Availability, price and affordability of selected chronic medications in private retail pharmacies in Eswatini

Magister Public Health - MPHChronic non-communicable diseases (NCDs) have not received adequate attention in Eswatini (formerly Swaziland) due to the high burden of HIV/AIDS, tuberculosis and other communicable diseases. However, in 2019, NCDs were estimated to account for 45.86% of all deaths in the country with cardiovascular diseases, diabetes mellitus and chronic respiratory conditions amongst the top ten causes of death. Persistent shortages of medicines in public health facilities in Eswatini have been observed resulting in patients purchasing their medicines from private retail pharmacies

An Analysis of the Viability of Winter Wheat Farming Under the A1 Land Resettlement Model in Zimbabwe: A Case Study of Mazowe District

The study analyses the viability of winter wheat production in Zimbabwe’s A1 resettlement farming sector. This sector emerged from the implementation of the Fast Track Land Reform Programme (FTLRP), starting 2000, when a new farming structure with new farming communities emerged. In most sectors, and for the major crops grown, output seemed depressed as compared to pre 2000 levels. This study picked winter wheat, a strategic food crop in Zimbabwe and examined its production viability under the new dispensation and to understand the factors influencing its viability. A sample of 80 farmers from Mazowe district was used to assess viability over a season, typifying a single production cycle. The mean gross margin figure was calculated, and found to be –US$155.7, indicating qualified non-viability of the enterprise. Regression analyses identified fertiliser, working capital, area planted and education as the key factors affecting viability, with R2 =0.725. The study recommended government to partner the private sector to address production side factors, key of which are input prices including water, energy, credit and extension; and then pricing on the marketing side to improve winter wheat viability. Keywords: Fast track land resettlement programme(FTLRP), strategic food crop, wheat, viability, Mazowe

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

Perceptions and Barriers to Exclusive Breastfeeding in Manicaland, Zimbabwe

The study explored perceptions and barriers to exclusive breastfeeding (EBF) among rural women in Zimbabwe. A descriptive cross sectional design was used with 490 participants (146 men and 344 women). Questionnaires and Focus Group Discussions were held with women 15-49 years who had a child below 2 years and their male partners. The prevalence of exclusive breastfeeding amongst the infants 0 – 6months was 66.8%. Seventy-four and 64.7% of girls and boys respectively were exclusively breastfed. Sixty-three percent of newborns were exclusively breastfed immediately after birth with 32% and 5% of the newborns being initiated within 6 hours and 1 day respectively. Women reported that they were comfortable to exclusively breastfeed for the first 3 months. The top six barriers to EBF were poor support from men(<30%),pressure from in-laws to introduce other foods, scanty knowledge on appropriate infant feeding practices, negative cultural and religious practices and lack of interest in women to exclusively breastfeed. The EBF prevalence was higher amongst young mothers (below 19 years) as compared to older women (20-49 years). EBF practices were lower (58.2%) amongst the more educated women compared to the less educated women (79.2%). The study concluded that community social mobilization should be intensified to increase knowledge and improve perceptions by engaging both men and women and other powerful stakeholders on infant and young child feeding through participatory approaches. Keywords: Exclusive breastfeeding, perceptions, attitudes, knowledg

The potential of computer-based quantitative structure activity approaches for predicting acute toxicity of chemicals

Within the EU, the management of the risks of chemicals currently falls under a new legislation called Registration, Evaluation, and Authorization of Chemicals (REACH). Within the next 10 years, existing (eco)toxicological data gaps for the more than 100 000 chemicals on the European Inventory of Existing Commercial Substances (EINECS) should be filled. The challenge is to provide this toxicity information in a fast, cost effective manner, avoiding the use of experimental animals as much as possible. In this regard, REACH has provisions to allow for the use of in vitro and/or in silico methods, e.g. those based on (Quantitative) Structure Activity Relationships [(Q)SARs], to provide toxicity information or identify hazards of chemicals. This information can subsequently be used to identify priority chemicals for further risk evaluation. A QSAR is based on the assumption that the biological activity of a new or untested chemical can be inferred from the molecular structure, or properties of similar compounds whose activities have already been assessed. Therefore, using the chemical structure of chemical compounds as the sole input, one can build a toxicity prediction model based on parameters that define the physico-chemical properties and relative reactivity of the compounds. The objective of this thesis was to apply OECD guidelines in the development of validated QSAR models that describe acute toxicity of selected groups of EINECS chemicals to various organisms. In addition, an estimate was made of the total number of EINECS chemicals that could be possibly evaluated using (Q)SAR approaches. Based on experimental toxicity data from literature and in silico calculated log Kow (a measure of hydrophobicity) values, a QSAR advisory tool was developed that directs users to the appropriate QSAR model to apply for predicting toxicity of substituted mononitrobenzenes to five types of organisms within specified log Kow ranges. In a next study, QSAR models were developed to predict in vivo acute toxicity of chlorinated alkanes to fish based on data from in vitro experiments, and even based on in silico log Kow data only. Furthermore, using toxicity data from acute immobilization experiments with daphnids, an interspecies QSAR model was developed to predict toxicity of organothiophosphate pesticides to fish based on these data for daphnids and in silico log Kow values. The QSAR models for the mononitrobenzenes, chlorinated alkanes, and organothiophosphates covered in total 0.7 % of the 100 196 EINECS chemicals. In a final step, using chemical classification software, 54 % of the EINECS chemicals were grouped into specific classes that can in theory be subject to QSAR modeling. The safety assessment of one group of compounds that could not be classified e.g. botanical extracts might be done by further development of a method recently reported for the safety assessment of natural flavour complexes used as ingredients in food. This would result in an additional 3 % of the EINECS chemicals that could potentially be covered by SAR approaches, bringing the total percentage of EINECS compounds that can be covered by (Q)SAR approaches to 57. In conclusion, the results of this thesis reveal that, (i) in vitro experiments and even in silico calculations can help to reduce or replace animals used for experimental toxicity testing and (ii) despite the fact that individual QSARs may often each cover only limited, i.e. less than 1%, of the EINECS compounds, (Q)SAR approaches have the potential to cover about 57 % of the EINECS compounds. <br/

The AIDS crisis: Examining factors that influence use of condoms by young adult Zimbabwean males.

Condoms prevent both unintended pregnancies and HIV/AIDS. Almost 90% of the deaths occurring in hospitals in Zimbabwe are attributed to HIV/AIDS related illness (NACP, 1995). Half of the Zimbabwean army and 15% of the population are thought to be infected (CFU, 1993). Also, 80,000 illegal abortions occur annually in Zimbabwe. The purpose of this study is to examine factors that influence the reported quality of condom use by Zimbabwean men. Pender's Health Promotion model, which includes a set of General Influences and a set of Behavior Specific Influences was used to guide study design and analysis. The sample consisted of 400 Zimbabwean males studying at Belvedere Teachers college and Harare Institute of Technology with a mean age of 24 years (SD = 3.5). The reported quality of condom use in the last 12 months by participants in this sample was measured by four items: 24.6% reported using condoms every time, 27.7% put the condom on every time before the penis entered the vagina for the first time, 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. The sum score of responses to these four items was the dependent variable considered in this study. The higher the score, the higher the quality of condom use. In testing the model, four multiple regression results were examined. First, the quality of condom use score was regressed on all General influences variables. No General Influences variables had significant independent predictive power. Then the quality of condom use score was regressed on the Behavior Specific influences. Attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the quality of condom use. Next, the full model was tested using all variables in the proposed model. Although 27% of the variance was explained, multicollinearity and severe reduction in sample size led to a reduced model. For that purpose all predictors with significant bivariate relationships with condom use were tested in a reduced model. Using that model, multiple regression indicated that marital status, having been shown how to use condoms, attitudes toward condom use, and use of marijuana were all independently predictive of the reported quality of condom use. These findings are discussed in detail and compared to other findings so as to design effective interventions with Zimbabwean men. The situation in Zimbabwe and these results suggest that family planning programs need to integrate information on both contraceptives and sexually transmitted diseases including AIDS/HIV.Ph.D.Behavioral psychologyHealth and Environmental SciencesNursingPsychologyPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129832/2/9624776.pd

A Bioinspired Approach to Engineer the Seed Microenvironment

Bioinspired by the tardigrade and bombyx mori, we engineer the seed microenvironment to encapsulate, preserve and deliver Rhizobium tropici. Scientific discoveries in agriculture and sustainability are at the crossroads of material science, biochemistry, agriculture and biology. They underpin the innovative technological solutions that will impact water, energy and food security (WEFS). These new technologies can then be implemented to address major societal problems that are linked to climate change, soil degradation and increasing population. In particular, our objective is to augment agricultural outputs (i.e. crop yield and production) while decreasing inputs (e.g. water, energy, fertilizers, land, pesticides) by developing new technology to deploy plantgrowth-promoting-bacteria (PGPB) in the soil to alleviate abiotic plant stressors such as soil salinity and drought. Using PGPB to reduce and complement the use of synthetic fertilizer, our design approach engineers the seed microenvironment by coating the seeds with PGPB laden biopolymers. PGPB are well known to enhance crop production and protect plants from biotic and abiotic stresses, while decreasing the need for water and fertilizers. However, the bacteria’s delicate nature has hindered their use in current agricultural practices, due to low survivability. We use a silk and trehalose mixture that is able to encapsulate, protect, preserve and deliver Rhizobium tropici to Phaseolus Vulgaris, upon sowing. The coated P.vulgaris seeds are shown to be able to significantly alleviate soil salinity and water stresses in Moroccan soil when compared with uncoated (control) P.vulgaris seeds.Ph.D

Promises and pitfalls of Quantitative Structure-Activity Relationship approaches for predicting metabolism and toxicity

The description of quantitative structure¿activity relationship (QSAR) models has been a topic for scientific research for more than 40 years and a topic within the regulatory framework for more than 20 years. At present, efforts on QSAR development are increasing because of their promise for supporting reduction, refinement, and/or replacement of animal toxicity experiments. However, their acceptance in risk assessment seems to require a more standardized and scientific underpinning of QSAR technology to avoid possible pitfalls. For this reason, guidelines for QSAR model development recently proposed by the Organization for Economic Cooperation and Development (OECD) [ Organization for Economic Cooperation and Development (OECD) (2007) Guidance document on the validation of (quantitative) structure¿activity relationships [(Q)SAR] models. OECD Environment Health and Safety Publications: Series on Testing and Assessment No. 69, Paris] are expected to help increase the acceptability of QSAR models for regulatory purposes. The guidelines recommend that QSAR models should be associated with (i) a defined end point, (ii) an unambiguous algorithm, (iii) a defined domain of applicability, (iv) appropriate measures of goodness-of-fit, robustness, and predictivity, and (v) a mechanistic interpretation, if possible [ Organization for Economic Cooperation and Development (OECD) (2007) Guidance document on the validation of (quantitative) structure¿activity relationships [(Q)SAR] models. The present perspective provides an overview of these guidelines for QSAR model development and their rationale, as well as the promises and pitfalls of using QSAR approaches and these guidelines for predicting metabolism and toxicity of new and existing chemicals

Economic valuation of potential products from Jatropha seed in five selected countries: Zimbabwe, Tanzania, Mali, Indonesia, and The Netherlands

Currently, Jatropha seeds are mainly used to produce biodiesel, and a resultant press cakeis obtained as a by-product. Jatropha press cake fractionation and conversion into variouspotential products using biorefinery, could improve the economic value of Jatropha seed.The objectives of this study were to calculate the potential generated income and economicvalue of products from Jatropha. These were classified into two product groups: 1) Ruralproducts, and 2) Industrial products. The potential generated income is the summation ofthe net profit and the labour costs. Using the national gross domestic product (GDP) percapita as a reference, we calculated and compared the potential economic value, whichexpresses the number of people that could obtain a certain income for every hectare ofJatropha plantation, in five selected countries. These countries consisted of four developingcountries: Tanzania, Mali, Zimbabwe, and Indonesia, and a developed country, theNetherlands. This study shows that the potential generated income from rural productsper hectare of (imported) Jatropha was much lower than the income of one person inIndonesia and the Netherlands. In Zimbabwe, Tanzania, and Mali, the potential economicvalue per hectare Jatropha suggests that manufacturing rural products can generate potentialincome for one person. Manufacturing industrial products can generate potentialincome for one person in the Netherlands and approx. 7e39 people in Indonesia,Zimbabwe, Tanzania, and Mali. In conclusion, the potential generated income is highlydependent on the GDP per capita and the price of the selected products in each country

On the number of EINECS compounds that can be covered by (Q)SAR models for acute toxicity

The new EU legislation for managing chemicals called REACH aims to fill in gaps in toxicity information that exist for the chemicals listed on the European Inventory of Existing Chemical Substances (EINECS). REACH advocates the use of alternatives to animal experimentation including, amongst others, (quantitative) structure¿activity relationship models [(Q)SARs] to help fill in the toxicity data gaps. The aim of the present study was to provide a science-based estimate of the number of EINECS compounds that can be covered by (Q)SAR models for acute toxicity. Using the ECOSAR software, 54% of the 100 196 EINECS chemicals were classified into 49 classes that can be potentially covered by (Q)SAR models. The largest proportion of the classified compounds (40% of the EINECS list) falls into the classes of non-polar and polar narcotics. Compounds that were not classified include, for example, fish oils, botanical and animal extracts, and crude oil distillates. With rapid improvements in analytical tools, the number of EINECS compounds for which toxicity evaluations may be based on (Q)SAR approaches may be extended by further developing the method recently developed for the safety assessment of natural flavor complexes used as ingredients in food. This method is based on identification of the individual components in a mixture, and judgment of the safety of these identified individual compounds using toxicity information on structurally similar congeners in the respective classes. Such (Q)SAR approaches may be applied to an additional 2938 EINECS compounds, representing botanical and animal extracts, leading to a total estimate of 57% of the EINECS compounds for which (Q)SAR-based approaches may assist in their safety assessment. It is concluded that, despite the fact that individual (Q)SARs may often each cover only a limited number, i.e. less than 1%, of the EINECS compounds, the potential for applying (Q)SAR approaches for safety assessment of EINECS compounds may prove to be significant