Maternal outcome in eclampsia at Harare Maternity Hospital.

A CAJM article on maternal mortality rates in Zimbabwe.Sub-Saharan Africa has one of the world’s highest maternal mortality ratios, estimated at 870/100 000 live births.1 Maternal mortality for the Greater Harare Maternity Unit (GHMU) was 370/100 000 live births in 1997 and eclampsia was responsible for 24.2% of maternal deaths.2 In the Greater Harare Maternity Unit (GHMU) the proportion of maternal deaths due to eclampsia has ranged between eight and 24% (Figure I). The proportion of maternal deaths due to eclampsia in similar settings ranges between 14 and 39%.3,4 Case fatality for eclampsia varies widely.3:5'9 There is need to reduce maternal mortality and interventions to achieve this reduction need to identify preventable causes of maternal death. Eclampsia is one such cause where case fatality can be reduced. We conducted a contemporaneous review of all clinical notes of women with a diagnosis of eclampsia managed in HMH from January 1997 to June 1998 with the purpose of identifying factors which adversely affected maternal outcome. Identification of risk factors for maternal death in eclamptic women was an essential step in the process of designing intervention strategies for reduction of maternal deaths from this preventable cause

Solid state spectroscopy : laser selective excitation of holmium ions in crystalline solids

The technique of laser selective excitation has been used to study the spectra of 23 Ho³⁺centres present in CaF₂ and SrF₂ crystals, in mixed Ca₀.₉₉Sr₀.₀₁F₂ and Ca₀.₉₉Ba₀.₀₁F₂ crystals and in CsCdBr₃ crystals. The polarisation of the fluorescence from and oriented crystals has been used to assign specific Ho³⁺ site symmetries to the various centres and to label the crystal-field energy levels of each centre by their group irreps. The two principal Ho³⁺ centres (A and B) observed in both CaF2:Ho³⁺and SrF2:Ho³⁺ crystals have been shown to be of C₄ᵥ and C₃ᵥ symmetry respectively. The four new centres identified in Ca₀.₉₉Sr₀.₀₁F₂:Ho3³⁺ and Ca₀.₉₉Ba₀.₀₁F₂:Ho³⁺ crystals, are derived from the parent CaF₂ C₄ᵥ symmetry (A) centre by an on-axis and an off-axis placement of a dopant cation, Sr²⁺+ or Ba²⁺, in the vicinity of the Ho³⁺ - F- pair. The three additional centres found in SrF₂:Ho³⁺ crystals are from similar Ca²⁺and Ba²⁺ substitutions in the SrF₂ lattice. Seven centres associated with n- charge compensation were observed in deuterated CaF₂:Ho³⁺ and SrF₂:Ho³⁺ crystals, with no C₄ᵥ symmetry centre being apparent. For the CsCdBr3:Ho³⁺ system, spectra of the principal dimer centre and three other minority centres are reported. Strong upconversion fluorescence was observed for the principal dimer centre, enabling crystal-field energy levels for 18 Ho³⁺ multiplets to be determined. Low symmetry crystal-field splittings and pair splittings were observed on some of the sharper transitions. Crystal-field analyses performed for all the C₄ᵥ and C₃ᵥ symmetry centres in CaF2:Ho³⁺, SrF2:Ho³⁺ and CsCdBr3:Ho³⁺ crystals are reported and the resulting crystal-field parameters discussed. Fluorescence lifetimes determined for the major Ho³⁺ centres are also presented. The high resolution and ODNMR results for the C₄ᵥ symmetry A and SB1 centres in SrF2:Ho³⁺ crystals confirm the centre symmetry assignments and the model configurations proposed on the basis of the polarisation ratio measurements. The superhyperfine ODNMR frequencies correlate well with the changes in the crystal-field parameters between the two centres

Investigation of the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road and Wilkins Infectious Diseases Hospital opportunistic infections clinics in Harare, Zimbabwe

A journal article on the effects of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on patients suffering from HV/AIDS in Zimbabwe.HIV/AIDS has become a significant public health problem in Zimbabwe, threatening the socio-economic fibre of the country and placing a tremendous strain on health delivery capacity. Although antiretroviral therapy (ART) roll out has reduced morbidity and mortality due to HIV/ AIDS, new challenges have arisen because of the development of metabolic changes induced by ART. These include impaired glucose metabolism, insulin resistance, lactic acidosis, osteopenia and dyslipidaemia1. Stavudine has been reported to cause mitochondrial toxicity that manifests as lactic acidosis in the majority of patient

Clinical laboratory test prices in Zimbabwe: a case of profiteering?

A journal study of profiteering in the pricing of clinical laboratory test prices in Zimbabwe.Cost containment has become a major cause of concern for health insurance companies and laboratory services-the traditional cash cow of hospitals can no longer be milked for institutional profit. In developing countries, studies and data on laboratory test prices are scanty. Measuring and understanding the reasons for the price of laboratory tests may contribute to the development of laboratory tests pricing policies that would ensure their affordability. Although public institutions in most developing countries provide some laboratory tests for free, equipment is often broken down and service unreliable. As a result, patients increasingly have to pay for services in better resourced independent laboratories. Laboratory technology has advanced to the point where high volumes of tests can be handled quickly and cheaply on automated equipment. Regardless of whether the resultant lower costs are passed on to the patient or his insurer, price has taken on new significance to all parties concerned with laboratory testing

The Zimbabwe external quality assessment scheme (ZEQAS) in clinical chemistry: results of the pilot programme

A pilot programme for assessing laboratory performance in clinical chemistry laboratories in Zimbabwe (ZEQAS) is described in this CAJM article.A pilot programme for assessing laboratory performance in clinical chemistry laboratories in Zimbabwe is described (ZEQAS). Twenty four laboratories providing patient care services participated. Eightlyphilised bovine sera were distributed over one year. Consensus values and the spread of interlaboratory agreement were calculated for each of 12 analytes and compared with results previously obtained in a large mature national EQA scheme in the UK (UK NEQAS). For all analytes except phosphate, the mean consensus value obtained in ZEQAS was between 94 and 108 pc of the UK target, although the spread of results in ZEQAS was generally two to threefold greater for individual analytes than in UK NEQAS. It is concluded that the ZEQAS consensus values for the analytes surveyed provide a valid target against which individual laboratory performance can be assessed. The wide spread of results from individual laboratories suggests there is considerable scope for improving inter-laboratory agreement. This is being addressed by the continuing programme, with increased interaction and production of local specimens

Prepaid electricity model in Zimbabwe: a cost-benefit analysis

To manage credit risk and improve working capital, many power utility companies have moved consumers from conventional post-payment for electricity to prepayment. Despite the growing use of this prepayment system, the welfare implications of this strategy are unclear and contested. The Zimbabwean utility company, Zimbabwe Electricity Transmission and Distribution Company (ZETDC), introduced prepaid meters in August 2012 and installed over 550,000 prepaid meters by the 31st of December 2015. This thesis' objective was to quantitatively assess the societal costs and benefits of introducing prepaid electricity to Zimbabwe, by calculating the net present value of the estimated annual costs and benefits over time. A qualitative analysis was also conducted, based on a consumer survey of 100 consumers who had switched from the post-paid to the prepaid system. The survey captured consumers' perceptions of the prepaid system's costs and benefits. Results of the study showed that both consumers and the utility company have benefited from the prepaid system. The average net benefit per user under the prepaid system was estimated at US$58.93 per annum. 74% of consumers surveyed confirmed having benefited from the switch to the prepaid system. The main policy recommendation, based on the results of the study, is for ZETDC to continue with its roll out of the prepaid system. However, as the research was limited to the current ZETDC prepaid consumer base of only domestic and small business users, a recommendation for future research would be to evaluate the costs and benefits for larger industrial consumers as well

The effect of antimalarial drugs on the metabolism of steroid hormones with respect to oral contraceptives

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