How can we improve the use of essential evidence-based interventions?

Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salaria, Natasha. BioMed Central; Reino UnidoFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Mbizvo, Michael. University of Zimbabwe; Zimbabu

Male fertility regulation: a study on acceptance among men in Zimbabwe

A clinical study of family planning and birth control methods preferred and used by Zimbabwean men.Both traditional and modem methods of family planning widely practiced currently in most countries, especially in sub-Saharan Africa, focus solely on the woman. There is hardly data on male directed methods of fertility regulation, or indeed whether, or not, such contraceptive options are acceptable. Contraception, whether for spacing, avoiding unintended pregnancy or limiting family size, is almost always a female prerogative. This, in certain circumstances, is despite the available female method being contraindicated. Acceptance of male sterilisation (vasectomy), condom use and male contraceptive pill were investigated in a representative sample of 711 Zimbabwean men. Only 14 pc of men considered vasectomy an acceptable method of contraception and none of the men had current or previous use of this method. Seventeen17 percent of the men had prompted knowledge of this method, compared to 53 pc who had prompted knowledge of female sterilisation

Sentinel surveillance identifies a high HIV prevalence in population in Zimbabwe

a position paper on HIV surveillance and planning in Zimbabwe during the late 1990's.Sero-surveillance of the human immunodeficiency virus (HIV) and analysis of the patterns and temporal trends of the acquired immunodeficiency disease (AIDS) epidemic assist in planning for its impact and the continued development and monitoring of preventive strategies. Data regarding differential sero-prevalence status in rural versus urban areas of Zimbabwe and indeed many other countries in the region is very sparse. Anecdotal evidence suggests that whereas early infections occurred in mobile urban and high risk populations, the epidemic could now be taking hold in traditionally non-high risk categorized rural populations. The notion of the epidemic being spatially variable with rural areas being less affected may, with time and given the developed road infrastructures, not hold true

Benchmark assessment of orphaned and vulnerable children in areas of the Zambia Family (ZAMFAM) Project—Brief

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. This brief provides a summary of the findings outlined in the final report on the needs of OVC families and the gaps in service provision, as well as suggestions for strengthening care and support strategies for OVC in Zambia

HIV-1 Seroconversion Incidence Following Pregnancy and Delivery Among Women Seronegative at Recruitment in Harare, Zimbabwe

A CAJM article on the incidence of HIV amongst pregnant women in Zimbabwe.Objective: To estimate the incidence of HIV sero-conversion among women following pregnancy and' delivery. Design: A prospective cohort of women who were HIV negative at recruitment on first antenatal care visit. Materials and Methods: Pregnant women were invited to undergo voluntary confidential HIV counseling and blood draw for HIV testing during the first antenatal care visit as part of a prospective study of mother- to-child transmission of HIV-1. Repeat tests were conducted at delivery, six weeks post partum and at three monthly intervals until 24 months or on termination due to subsequent pregnancy, death or loss to follow up. Logistic regression modelling was used to determine independent predictors of HIV sero-conversion. Results: Among 372 HIV negative pregnant women who were enrolled, 66 sero-converted during follow up, resulting in a sero-incidence of 4.8 per 100 person years (95% confidence interval [Cl], 3.1 to 6.5). Women who did not seroconvert during the time of pregnancy or follow up were significantly more likely to have used a condom with their partners (OR = 0.68,95% Cl = 0.47 to 0.99). Women aged 17 years and below had the highest sero-conversion incidence (6.25%) followed by those aged 18 to 19 years (5.42%). Women who sero-converted and those who were HIV positive at recruitment were more likely to be married. Lack of education by the partner of a pregnant woman constituted a significant risk factor for HIV sero-conversion (OR = 2.8; 95% Cl = 1.1 toll.0). Conclusions: There is a high HIV sero-conversion incidence among women during pregnancy and following delivery, especially those aged 19 years and below. Being married does not protect the women from the risk of HIV sero-conversion. Strategies for HIV prevention should target pregnant women and their partners

Unsafe abortions and unwanted pregnancies contribute to maternal mortality in Zimbabwe

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A critical analysis of governance and management in Zimbabwe's colleges of technical and vocational education: issues for revitalisation

This research was carried out in order to gain a better understanding of the practice of governance in a technical or vocationally oriented college and the critical role played by the principal as a college manager within the governance system in which industrialists and head office are also key players. Conceptual literature relating to issues of governance and management within the education scenario is examined. The wider issues of governance are critically analysed in the context of power and control mechanisms initiated by the Ministry of Higher Education as the responsible authority for the colleges. The influence of the industrial sector as the consumers of skilled labour force is analysed through college advisory councils set up in terms of the relevant pieces of legislation. The research is qualitative and takes the form of three case studies of technical and vocational colleges in Zimbabwe. Data were collected through multiple methods from varied sources with a view to ensuring triangulation. The multiple-case design enabled me to dig beneath the surface of what apparently happens in these organisations and unearth issues and concerns at the wider governance and management levels. Views and experiences of participants are captured and explained through in-depth interviews, observations and documentary sources. Results are discussed in relation to the relevant literature allowing grounded theory to emerge. The research highlights the roles of key players in governance and the issues of relationships among these actors. What emerges is a desperate situation of ineffectiveness, problematic processes in governance and poor responsiveness of these colleges to the labour market demands. The potential for generalisability and transferability is discussed in the report and possible corrective intervention strategies are recommended. The thesis demonstrates that managers of these colleges and indeed senior officers in head office who are at the centre of governance and will need transformational leadership development in order for them to come to terms with such things as people’s feelings, abandoning ‘outdated’ policies, managing change, and handling communication effectively. Various strategies for revitalisation of governance and management in technical and vocational colleges are suggested

Generational differences in male sexuality that may affect Zimbabwean women's risk for sexually transmitted diseases and HIV/AIDS

Objective: To determine generational differences in male sexuality, which could predispose men’s female sexual partners to STDs/HlV.Design: Cross-sectional study. Setting: Harare, Zimbabwe.Subjects: Three hundred and ninety seven male adults aged eighteen years and above. Main outcome measures: Number of sexual partners, condom use, likelihood of sharing information on HIV status with wife or with other sexual partners, preference for women with dry vaginas prior to sex and discussion about sexual satisfaction with wife or with girlfriend.Results: Fewer men in the 27-39 year age group when compared to men aged 18-26 years (22.2% versus 28.9%) had two or more sexual partners. The greatest proportion of ever condom users were men aged 27-39 years, but this proportion was not significantly differentfrom the proportion of ever condom users aged 18-26 years (76.5% versus 69.5%; Odds Ratio [OR] = 1.42, 95% Confidence interval [CI] 0.81-2.51). Men aged > 40 years (43.8%, OR = 0.34, 95% CI 0.20-0.84) were significantly fewer than men aged 18-26 years in ever use of condoms. In the event that they contracted HIV, 79.5%, 82.4 % and 85.9% of men aged 18-26, 27-39 and 40 years and above respectively indicated that they would disclose their HIVstatus to their wives. On the other hand, men aged 18-26 years (56.8%), 27-39 years (54.0%) and > 40 years (53.1%) indicated that they would disclose their HIV status to girl friends or other sexual partners. Significantly, more men aged 40 years (OR= 2.23; 95% CI 1.19-4.18) and 27-39 years (OR = 1.82; 95% CI 1.00-3.32) in comparison to 18-26 year old men indicated their preference for women with dry vaginas prior to sex. The greatest proportion of menwho discussed sexual satisfaction with their wives (85.7%) and girl friends or other sexual partners (23.5%) were aged 27-39 years.Conclusion: It is recommended that public health and behavioural scientists in Zimbabwe devote more time to understanding the intricacies of male sexual behaviour at different stages of life. This would provide the important insight needed to develop effective targetedinterventions to reduce the spread of STDs/HIV in Zimbabwe

The burden and risk factors of Sexually Transmitted Infections and Reproductive Tract Infections among pregnant women in Zimbabwe

<p>Abstract</p> <p>Background</p> <p>Sexually transmitted infections (STIs) and Reproductive tract infections (RTIs) are responsible for high morbidity among women. We aim to quantify the magnitude of the burden and risk factors of STI/RTI s among pregnant women in Zimbabwe.</p> <p>Methods</p> <p>A cross sectional study of pregnant women enrolled at 36 weeks of gestation from the national PMTCT program. Study was conducted from three peri-urban clinics around Harare Zimbabwe offering maternal and child health services.</p> <p>Results</p> <p>A total of 691 pregnant women were enrolled. Prevalence of HSV was (51.1%), HIV (25.6%) syphilis (1.2%), <it>Trichomonas vaginalis </it>(11.8%), bacterial vaginosis (32.6%) and Candidiasis (39.9%). Seven percent of the women had genital warts, 3% had genital ulcers and 28% had an abnormal vaginal discharge. Prevalence of serological STIs and vaginal infections were 51% and 64% respectively.</p> <p>Risk factors for a positive serologic STI were increasing age above 30 years, polygamy and multigravid; adjusted OR (95% CI) 2.61(1.49-4.59), 2.16(1.06-4.39), 3.89(1.27-11.98) respectively, partner taking alcohol and number of lifetime sexual partners. For vaginal infections it was age at sexual debut; OR (95% CI) 1.60(1.06-2.42). More than 25% of the women reported previous STI treatment. Fifty two percent reported ever use of condoms and 65% were on oral contraceptives. Mean age gap for sexual partners was 6.3 years older.</p> <p>Conclusions</p> <p>There is a high morbidity of STI/RTIs in this cohort. There is need to continuously screen, counsel, treat and monitor trends of STI/RTIs to assess if behaviour changes lead to reduction in infections and their sustainability.</p