POVERTY IN ZIMBABWE: A CRITICAL REVIEW

A lot of debate has been made on the concept of poverty and what causes it. This paper seeks to undertake a critical analysis of the acute causes of poverty in Zimbabwe. A secondary research approach took a central stage in data acquisition, as the researchers focused on reviewing secondary data especially from published sources on the causes of Zimbabwean poverty especially in the 21st century. The study at hand becomes highly pertinent to Zimbabwe that has faced various episodes and phases of poverty ever since its 1980 political independence. The results of the study showed that the acute causes of poverty in Zimbabwe include corruption, high unemployment rates, underperforming banking system, lack of foreign investment, underperforming industries and poor infrastructure. Numerous recommendations were made for the reduction of poverty in Zimbabwe. It is hoped that if these recommendations are taken into account, there is going to be improvement of socio-economic development in the country and consequent reduction in levels of poverty in Zimbabwe. Article visualizations

A Critical Review of the Characteristics of Presumptive Tax Systems in Developing Countries

This paper considers the effect of the presumptive tax system characteristics on the tax compliance behaviour of small businesses in developing countries. Since the concept of presumptive taxation involves several features influencing the formalisation of small businesses, this paper seeks to survey three key areas of literature: targeted taxpayers, thresholds and timeframe. This paper differs fundamentally from previous studies in that it analyses presumptive tax system characteristics. A descriptive review approach was followed in evaluating the empirical literature on presumptive tax system characteristics. A content analysis was then performed on literature about categories and subcategories provided in the classification framework. The review highlights similarities and conflicting evidence of presumptive tax system characteristics in transforming the compliance behaviour of small businesses. It was concluded that the blended use of information technology and existing presumptive tax systems can facilitate the movement of small businesses from the informal to the formal sector

Assessment of heavy metals and radionuclides in dust fallout in the West Rand mining area of South Africa

Windblown dust can contain radioactive materials from mining. These radionuclides when inhaled in dust produce ionizing radiation which damages the cells and tissues in the body. The aim of this study was to assess dust fallout radionuclides in the West Rand mining area of South Africa. Dust fallout monitoring was done using the method (ASTM) D-1739 of 1998 employing multi-directional buckets. Results show that all 9 locations investigated in the different seasons recorded dust fallout rates within stipulated residential limit according to the National Dust Control Regulations (NDCR) (Government Gazette 36974, 1 Nov 2013). Locations 3 in spring (301.93 mg/m2/day) and 6 in winter (589.8 mg/m2/day) recorded dust fallout rates with values above the target value of 300 mg/m2/day according to guidelines by South African Standards (SANS 1929:2011). The ANOVA tests (p-value < 0.05) indicate that the mean dust fallout rate is significantly different across the seasons, mean dust fallout rate in summer is significantly (p-value < 0.05) more than the autumn by 103.15 mg/m2/day. Moderate, positive correlations (0.4 ≤ r < 0.7) exist between average dust fallout rate and wind speed. A weak, negative correlation exist between average dust fallout rate and rainfall with a value of -0.393. All the investigated elements had Enrichment Factor (EF) greater than 1. Cadmium (Cd) and lead (Pb) were extremely enriched (68.36 and 43.48, respectively), whereas Thorium (Th) (7.26) and Chromium (Cr) (9.79) had significant enrichment. Activity concentrations obtained for 226Ra, 238U, 232Th and 40K were 53.59 ± 20.45 Bq/kg, 15.20 ± 6.74 Bq/kg, 6.62 ± 2.76 Bq/kg and 278.51 ± 84.39 Bq/kg, respectively. Activity concentrations were within world averages except 226Ra which exceeded the 32 Bq/kg world average. Statistically significant (p-value < 0.05), strong (0.7≤ r< 0.9) and positive correlation exists between 226Ra and 40K. A moderate, positive correlation (0.4 ≤ r < 0.7) exist between 238U and 232Th. Since EF values showed that the elements in the dust had anthropogenic influence, further studies should look at contributions of different sources to the elements found in dust

A review of perspectives on the use of randomization in phase II oncology trials

Historically, phase II oncology trials assessed a treatment’s efficacy by examining its tumor response rate in a single-arm trial. Then, approximately 25 years ago, certain statistical and pharmacological considerations ignited a debate around whether randomized designs should be utilized instead. Here, based upon an extensive literature review, we review the arguments on either side of this debate. In particular, we describe the numerous factors that relate to the reliance of single-arm trials on historical control data, and detail the trial scenarios in which there was general agreement on preferential utilization of single-arm or randomized design frameworks, such as the use of single-arm designs when investigating treatments for rare cancers. We then summarize the latest figures on phase II oncology trial design, contrasting current design choices against historical recommendations on best practice. Ultimately, we find several ways in which the design of recently completed phase II trials does not appear to align with said recommendations. For example, despite advice to the contrary, only 66.2% of the assessed trials that employed progression-free survival as a primary or co-primary outcome used a randomized comparative design. In addition, we identify that just 28.2% of the considered randomized comparative trials came to a positive conclusion, as opposed to 72.7% of the single-arm trials. We conclude by describing a selection of important issues influencing contemporary design, framing this discourse in light of current trends in phase II, such as the increased use of biomarkers and recent interest in novel adaptive designs

Antiretroviral Therapy outcomes among adolescents and youth in rural Zimbabwe

Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10-30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10-15 (young adolescents) 15.1-19 years (adolescents), 19.1-24 years (young adults) and 24.1-29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17-4.35). Young adults and adolescents had a 2-3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62-4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults

COVID-19 : comparison of the response in Rwanda, South Africa and Zimbabwe

The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefi t having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.http://mediccreview.orgam2022School of Health Systems and Public Health (SHSPH

Reduced HIV transmission at subsequent pregnancy in a resource-poor setting

Several studies indicate that HIV-infected women continue to have children. We set out to determine the trend in HIV transmission at subsequent pregnancies. From 2002–2003, pregnant women were enrolled in a single dose nevirapine-based Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. Six years later, women with subsequent children in this cohort were identified and their children's HIV status determined. From 330 identified HIV-infected mothers, 73 had second/subsequent children with HIV results. Of these, nine (12.3%, 95% confidence interval [CI]: 4.6–20.1%) children were HIV-infected. Of the 73 second children, 51 had older siblings who had been initially enrolled in the study with definitive HIV results with an infection rate of 17/51 (33.3%, 95% CI: 19.9–46.7). About 35% of the women had been on antiretroviral drugs. These results demonstrate lower subsequent HIV transmission rates in women on a national PMTCT programme in a resource-poor setting with the advent of antiretroviral therapy

Sexual behaviour does not reflect HIV-1 prevalence differences: a comparison study of Zimbabwe and Tanzania

Background Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania. Methods Cross-sectional data from a two-centre study that enrolled pregnant women in Harare (N = 691) and Moshi (N = 2654) was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. Prevalence distribution of risk factors for HIV acquisition and spread were compared between the two areas. Results The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. Reported male partner circumcision rates between the two countries were widely different, but the effect of male circumcision on HIV prevalence was not apparent within the populations. Conclusions The higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania cannot be explained by differences in risky sexual behaviour: all risk factors tested for in our study were higher for Tanzania than Zimbabwe. Non-sexual transmission of HIV might have played an important role in variation of HIV prevalence. Male circumcision rates and mobility could contribute to the rate and extent of spread of HIV in the two countries

Adaptive designs in clinical trials: why use them, and how to run and report them

Adaptive designs can make clinical trials more flexible by utilising results accumulating in the trial to modify the trial’s course in accordance with pre-specified rules. Trials with an adaptive design are often more efficient, informative and ethical than trials with a traditional fixed design since they often make better use of resources such as time and money, and might require fewer participants. Adaptive designs can be applied across all phases of clinical research, from early-phase dose escalation to confirmatory trials. The pace of the uptake of adaptive designs in clinical research, however, has remained well behind that of the statistical literature introducing new methods and highlighting their potential advantages. We speculate that one factor contributing to this is that the full range of adaptations available to trial designs, as well as their goals, advantages and limitations, remains unfamiliar to many parts of the clinical community. Additionally, the term adaptive design has been misleadingly used as an all-encompassing label to refer to certain methods that could be deemed controversial or that have been inadequately implemented. We believe that even if the planning and analysis of a trial is undertaken by an expert statistician, it is essential that the investigators understand the implications of using an adaptive design, for example, what the practical challenges are, what can (and cannot) be inferred from the results of such a trial, and how to report and communicate the results. This tutorial paper provides guidance on key aspects of adaptive designs that are relevant to clinical triallists. We explain the basic rationale behind adaptive designs, clarify ambiguous terminology and summarise the utility and pitfalls of adaptive designs. We discuss practical aspects around funding, ethical approval, treatment supply and communication with stakeholders and trial participants. Our focus, however, is on the interpretation and reporting of results from adaptive design trials, which we consider vital for anyone involved in medical research. We emphasise the general principles of transparency and reproducibility and suggest how best to put them into practice

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