Mortality in an ophthalmic ward at a tertiary eye unit in Zimbabwe

A journal article on mortality in an ophthalmic ward, Zimbabwe.Ocular problems the world over have not drawn the attention they deserve outside the “Vision 2020 Programme” because of the associated negligibly low mortality rate. This has resulted in little if any funding at all being allocated for Eye Care Services by Central Governments outside the first world. Knowledge of the causes and rate of mortality among patients admitted to a tertiary eye unit in Zimbabwe would be of immense value in lobbing for funding and resource mobilization for Eye Care Services from Central Government. Traditionally Ophthalmic Wards are known to have the lowest mortality figures in hospitals the world over. Studies done in West Africa have confirmed low mortality figures in Ophthalmic Wards where orbital cellulites and orbital malignancies were among the leading causes of death.'2 Anecdotal reports in Zimbabwe suggest that we have higher mortality figures and different patterns of leading causes of mortality in our Ophthalmic Wards when compared to other units in Africa. The aim of this audit was to review all case records of patients who died in SKH Eye Unit Wards between August 1984 and October 2008 and determine the attributed causes of those deaths

Orbital Exenterations and Squamous Cell Carcinoma of the Conjunctiva at Sekuru Kaguvi Eye Unit, Zimbabwe

A CAJM article on Orbital exenterations in a Zimbabwe hospital.The association of squamous cell carcinomas of the conjunctiva and human immunodeficiency virus (HIV) is well documented in the literature.1'3 Early detection and treatment of patients with SCCA of the conjunctiva is of utmost importance in terms of curing the disease and minimizing the problems associated with managing advanced disease. Inadequate ophthalmic services in Zimbabwe coupled with harsh socio-economic circumstances contribute to late presentation of patients with SCCA of the conjunctiva, thus necessitating the use of orbital exenteration as the most appropriate management option. Orbital exenteration is a surgical procedure involving the removal of all orbital contents including eyelids up to the brow leaving the bony walls. The procedure is usually recommended for patients with advanced orbital malignancies. It facilitates the delivery of both radiotherapy and chemotherapy,4 offers the patient a chance of complete recovery from the disease and also improves the quality life for the patient. The procedure is very rare among developed countries and was fairly uncommon in our department during the eighties

Low level technology tool (LLT) in screening for blindness: test qualities in the outpatients department of a tertiary eye unit using the Snellen Chart

A journal article on low level technology (LLT) tool in screening for blindness.Visual acuity is a measure of form sense which depends on the resolving power of the eye and light sense. The Snellen chart had been the universally accepted "gold standard" method used to measure visual acuity until the introduction of the crowded logMAR acuity test.Illiteracy, the cost of making the charts and the need for some basic training of the user are some of the limitations associated with the instrument when employed to screen for blindness in communities which are hard to reach. The need for a reliable, cheap, readily available and universally accepted alternative instrument for screening people with visual problems in remote places cannot be underscored especially today when there is a global fight against avoidable blindness through “Vision 2020” programmes. Locals can use this tool to identify those with visual impairment and arrange for them to be seen by the ophthalmic team for proper assessment

Zimbabwe’s food insecurity paradox: hunger amid potential

A research paper on the paradox of poverty in a situation of great potential agricultural yields in Zimbabwe's quest for food security.Food security is one of the primary goals for human and sustainable development the world over. At the global level, one of the millennium development goals is halving the number of undernourished people in the world by 2015. In Zimbabwe, food security has been at the centre of development goals and strategies since independence in 1980. Zimbabwe has also ratified all the conventions regarding sustainable development, including the United Nations Millennium Development Goals. In the 1980s, Zimbabwe received international acclaim for its agricultural policies and grain surpluses212 but many households in the rural areas faced chronic food insecurity. Although Zimbabwe has the potential to achieve food security, it has experienced food shortages since the 1990s at both the national and household levels. Food self sufficiency in Zimbabwe could be achieved primarily through production and then distribution to the population through appropriate marketing policies and channels. In 1985, grain self-sufficiency was 212 per cent and Zimbabwe was regarded as the grain basket of the Southern African Development Community." However, production of the main staple food crops has been declining over the years. Whilst low production can be attributed to poor and erratic rainfall, low soil fertility and other institutional and policy factors have been responsible for lagging production from the 1999/2000 season onwards

Providing marketing information to smallholders in Zimbabwe: What can the state usefully do?

In recent decades, significant international assistance has been provided to assist the establishment of market information systems (MISs) in a range of developing countries, including many in Africa. However, experience with state-run MISs, looking to provide current price information to market participants, has not been encouraging. Volatile horticultural markets provide particular challenges for such MISs. Therefore, it is suggested that it might be more appropriate to provide other types of marketing information to inform the production and marketing decisions of smallholder producers. This paper reports on recent efforts by the national extension agency, Agritex, to provide such information to smallholder horticultural producers in two districts of north-eastern Zimbabwe. Drawing on an initial evaluation of this pilot programme, the paper suggests that: 1) in the Zimbabwe case, the extension service may provide a viable vehicle for dissemination of marketing information to smallholder (horticultural) producers; 2) information on new crops and market opportunities is valued more highly by farmers than information on current market prices; 3) such information should complement, not supplant, traditional production extension advice. The paper concludes by considering some of the issues pertaining to the continuation and expansion of the pilot programme.Marketing,

Rhabdomyosarcoma of the orbit in a four months old infant in Zimbabwe: a case report

Rhabdomyosacoma, as a medical condition, observed in a four month old infant at a Zimbabwe hospital.Infants younger than one year of age with Rhabdomyosacoma appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome.. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Call is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma

Bilateral HIV related ocular surface squamous neoplasia: a paradigm shift

A CAJM research article on HIV related ocular surface squamous neoplasia at an eye unit hospital in Zimbabwe.Four patients with bilateral ocular surface squamous neoplasia attended to at Sekuru Kaguvi Hospital Eye Unit are being presented to alert practitioners that OSSN is potentially a bilateral disease and its prevalence is likely to increase as the life expectancy of HIV infected patients is being positively affected by antiretroviral therapy. Reports on ocular diseases should be clear on laterality to avoid confusion between number of patients affected and number of eyes involved since the two cannot be used interchangeably

Patterns of retinoblastoma in Zimbabwe: 2000-2009

A research study on the high incidence of Retinoblastoma eye diseases among children from poor countries like Zimbabwe between the period 2 000 to 2009 .Retinoblastoma is the most common intraocular malignant tumour of childhood but it remains a rare disease. It occurs more commonly in less affluent regions of the world compared to richer regions. The incidence of retinoblastoma within age group 0-4 years varies from country to country. Africa generally has a higher incidence especially in the sub Saharan Africa region ranging from 10.6 to 42.5cases per million. This is in contrast to developed countries where in the USA, the incidence is 11.8 and in Europe it ranges from 6-12. Bulgaria has the lowest incidence of 3.4 cases per million."' In Zimbabwe the incidence of retinoblastoma is estimated at 23.3 per million ranking 3rd highest in the world after Uganda and Mali

Screening for Ocular Surface Squamous Neoplasia (OSSN) by Slit-lamp Assisted Visual Inspection (SAVI) following a short course of mild topical steroid-test qualities

Introduction: Ocular surface squamous neoplasia (OSSN) is currently the commonest ocular malignancy affecting people of child bearing age and is associated with high morbidity and mortality rates in Zimbabwe. Early surgical intervention has been shown to mitigate the effects of OSSN amongst its victims, however this is hampered by limited histopathological services which should guide the extent of surgical excisions of these tumours. Purpose: The purpose of this study was to determine the accuracy of Slit-lamp Assisted Visual Inspection (SAVI) in diagnosing ocular surface squamous neoplasia with the hope of recommending a fall back tool that ophthalmologists / medical practitioners / ophthalmic nurses or optometrists can use in resource limited situations without readily accessible histopathological services when surgical intervention is contemplated. Method: This was part of a study which screened one hundred and nineteen (119) patients with conjunctival growths and recruited sixty seven (67) patients with ocular surface squamous neoplasia by visual inspection over a period of six months. All patients received a week’s course of topical fluorometholone 0.1% and had the lesions excised either completely or partially depending on size of tumour and histology performed on the tissues. The histology results were compared with the results by visual inspection to determine diagnostic accuracy. Outcome measures were specificity, sensitivity and predictive values. Results: Total number of patients with conjunctival growths screened by visual inspection was 119, with median age of 42 years and a range of 18 to 90 years and gender ratio of 1:1.9 in favour of females. There was no significant age difference between confirmed OSSN patients and non-OSSN (pterygia) and the p-value was 0.617. Sensitivity and specificity of visual inspection in diagnosing OSSN when compared to histology were 94.3% and 74.2% respectively, with a positive predictive value of 74.6%. Histology reports indicated that 24.5% of OSSN specimens seen actually arose from pterygia. Conclusions: Slit lamp assisted visual inspection (SAVI) is an accurate method of clinically diagnosing OSSN and can be recommended for use in resource limited settings with hard to access histopathological services