrated HIV and maternal/reproductive health service utilization: trajectory for prevention of mother to child transmission of HIV in Zimbabwe

Background: The persistent high mortality related to HIV infection in sub-Saharan Africa has prompted calls for scaling-up access to sexual and reproductive health services including family planning as a trajectory to prevent HIV infection. Thus, HIV prevention programs have been integrated into family planning and reproductive health care services as a means to reach out to men and women who are HIV positive and those who are vulnerable to HIV infection. While the rationale for integration of HIV and reproductive health (RH) services is strong, there is paucity of information on which population groups most utilize these services. Due to the considerable stigma attached to HIV/AIDS, people living with HIV and those who perceive themselves to be at risk of HIV infection may be less likely to use integrated health care services. This thesis aims to inform policy and programs on better integration of HIV testing, maternal health care, and family planning services in order to optimize HIV prevention programs such as prevention of mother to child HIV transmission and condom use with the broader aim to reduce the HIV pandemic.Objectives: Focusing on individual and community-level predisposing, enabling and perceived need factors (PREP), the specific objectives of the study are to: (i) examine the effects of HIV on reproductive health care services; (ii) identify the determinants of HIV testing, antenatal and delivery care services; (iii) examine contraceptive methods choice among women who know their HIV-sero status; and (iv) establish community-level variation in service utilization.Data and Methods: The study applied multilevel binary and multinomial logistic regression models to nationally-representative samples of women and men who participated in the 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys.Results: Overall, those who were ever tested for HIV and with low HIV stigma were more likely to use maternal health services than their counterparts who had never been tested or with high HIV stigma. These groups were also more likely to use condoms and long-term contraceptive methods as a means to prevent both unwanted pregnancies and HIV infection. The results from the analysis of HIV testing showed an evidence of improvement in HIV testing uptake between 2005/6 and 2010/11, especially for women. Most individual level socio-economic and demographic factors associated with HIV testing are largely consistent with patterns in Southern Africa (e.g higher uptake by women and those who are wealthier), but important patterns have also emerged. In particular, results reveal notable gender differences in the determinants of HIV testing: rural residence is associated with lower uptake of HIV testing for women but higher for men; for women, average wealth in a community is a more important factor in enabling HIV testing than household wealth, but the converse is true for men; individual-level, rather than community-level stigma is important for women, while for men, it is community-level stigma that is important.The analysis of determinants of maternal health care shows that use of antenatal and delivery care services in Zimbabwe are improving and are determined by a wide range of individual-level factors relating to women’s economic and demographic status as well as HIV factors relating to stigma, HIV awareness, ever been tested for HIV during pregnancy, knowing someone who died due to HIV, and factors relating to availability and access to health care and media within the community. The individual-level enabling factors that were particularly strong for women included high socio-economic status and not having observed HIV stigmatisation and discrimination. These groups of individuals have an extremely high likelihood of having been ever tested for HIV during pregnancy, or having an early or more than four ANC visits; and have delivered their babies in a health institution with a professional delivery attendant, particularly if they live in richer communities or in communities with low stigma and HIV prevalence.The analysis of determinants of contraceptive methods choice among women who know their HIV status identified a number of potential pathways of the determinants of this outcome. The analysis revealed that women who know their HIV-positive status were more likely to use condoms and long-term methods than those who know their HIV-negative status. The study also revealed that even though wealth status has no direct effect on the choice of contraceptive methods, it has an indirect impact on the choice of condom versus hormonal methods through intermediate factors such as HIV sero-status.Conclusions: First, the observed gender disparities in determinants of HIV testing calls for a gender specific response. Couple-oriented HIV counselling and testing services where men accompany their spouses to HIV screening during pregnancy may help increase HIV testing uptake for males and reduce gender disparities. Second, the fact that enabling factors such as socioeconomic status, having been tested for HIV as part of ANC and stigmatization are predictors of maternal health care utilization suggests that being wealthier, having been HIV tested during pregnancy; and having low HIV stigma do translate into expected behavior for pregnant women. Third, knowing own HIV status emerges as a major predictor of condom use and long-term contraceptive methods for women who are HIV positive. These findings have important policy and integrated programme implications for addressing unmet need for HIV and RH services in Zimbabwe

The strengths and difficulties of adopted children: a pilot study

Includes abstract.Includes bibliographical references.International research has led to the conclusion that adopted children are at a greater risk of behavioural and emotional difficulties than non-adopted children. However, these findings have been inconsistent and inconclusive, and therefore cannot necessarily be generalised to a country such as South Africa with its diverse populations. This study explored the strengths of adopted children and the difficulties they face, in comparison with children who are raised by their biological parents, with a focus on the Cape Town area. Furthermore, this study sought to establish whether there was an association between demographic variables and adopted children’s total difficulties scores

Exploring the effect of male child sexual abuse on a sample of men in Zimbabwe

Several studies suggest that sexual assaults are experienced differently by males than by females. In dominant discourses in which sexual perpetration is associated with males and sexual victimisation with females, males are expected to practice and exhibit hegemonic masculinity. This gendered perception of sexual assaults means that female perpetration of male child sexual abuse often goes unrecognised and that male perpetration is particularly problematic for male victims. Using a feminist critical paradigm and critical discourse analysis as a research design, this study explored how a sample of male victims in Zimbabwe experienced sexual abuse as children and how they were affected by it. The study, further, explored how the male victims of childhood sexual abuse sought to reconcile the experience of victimisation with their identity as males. Nine men participated in the study. The sample was, due to the sensitive nature of the topic, purposively selected using letters describing the nature of the study and inviting participation. The letters were distributed through diverse channels, including a newspaper with national coverage. Most participants reported experiences of female perpetrated abuse. The study found that, in keeping with dominant discourses of hegemonic masculinity, the participants struggled to construct themselves as victims. Many of the participants were considerably and negatively affected by having been sexually abused. Participants utilised a variety of methods to come to terms with the fact that they were males who had been victimised.PsychologyM.A. (Psychology

Role of green manure options in organic cropping systems

On the Canadian prairies, organic production generally includes the use of annual green manure (GrM) crops, which are terminated using tillage to add nutrients and organic matter to the soil. However, in a GrM plough-down year, farmers face loss of income. As an alternative to growing traditional GrM crops, legumes can be grown alone or intercropped with cereals and harvested as green feed forage (GF) for use on-farm or for sale to other producers without depleting soil nitrogen (N) for the subsequent crop. We hypothesized that the GF system would have similar biomass, and N yield, and ultimately would return N into the soil. Furthermore, by intercropping a legume with a cereal, biological N2-fixation will be enhanced in the legume. Field experiments, conducted over two years, were established at Vonda and Delisle, Saskatchewan, Canada. The experiment was conducted using a randomized complete block design (RCBD) with 16 treatments and four replicates in which field pea (Pisum sativum cv 40-10 silage pea), oat (Avena sativa L.cv AC Morgan), and triticale (X Triticosecale Wittmack cv Pika) were grown alone or in combination and managed as GrM or GF. Wheat and tillage fallow served as cropped and uncropped controls, respectively. The tillage fallow-control system was tilled twice in the growing season using a small tractor disc. The intercropped oat was seeded at three densities (50, 100, and 150 plants m-2) to determine whether increasing cereal density stimulated N2-fixation in the field pea. The GrM system was sampled and incorporated (when the field pea was at full bloom) two weeks earlier than the GF system. Consequently, at both sites, all treatments in the GF system consistently yielded more dry matter and accumulated more N than treatments in the GrM system. At the Delisle site, where percent nitrogen derived from the atmosphere (%Ndfa) was compared, increasing cereal density did not increase N2-fixation in both management systems. However, pea in the GF system accumulated more than twice the amount of N (kg ha-1) from fixation as compared to pea in the GrM system, presumably because of the longer growth period. Wheat grown following the GrM treatments produced more biomass and accumulated more N than wheat following the GF treatments. Wheat grown after the monoculture field pea as a GrM had greater yield than all treatments. As well, the GrM system returned more N to the soil than did the GF system. The extra two weeks of growth in the GF system resulted in the extraction of significant amounts of nutrients and probably moisture from the soil, which adversely affected yield and nutrient composition of the following wheat crop. Although organic farmers may lose income in the plough-down year, on a longterm soil sustainability basis, the GrM system is a better option than the GF system as it returns nutrients to the soil, thus providing improved plant biomass, and N accumulation of subsequent crops. However, organic farmers growing GF for hay may benefit from the increased productivity of this system on a short-term basis. Thus, farmers pursuing GF options may need to adopt other means of sustaining soil productivity on a longer term. The tilled fallow-control system resulted in high amounts of biomass and N accumulation by the subsequent wheat crop, probably due to the fact that there were no nutrients taken up in the previous year and moisture was conserved in these treatments. However, this system may have less long-term benefits compared to the GrM regime, as no nutrients are returned through ploughing down a crop

Maternal smoking and the risk of still birth: systematic review and meta-analysis

BACKGROUND: Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth. METHODS: We searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31(st) December 2012. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth. RESULTS: 1766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p  <  0.0001). In subgroup analysis, smoking 1-9 cig/day and ≥10 cig/day was associated with an 9% and 52% increase in the odds of stillbirth respectively. Subsequently, studies defining stillbirth at ≥ 20 weeks demonstrated a 43% increase in odds for smoking mothers compared to mothers who do not smoke, (OR 1.43, 95% CI 1.32, 1.54, p  <  0.0001), whereas studies with stillbirth defined at ≥ 24 weeks and ≥ 28 weeks showed 58% and 33% increase in the odds of stillbirth respectively. CONCLUSION: Our review confirms a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority

Robust and cheating-resilient power auctioning on Resource Constrained Smart Micro-Grids

The principle of Continuous Double Auctioning (CDA) is known to provide an efficient way of matching supply and demand among distributed selfish participants with limited information. However, the literature indicates that the classic CDA algorithms developed for grid-like applications are centralised and insensitive to the processing resources capacity, which poses a hindrance for their application on resource constrained, smart micro-grids (RCSMG). A RCSMG loosely describes a micro-grid with distributed generators and demand controlled by selfish participants with limited information, power storage capacity and low literacy, communicate over an unreliable infrastructure burdened by limited bandwidth and low computational power of devices. In this thesis, we design and evaluate a CDA algorithm for power allocation in a RCSMG. Specifically, we offer the following contributions towards power auctioning on RCSMGs. First, we extend the original CDA scheme to enable decentralised auctioning. We do this by integrating a token-based, mutual-exclusion (MUTEX) distributive primitive, that ensures the CDA operates at a reasonably efficient time and message complexity of O(N) and O(logN) respectively, per critical section invocation (auction market execution). Our CDA algorithm scales better and avoids the single point of failure problem associated with centralised CDAs (which could be used to adversarially provoke a break-down of the grid marketing mechanism). In addition, the decentralised approach in our algorithm can help eliminate privacy and security concerns associated with centralised CDAs. Second, to handle CDA performance issues due to malfunctioning devices on an unreliable network (such as a lossy network), we extend our proposed CDA scheme to ensure robustness to failure. Using node redundancy, we modify the MUTEX protocol supporting our CDA algorithm to handle fail-stop and some Byzantine type faults of sites. This yields a time complexity of O(N), where N is number of cluster-head nodes; and message complexity of O((logN)+W) time, where W is the number of check-pointing messages. These results indicate that it is possible to add fault tolerance to a decentralised CDA, which guarantees continued participation in the auction while retaining reasonable performance overheads. In addition, we propose a decentralised consumption scheduling scheme that complements the auctioning scheme in guaranteeing successful power allocation within the RCSMG. Third, since grid participants are self-interested we must consider the issue of power theft that is provoked when participants cheat. We propose threat models centred on cheating attacks aimed at foiling the extended CDA scheme. More specifically, we focus on the Victim Strategy Downgrade; Collusion by Dynamic Strategy Change, Profiling with Market Prediction; and Strategy Manipulation cheating attacks, which are carried out by internal adversaries (auction participants). Internal adversaries are participants who want to get more benefits but have no interest in provoking a breakdown of the grid. However, their behaviour is dangerous because it could result in a breakdown of the grid. Fourth, to mitigate these cheating attacks, we propose an exception handling (EH) scheme, where sentinel agents use allocative efficiency and message overheads to detect and mitigate cheating forms. Sentinel agents are tasked to monitor trading agents to detect cheating and reprimand the misbehaving participant. Overall, message complexity expected in light demand is O(nLogN). The detection and resolution algorithm is expected to run in linear time complexity O(M). Overall, the main aim of our study is achieved by designing a resilient and cheating-free CDA algorithm that is scalable and performs well on resource constrained micro-grids. With the growing popularity of the CDA and its resource allocation applications, specifically to low resourced micro-grids, this thesis highlights further avenues for future research. First, we intend to extend the decentralised CDA algorithm to allow for participants’ mobile phones to connect (reconnect) at different shared smart meters. Such mobility should guarantee the desired CDA properties, the reliability and adequate security. Secondly, we seek to develop a simulation of the decentralised CDA based on the formal proofs presented in this thesis. Such a simulation platform can be used for future studies that involve decentralised CDAs. Third, we seek to find an optimal and efficient way in which the decentralised CDA and the scheduling algorithm can be integrated and deployed in a low resourced, smart micro-grid. Such an integration is important for system developers interested in exploiting the benefits of the two schemes while maintaining system efficiency. Forth, we aim to improve on the cheating detection and mitigation mechanism by developing an intrusion tolerance protocol. Such a scheme will allow continued auctioning in the presence of cheating attacks while incurring low performance overheads for applicability in a RCSMG

Testing the Applicability of the Twin Deficits Hypothesis in Zimbabwe

The concept of the twin deficit hypothesis is fraught with controversy. Some economists argue that there is independence between current account deficits and budget deficit while some believe that the relationship exists but the direction of causality is uncertain. While others say there is causality running from budget deficit to current account deficit and vice versa. The majority of economists trained in the Keynesian thinking are in favour of the twin deficits hypothesis while others are against it but in favour of the contrasting theory, the Ricardian equivalence.  The Ricardian equivalence hypothesis, argues that the two are independent. The major objective of the paper is to test the applicability of the twin deficits hypothesis to Zimbabwe. This is premised on the argument of persistent budget and current account deficits obtaining in Zimbabwe. The majority of researches done along this line are not in Southern Africa. A Granger representation alongside co-integration analysis is used in the study. The findings indicate that the twin deficit hypothesis holds using Johansen cointegration and Granger causality based on lag two. The public expenditure overruns should be a thing of the past. Keywords: Twin deficits, current account, budget deficit, Granger causality, Zimbabw