Ethics in reproductive health: clinical issues in Zimbabwe

A CAJM journal article.Reproductive health can present health practitioners with ethical problems because of the complex interaction between cultural practices, the laws of the country and individual personal preferences. In particular, the problems of pregnancy, sexually transmitted infections, family planning, sexual violence, and domestic abuse require a good knowledge of the laws of the country and the culture in which they operate. The practitioner should at all times respect the patient’s autonomy and serve their best interests, whilst keeping in mind the legitimate interest of their partners, spouses, parents or guardians

Translating coverage gains into health gains for all women and children : the quality care opportunity

Peer reviewedPublisher PD

Medication Reconciliation in the Elderly

Medication therapy is the most prevalent and critical intervention of health delivery and the source of most errors in healthcare. Medication errors and associated adverse drug events (ADE) have serious health and economic ramifications, and in elderly patients ADE are the leading cause of morbidity and mortality. Medication reconciliation is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing ADEs. This education project answered the question whether education provided to long term care staff would improve knowledge of medication reconciliation and be retained over time. The education program was developed through results of a literature search to identify evidence-based standards for medication reconciliation. The guiding theory for program was Kurt Lewin\u27s theory of planned change. The test was developed on the medication reconciliation content and arrangements made for each of the 30 participants who were RNs, LPNs, and CMAs to take the test before and after the education program and again at 30 and 45 days. Results showed statistically significant improvement (p \u3c 0.05) with knowledge of medication reconciliation retained at 30- and 45-days post intervention. Positive social change is possible as nurses and CMAs in the long-term care facility use the knowledge of medication reconciliation to improve patient medication safety for the long-term care residences in the facility. Through appropriate reconciliation, medication errors and ADEs can be reduced or prevented and patient outcomes improved

Obstacles to determining the fair values of financial instruments in Mozambique

The implementation of International Accounting Standard 32 Financial Instruments: Disclosure and Presentation (lAS 32), International Accounting Standard 39 Financial Instruments: Recognition and Measurement (lAS 39) and International Financial Reporting Standard 7 Financial Instruments: Disclosures (IFRS 7) by developing countries has been met with mixed reactions largely due to the extensive use of the fair value concept by the three accounting standards. The use of the fair value concept in developing countries has proved to be a significant challenge due to either a Jack of formal capital market systems or very thinly traded capital markets. This study investigates the obstacles to determining fair values of equity share investments, government bonds and corporate bonds, treasury bills and loan advances in Mozambique. The study was done through a combination of literature review and empirical research using a questionnaire. The trading statistics of the financial instruments on the Mozambique Stock Exchange and the prospectuses of bonds were used. The empirical research was carried out using a type of non-probability sampling technique called purposive sampling. A subcategory of purposive sampling called expert sampling was used to select the eventual sample which was composed of people with specialised knowledge on the capital market system in Mozambique. The results of the empirical research were analysed using pie charts to summarise the responses. The research concluded that the Mozambique Stock Exchange is an inactive market for financial instruments characterised by thin trading in both equity shares and bonds. The estimation of fair values evidenced by observable market transactions is therefore impossible. The absence of credit rating agencies in Mozambique presents a significant challenge in assigning credit risk and pricing financial instruments such as bonds. The research also noted that significant volatility of the main economic indicators such as treasury bills interest rates and inflation made it difficult to determine fair values of financial instruments using financial modelling techniques. Due to the above obstacles to determining fair values of certain financial instruments in Mozambique, the best alternatives are to value these financial instruments at either cost or amortised cost.Financial AccountingM. Com. (Accounting

Effect of a new antenatal care programme on the attitudes of pregnant women and midwives towards antenatal care in Harare

A clinical study on the importance of women participation and co-operation,them being a key stakeholder of any Antenatal Care (ANC) programme that may be introduced in Zimbabwe's health delivery system.Health providers have 'only recently been paying attention to the attitudes of women towards antenatal care programmes. Previously, the benefits of antenatal care (ANC) were considered so self evident that the consumers could not question how the services were delivered. However, the success of any ANC programme depends to a greater or lesser degree on the co-operation of the women. One of the aims of increased satisfaction with ANC is to achieve better compliance with the advice given, which may lead to improved pregnancy outcome. Satisfaction with the services, rather than the mere improvement of pregnancy outcome is also: now considered a goal in its own right

Association between adherence to anti-diabetic therapy and adverse maternal and perinatal outcomes in diabetes in pregnancy

Objectives: To analyse the association between adherence to anti-diabetic therapy (diet, physical activity and medications) and perinatal outcomes.Methods: A cohort design was used. Participants were 157 pregnant women with diabetes, and the setting was Mbuya Nehanda and Chitungwiza Maternity Hospitals, Harare, Zimbabwe.Results: Main outcome measures were maternal and perinatal outcomes. Mean adherence to anti-diabetic therapy was 66.7%. Perinatal outcomes observed were hypertensive disorders (34.5%), Caesarean delivery (45.9%), maternal diabetic ketoacidosis (5.1%), maternal hypoglycaemia (15.9%), and candidiasis (19.7%). Neonatal outcomes were perinatal mortality (15.9%), low Apgar score at 1 minute (26.8%), low Apgar score at 5 minutes (24.8%), macrosomia (33.8%), neonatal hypoglycaemia (15.3%), and neonatal hyperbilirubinemia (7.6%). There were significant associations between adherence and Caesarean delivery (RR 1.9, 95% CI 1.28 to 2.81, p = 0.0014), candidiasis (RR 3.95, 95% CI 1.65 to 9.47, p = 0.002), low Apgar score at 1 minute (RR 2.15, 95% CI 1.16 to 3.98, p = 0.015) and at 5 minutes (RR 1.95, 95% CI 1.03 to 3.69, p = 0.039), and perinatal mortality (RR 3.08, 95% CI 1.11 to 8.52, p = 0.018).Conclusions: Adherence to anti-diabetic therapy was sub-optimal and was associated with some adverse perinatal outcomes. Promotion of adherence, through routine individualised counselling, monitoring and assessment, is vital to minimise adverse outcomes.Keywords: anti-diabetic therapy, diabetes, maternal outcomes, perinatal outcomes, pregnanc

Intimate partner violence, forced first sex and adverse pregnancy outcomes in a sample of Zimbabwean women accessing maternal and child health care

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes. Methods: A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and during pregnancy) and maternal and newborn health outcomes. Results: Of the recent pregnancies 27.6% were not planned, 50.9% booked (registered for antenatal care) late and 5.6% never booked. A history of miscarriage was reported by 11.5%, and newborn death by 9.4% of the 2042 women while 8.6% of recent livebirths were low birth weight (LBW) babies. High prevalence of emotional (63,9%, 40.3%, 43.8%), physical (37.3%, 21.3%, 15.8%) and sexual (51.7%, 35.6%, 38.8%) IPV ever, 12 months before and during pregnancy were reported respectively. 15.7% reported forced first sex (FFS). Each form of lifetime IPV (emotional, physical, sexual, physical/sexual) was associated with a history of miscarrying (aOR ranges: 1.26–1.38), newborn death (aOR ranges: 1.13–2.05), and any negative maternal and newborn health outcome in their lifetime (aOR ranges: 1.32–1.55). FFS was associated with a history of a negative outcome (newborn death, miscarriage, stillbirth) (aOR1.45 95%CI: 1.06–1.98). IPV in the last 12 months before pregnancy was associated with unplanned pregnancy (aOR ranges 1.31–2.02) and booking late for antenatal care. Sexual IPV (aOR 2.09 CI1.31–3.34) and sexual/physical IPV (aOR2.13, 95%CI: 1.32–3.42) were associated with never booking for antenatal care. Only emotional IPV during pregnancy was associated with low birth weight (aOR1.78 95%CI1.26–2.52) in the recent pregnancy and any recent pregnancy negative outcomes including LBW, premature baby, emergency caesarean section (aOR1.38,95%CI:1.03–1.83). Conclusions: Forced first sex (FFS) and intimate partner violence (IPV) are associated with adverse maternal and newborn health outcomes. Strengthening primary and secondary violence prevention is required to improve pregnancy-related outcomes

Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis.

BACKGROUND: Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation. METHODS: A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined. RESULTS: Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked. CONCLUSION: MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women's accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation

2016 Zimbabwe: Independent Evaluation of the Health Transition Fund in Zimbabwe

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 3’ of the report, and the executive feedback summary labelled as 'Part 4'

Causes of maternal mortality in Sub-Saharan Africa : a systematic review of studies published from 2015 to 2020

BACKGROUND : Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of death must be analysed frequently in this region to guide interventions. METHODS : We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease – 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words “maternal mortality”, “maternal death”, “pregnancy-related death”, “reproductive age mortality” and “causes” as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. RESULTS : We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%- 21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. CONCLUSIONS : Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.http://www.jogh.orgam2022School of Health Systems and Public Health (SHSPH