Assessment of quality of obstetric care in Zimbabwe using the standard primipara

Background To improve maternity services in any country, there is need to monitor the quality of obstetric care. There is usually disparity of obstetric care and outcomes in most countries among women giving birth in different obstetric units. However, comparing the quality of obstetric care is difficult because of heterogeneous population characteristics and the difference in prevalence of complications. The concept of the standard primipara was introduced as a tool to control for these various confounding factors. This concept was used to compare the quality of obstetric care among districts in different geographical locations in Zimbabwe. Methods This was a substudy of the Zimbabwe Maternal and Perinatal Mortality Study. In the main study, cluster sampling was done with the provinces as clusters and 11 districts were randomly selected with one from each of the nine provinces and two from the largest province. This database was used to identify the standard primipara defined as; a woman in her first pregnancy without any known complications who has spontaneous onset of labour at term. Obstetric process and outcome indicators of the standard primipara were then used to compare the quality of care between rural and urban, across rural and across urban districts of Zimbabwe. Results A total of 45,240 births were recruited in the main study and 10,947 women met the definition of standard primipara. The maternal mortality ratio (MMR) and the perinatal mortality rate (PNMR) for the standard primiparae were 92/100000 live births and 15.4/1000 total births respectively. Compared to urban districts, the PNMR was higher in the rural districts (11/1000 total births vs 19/ 1000 total births, p < 0.001). In the urban to urban and rural to rural districts comparison, there were significant differences in most of the process indicators, but not in the PNMR. Conclusions The study has shown that the standard primipara can be used as a tool to measure and compare the quality of obstetric care in districts in different geographical areas. There is need to explore further how the quality of obstetric care can be improved in rural districts of Zimbabwe

Peripheral blood lymphocyte proviral DNA predicts neurocognitive impairment in clade C HIV

CITATION: Ruhanya, V. et al. 2020. Peripheral blood lymphocyte proviral DNA predicts neurocognitive impairment in clade C HIV. Journal of NeuroVirology, 26:920–928, doi:10.1007/s13365-020-00882-9.The original publication is available at https://link.springer.comIt is not known if proviral DNA in the periphery corresponds to cognitive status in clade C as it does in clade B and recombinant forms. A cross-sectional study was conducted on participants investigated for HIV-associated neurocognitive impairment in South Africa. HIV-1 proviral DNA was quantified using a PCR assay targeting a highly conserved HIV-1 LTR-gag region. Fifty-four (36.7%) participants were cognitively impaired and 93 (63.3%) were not impaired. Forty-three (79.6%) of the cognitively impaired participants were female and 11 (20.4%) were male. There was no significant age difference between cognitively impaired and unimpaired participants (p = 0.42). HIV-1 DNA in cognitively impaired PLWH was significantly higher than in cognitively normal individuals (p = .016). Considering impaired participants, lymphocyte HIV-1 DNA was significantly higher in males than females (p = 0.02). There was a modest positive correlation between lymphocyte HIV-1 DNA and global deficit scores (GDS) r = 0.176; p = 0.03). The two measures of viral load, lymphocyte HIV-1 DNA copies/million and plasma RNA copies/ml, were positively correlated (r = 0.39; p < .001). After adjusting for other covariates, age, sex, treatment status, and the interactions between impairment and treatment, the multivariate regression showed association between proviral load and neurocognitive impairment; omega effect size was 0.04, p value = 0.010. The burden of HIV-1 peripheral blood lymphocyte proviral DNA corresponds to neurocognitive impairment among individuals infected with clade C disease. Therefore, therapeutic strategies to reduce the HIV-1 proviral DNA reservoir in lymphocytes may improve neurocognitive outcomes in PLWH.Poliomyelitis Research Foundation (PRF)National Research Foundation (NRF)South African Medical Research Council (SAMRC)Publisher's versio

Accuracy of the kato-katz method in diagnosis of s.mansoni and soil transmitted helminths infection in Zimbabwe.

Introduction: Mapping of schistosomiasis and soil transmitted helminths infection in Zimbabwe was prioritized for evidence based treatment control strategy in year 2010. Two diagnostics tests: Kato-Katz (KK) and fomol ether concentration (FEC) were used during the mapping process. Objective: This study aimed to determine the sensitivity and specificity of Kato-Katz technique in the absence of a gold standard using Bayesian modelling for the determination of S. mansoni and soil transmitted helminths infection (STHs) in Zimbabwe. Methods: This is a secondary data analysis based on primary school children (n=15 818) aged 10-15 years who were enrolled in the national mapping of S. mansoni and STHs study, since they were reported to be the most exposed age group. Both parasitic infection by S. mansoni and STHs were diagnosed using a combination of two diagnostic techniques: the Kato Katz technique and the formol-ether concentration technique. A Bayesian approach was used to evaluate the diagnostic performance of the evaluation tool. Results: The formol ether diagnostic technique was generally more sensitive with S. mansoni detection operational characteristics as follows (Sensitivity: 0.995; 95% Bayesian Credible Interval (BCI): 0.989 - 0.999), STHs- Hookworm detection (Sensitivity: 0.991; 95% BCI;0.988 - 0.993 ) , STHs– A. lumbricoides detection (Sensitivity:0.992; 95% BCI;0.989 - 0.995) and STHs– T. trichiuria (Sensitivity:0.988 95% BCI: 0.926 - 1.00); than the Kato- Katz diagnostic technique (for S. mansoni detection (Sensitivity: 0.981; 95% BCI:0.971 - 0.994), STHs - Hookworm detection (Sensitivity:0.966; 95% BCI;0.963 - 0.970) , STHs – A. lumbricoides detection (Sensitivity: 0.967; 95% BCI;0.974-0.981) and STHs – T. trichiuria (Sensitivity:0.988; 95% BCI;0.974 - 0.981). However, specificity is higher for the Kato- Katz technique compared to the formol ether concentration technique. Conclusion: The formol ether concentration technique has better sensitivity compared to the Kato-Katz technique, but however it has less specificity compared to the formol ether concentration technique. been shown for the Kato – Katz technique for all the infections respectively

Staging Nation Statist Self-Identity in Jaramogi Odinga’s Not Yet Uhuru (1967)

This article argues that an autobiographer, at the time of writing about self, is aware of existing public perception about who s/he is. The construction of self in the autobiography is therefore a form of staging self as an interplay between knowledge of self against nuanced public understanding of the autobiographer and circumstances which produce him. The paper employs Istvan Dobos’s argument on autobiography as a staging of self to analyse how Oginga Odinga constructs self in his Not Yet Uhuru. The paper is also informed by Craig Calhoun’s theory of nationalism particularly his arguments on the construction of civic nationalist identities. The paper relied on close reading of the text to evaluate how the autobiographical self-constructs self-relative to his thematic thrust a well as relative to other characters in the text. However, insights of the context which informed the autobiography were gleaned by extrapolating other secondary texts

Postcolonial tensions in a fictitious African State: The unconventional first-person point of view in Anthills of the Savannah (1987)

In the three decades, or so, postdating the attainment of independence in Africa, a whirlwind of coup d'états ravaged many African countries. A subject which Chinua Achebe explores in Anthills of the Savannah. This article explores post-colonial tensions in the novel’s fictionalized state of Kangan, as postulated by two of the three first person narrator-characters. By applying the textual methodology of close reading and anchored on American Formalism, particularly on the tenets of Robert Kellogg and Robert Scholes’ nature of the narrative and Percy Lubbock’s craft of fiction, the article argues that spatial and temporal positionality of the character-narrator informs narrative perspective. Aware that the two of the three first person narrators, under discussion in the article, die before their narrative is articulated, the article explores this unconventional first person point of view by making a critical review of Chris Oriko’s complicit positionality to the explosive events of Kangan on the one hand and the ideological idealism of Ikem Osodi on the other to foreground the implausibility of their having to survive the fatalistic logic of the tensions in Kangan, hence their physical vacation of the narrative space, and yet, their retention&nbsp; as&nbsp; witnesses to the tragedy

The discourse of autobiographical intention: An analysis of selected Kenyan autobiographies

The death and resurrection of the author has made for interesting discourse since Wimsatt and Beardsley famously attacked the author’s intention in writing as a fallacious presumption in 1946 and Barthes declared, in 1967, the death of the author, to when critics such as Carlier and Watts resurrected her/him in the first decade of the new milleum. &nbsp;By anchoring itself on Autobiographical theory, particularly on the tenets of Linda Anderson and Francis Hart, and by lending itself to a critical methodology of textual evaluation, this article particularises the discourse of intentionality in the genre of autobiography by making a close reading of selected Kenyan autobiographies: Not yet Uhuru, Walking in Kenyatta Struggles; My Story and Unbowed; One Woman’s Story. The article argues that the significance of intentionality in authorship gains credence in the emerging critical engagement in marginality, particularly on women’s writing, writing on differently sexualised bodies, writing on differently abled bodies and equally significant in the emerging narratives of re-imagining the postcolonial project of national construction and citizenship. The article argues that to thematise these spaces the re-instantiation of the subjective presence of the author in time and place is as significant as the re-instantiation of her/his voice

Imagining cultural antecedents in constructing autobiographical self: Duncan Ndegwa’s Walking in Kenyatta Struggles: My Story (2006)

This article argues that autobiography is a site in which cultural antecedents can be retrieved in the construction of the autobiographical self. The article relies on exploratory research design by interrogating literature related to the recollection and retrieval of the autobiographer’s past to situate self in time and place. The article analyses Walking in Kenyatta Struggles: My Story as an insight stimulating example and demonstrates that the author retrieves the provenance of his community, the Agikuyu’s cosmology to construct an autobiographical self whose engagements in private and public spaces is highly motivated by the cultural history of his people and the primordial patterns of governance and social justice. The article argues that autobiographical writing is an important practice in which thinkers and practitioners of Africa’s modern day’s socio-cultural spaces can engage in the process of (re) production, circulation, consumption, archiving and retrieval of past African knowledges and cultural spaces in view of their significance in the modern world. This process would be important not only to restore the pride of place of traditional institutions of governance and social justice but also to assure that these past institutions remain relevant in the present and the future imagination of Africa’s socio-cultural spaces

Schisms of Pre-Independence Nationalist Movement

The decade between 1950-1960 was a decisive period for both the coloniser and the nationalist movement in Kenya. After the world wars which had devastated her economy, Britain was confronted by the unsustainability of the empire, while the nationalist movement agitated for self-governance and self-determination. Anchored on the theory of New historicism, particularly on Stephen Greenblatt’s historicities of texts and textualities of history and Hayden White’s historical emplotment the article employs the methodology of explorative reading to interrogate autobiographies, biographies and historical accounts of that transitive period with a view to explicate the nationalist movement’s vision and programme of action. The article argues that the three streams of the nationalist movement: the political prisoners in detention; political party agitation and military insurgence were asynchronous and in some cases at cross purposes. Further, even within each stream were aggravated personal rivalries: Kenyatta/ Kaggia, Odinga/ Mboya and Kimathi/ Mathenge which blurred clarity for a nation state ideology. The coloniser exploited this discordance to imperil the nationalists’ agenda for self independence and firmed up continued post-colonial subjugation under a neocolonial framework. The article suggests re-instantiation of nationalist frameworks for self-governance and determination in view of the cacophonic global political order

Historical Narratives and the Politics of Identity: A Comparative Analysis of Hotel Rwanda, Shooting Dogs and Sometimes in April

Identity is a contested construct grounded in various narratives such as history. As a result of that, it appears to have stable and fixed borders. However, characters with multiple identities cross their borders in different contexts to co-exist, hence disavowing the assumed fixity. The study used exploratory research design to explain its findings. Data analysis and presentation was guided by tenets of the theory of nationalism: primordialism; instrumentalism and constructivism by Ernest Gellner (1964) and structuralist film theory by Leo Kuleshov (1920). This study concluded that history is among the multiple narratives that can be used to mark identity. However, identity is a fluid construct that keeps refashioning in different contexts

Assessing the effectiveness of reporting procedures in controlling child defilement in Kitutu Central Sub County, Kisii County, Kenya

Child defilement is a significant social development and health issue in Kenya, with at least 32% of females and 18% of males experiencing defilement during their childhood. Health facility data indicates a higher number of children in need of defilement management services. This study aimed to assess the effectiveness of reporting procedures in controlling child defilement in Kitutu central sub-county, Kisii County, Kenya. The target population consisted of 485 respondents, including court officers, area chiefs, assistant chiefs, police officers, local elders, and child program health officers. A sample of 98 (20%) was drawn from the target population. The study used questionnaires and interview guides to collect primary data, while document analysis was used to collect secondary data. The validity of the instruments was determined through expert judgment by supervisors from the faculty of Art and Social Sciences at Kisii University. The quantitative data was keyed into SPSS version 22, and Pearson\u27s t-test was used to analyze the extent of relationship between variables. The study found that child defilement cases were on an upward trajectory in Kitutu central sub-county, with most victims being defiled. The defilement cases were mostly reported to the offices of area chiefs, assistant chiefs, and police stations. The administrators may have lacked the know-how, resources, or were easily compromised, making it difficult to investigate each case. There is no proper channel for reportin