Low level technology tool (LLT) in screening for blindness: test qualities in the outpatients department of a tertiary eye unit using the Snellen Chart

A journal article on low level technology (LLT) tool in screening for blindness.Visual acuity is a measure of form sense which depends on the resolving power of the eye and light sense. The Snellen chart had been the universally accepted "gold standard" method used to measure visual acuity until the introduction of the crowded logMAR acuity test.Illiteracy, the cost of making the charts and the need for some basic training of the user are some of the limitations associated with the instrument when employed to screen for blindness in communities which are hard to reach. The need for a reliable, cheap, readily available and universally accepted alternative instrument for screening people with visual problems in remote places cannot be underscored especially today when there is a global fight against avoidable blindness through “Vision 2020” programmes. Locals can use this tool to identify those with visual impairment and arrange for them to be seen by the ophthalmic team for proper assessment

Etiology and risk factors of meningitis in patients admitted at a central hospital in Harare

A medical research paper on the menace of meningitis in Zimbabwe.Meningitis is an infectious disease characterized by inflammation of the membrane surrounding the brain and spina] code most often caused by infection. There is a wide array of causes of meningitis which include bacteria, viruses, fungi and parasites.1 Isolation and identification of these etiological agents depends on the availability of ideal medical laboratory facilities and trained personnel. The disease is a serious source of Public Health concern associated with high morbidity and mortality worldwide. An approximated 890 000 cases of meningitis are reported to occur annually worldwide with at least 500 000 of these cases occurring in Africa due to poor socioeconomic conditions. The Pacific countries account for an estimated 210 000 cases with 100 000 in Europe and about 80 000 in the United States of America.2 4 Out of the approximated 130 000 annual deaths worldwide, two thirds occur in low income countries like those in Africa affecting mainly children under the age of 15 years.3 These statistics show the disproportionately large burden of meningitis on Africa with more than 50% of cases occurring within this region

Serum IgG Subclasses Levels In Paediatric Patients With Pneumonia

A CAJM study.Bacterial pneumonia is the commonest cause of morbidity and mortality in Zimbabwe.1 The children most at risk are those infected with HIV 2-4 We reported, in a recent study 2 that the great majority of children admitted to hospital with pneumonia have hypergammaglobulinaemia in immunoglobulins A (IgA), G (IgG) and M (IgM) IgG was the most raised immunoglobulin class with concentrations of up to 10 times that of normal age-matched reference ranges. The report was in agreement with other studies done previously 3,5 More recent studies 6,7 have shown that the concentrations of total IgGl and IgG3, in various mucosal fluids, are increased in HIV-infected individuals while those of IgG2' and IgG4 are decreased. Furthermore, the concentrations of specific IgGl and IgG3 antibodies to HIV virus are correspondingly increased in the same HIV-infected subjects while specific IgG2 and IgG4 antibodies were reduced. It is now established that IgG2 type antibodies are the most effective against encapsulated bacteria such as Streptococcus pneumonia, particularly in young children's It would appear that children with low IgG2 levels would have correspondingly low levels of IgG2-type antibodies and therefore a deficient humoral immune response to encapsulated bacteria. Such a deficient immune response , would be further compromised by HIV infection. The main objective of this study was to investigate the relationship between levels of IgG subclasses and the occurrence of pneumoilia in children aged one month to six years with or without evidence of HIV infection

Potential impact of reactive vaccination in controlling cholera outbreaks: An exploratory analysis using a Zimbabwean experience

Background. To contain ongoing cholera outbreaks, the World Health Organization has suggested that reactive vaccination should be considered in addition to its previous control measures. Objectives. To explore the potential impact of a hypothetical reactive oral cholera vaccination using the example of the recent large-scale cholera outbreak in Zimbabwe. Methods. This was a retrospective cost-effectiveness analysis calculating the health and economic burden of the cholera outbreak in Zimbabwe with and without reactive vaccination. The primary outcome measure was incremental cost per disability-adjusted life year (DALY) averted. Results. Under the base-case assumptions (assuming 50% coverage among individuals aged ≥2 years), reactive vaccination could have averted 1 320 deaths and 23 650 DALYs. Considering herd immunity, the corresponding values would have been 2 920 deaths and 52 360 DALYs averted. The total vaccination costs would have been ~$74 million and ~$21 million, respectively, with per-dose vaccine price of US$5 and$1. The incremental costs per DALY averted of reactive vaccination were $2 770 and$370, respectively, for vaccine price set at $5 and$1. Assuming herd immunity, the corresponding cost was $980 with vaccine price of$5, and the programme was cost-saving with a vaccine price of $1. Results were most sensitive to case-fatality rate, per-dose vaccine price, and the size of the outbreak. Conclusions. Reactive vaccination has the potential to be a costeffective measure to contain cholera outbreaks in countries at high risk. However, the feasibility of implementation should be further evaluated, and caution is warranted in extrapolating the findings to different settings in the absence of other in-depth studies

Mercury poisoning: prevalence, knowledge and frequency of gold panning and doing retort among alluvial gold panners in Chiweshe and Tafuna communal lands in Zimbabwe

A CAJM journal article.Objectives: To estimate the prevalence of mercury poisoning, to estimate the knowledge level that mercury can be a poison, and to establish the frequency of gold panning and doing retorts. Design: Cross sectional study. Setting: Chiweshe and Tafuna communal lands. Subjects: Gold panners. Main Outcome Measure: Mercury levels in blood and urine. Results: Totals of 23 respondents from Chiweshe and 43 respondents from Tafuna were recruited. Four out of 43 respondents in Tafuna and seven out of 23 respondents in Chiweshe had levels of mercury greater than 0.05 mg/L in blood (p=0.040). Out of 43 respondents in Tafuna, four (9.3%) had levels of mercury of more than 0.01 mg/L in urine. Totals of 18 out of 37 and seveil out of 22 respondents from Tafuna and Chiweshe, respectively, did not know that mercury could be a poison. Altogether, 35 (56.5%) out of 62 respondents were full time gold panners. Significantly more respondents in Chiweshe (14/19) than in Tafuna (8/29) did less than four retorts per month (p=0.005). Respondents who did four or more retorts per month were 3.21 (95%CI 1.06 to 9.72) times more likely to have had raised levels of mercury in their blood compared with persons who did less than four retorts per month. Conclusion: Mercury poisoning among gold panners in Chiweshe and Tafuna communal lands is of public health importance. Panners should be educated on the possibilities of mercury being a poison. A low cost and safe technology to separating mercury from the amalgam should be introduced to the panners

Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe

A clinical report on reproductive health education programmes among the youths in Zimbabwe.The question of what young people do and don’t do and why, where and with whom is influenced not only by their age and sex, but also their knowledge, attitude and self esteem. Appropriate mechanisms for the youths to be educated about self- protection from adverse reproductive outcomes arc limited. Generally adolescents arc ill-informed on how to cope and deal with sexual feelings. As a result they lack the knowledge that empowers them to make informed decisions on sexual and reproductive health matters

Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe.

BACKGROUND: There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe. METHODS: A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up. RESULTS: Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up. CONCLUSION: Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors

A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa

Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions