Women in Surgery: Factors Deterring Women from Being Surgeons in Zimbabwe

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Referral of sexual violence against children: How do children and caregivers use a formal child protection mechanism in Harare, Zimbabwe?

Despite widespread expansion of policies to prevent and respond to violence over the past three decades, sexual violence against children remains common globally. Zimbabwe has expansive legal and policy frameworks to prevent, and formal services to respond to, sexual violence. Yet evidence is lacking about how children and caregivers use formal referral mechanisms. This study conducted secondary qualitative analysis of sexual violence cases [N=74] processed in Harare Magistrates Court and referred to Childline Zimbabwe, in October-November 2020, to examine which experiences children and/or their caregivers formally refer as sexual violence; how they perceive and manage these experiences; and how this relates to national policy contexts. Caregivers, particularly female, were central to reporting sexual violence. Data suggested that some forms of sexual violence were formally referred, including community sexual assault and abuse within families, however some adolescent girls faced blame and shame. There were gaps in reporting of sexual violence against boys, and sexual violence from dating partners or authority figures, with data suggesting that gendered stigma, shame, and fears of institutional authority, were barriers for reporting. Caregivers also reported consensual adolescent sexual relationships to police. These findings contribute to the limited evidence on forms of sexual violence that are and are not formally referred globally, and in sub-Saharan African settings. Existing policy frameworks in Zimbabwe can be strengthened around age of maturity, adolescent sexuality, sidelining of boy survivors, and the role of schools in child protection. Interventions should support caregivers’ efforts to report violence, while also addressing gendered blame and stigma, and stigmatisation of adolescent sexuality

Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data.

BACKGROUND: The clinical and epidemiological significance of HIV-associated Mycobacterium tuberculosis bloodstream infection (BSI) is incompletely understood. We hypothesised that M tuberculosis BSI prevalence has been underestimated, that it independently predicts death, and that sputum Xpert MTB/RIF has suboptimal diagnostic yield for M tuberculosis BSI. METHODS: We did a systematic review and individual patient data (IPD) meta-analysis of studies performing routine mycobacterial blood culture in a prospectively defined patient population of people with HIV aged 13 years or older. Studies were identified through searching PubMed and Scopus up to Nov 10, 2018, without language or date restrictions and through manual review of reference lists. Risk of bias in the included studies was assessed with an adapted QUADAS-2 framework. IPD were requested for all identified studies and subject to harmonised inclusion criteria: age 13 years or older, HIV positivity, available CD4 cell count, a valid mycobacterial blood culture result (excluding patients with missing data from lost or contaminated blood cultures), and meeting WHO definitions for suspected tuberculosis (presence of screening symptom). Predicted probabilities of M tuberculosis BSI from mixed-effects modelling were used to estimate prevalence. Estimates of diagnostic yield of sputum testing with Xpert (or culture if Xpert was unavailable) and of urine lipoarabinomannan (LAM) testing for M tuberculosis BSI were obtained by two-level random-effect meta-analysis. Estimates of mortality associated with M tuberculosis BSI were obtained by mixed-effect Cox proportional-hazard modelling and of effect of treatment delay on mortality by propensity-score analysis. This study is registered with PROSPERO, number 42016050022. FINDINGS: We identified 23 datasets for inclusion (20 published and three unpublished at time of search) and obtained IPD from 20, representing 96·2% of eligible IPD. Risk of bias for the included studies was assessed to be generally low except for on the patient selection domain, which was moderate in most studies. 5751 patients met harmonised IPD-level inclusion criteria. Technical factors such as number of blood cultures done, timing of blood cultures relative to blood sampling, and patient factors such as inpatient setting and CD4 cell count, explained significant heterogeneity between primary studies. The predicted probability of M tuberculosis BSI in hospital inpatients with HIV-associated tuberculosis, WHO danger signs, and a CD4 count of 76 cells per μL (the median for the cohort) was 45% (95% CI 38-52). The diagnostic yield of sputum in patients with M tuberculosis BSI was 77% (95% CI 63-87), increasing to 89% (80-94) when combined with urine LAM testing. Presence of M tuberculosis BSI compared with its absence in patients with HIV-associated tuberculosis increased risk of death before 30 days (adjusted hazard ratio 2·48, 95% CI 2·05-3·08) but not after 30 days (1·25, 0·84-2·49). In a propensity-score matched cohort of participants with HIV-associated tuberculosis (n=630), mortality increased in patients with M tuberculosis BSI who had a delay in anti-tuberculosis treatment of longer than 4 days compared with those who had no delay (odds ratio 3·15, 95% CI 1·16-8·84). INTERPRETATION: In critically ill adults with HIV-tuberculosis, M tuberculosis BSI is a frequent manifestation of tuberculosis and predicts mortality within 30 days. Improved diagnostic yield in patients with M tuberculosis BSI could be achieved through combined use of sputum Xpert and urine LAM. Anti-tuberculosis treatment delay might increase the risk of mortality in these patients. FUNDING: This study was supported by Wellcome fellowships 109105Z/15/A and 105165/Z/14/A

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Dictatorships, disasters, and African soccer: Reflections on a moment in Zimbabwean soccer

This article is a reflection on a particular moment in Zimbabwean soccer, the National SportsStadiumdisasterofJuly2000.Reading thesoccerstadiumasadensesemiotic site with many slippages of symbols and meanings, the article draws links between the game of football and that of politics. Both games offer narratives of the nation that constantly collide and merge as they share the same features. Complex rules regulate both games but there is always a potential for dictatorship, subversion, and disaster. Using the trope suggested by the novelist, poet, and cultural critic, Chenjerai Hove, on dictatorship in soccer and politics, the article attends to areas of rule bending and flouting that diminish fair play and justice. The article uses the football stadium disaster genre to argue for a redemptive politics and politics of the human in the practices and ideologies of both ZANU PF and MDC, the arch-rivals in the political struggles in Zimbabwe. © 2011 Taylor & Francis.Articl

Role of mobile health on patient enrollment for cleft lip-palate surgery: A comparative study using SMS blast text messaging in zimbabwe.

BackgroundPatients' lack of awareness of available services is a significant barrier to delivering surgical care in resource-limited settings. Short message service (SMS) text messaging is a potential means to disseminate this information in resource-limited settings, where rates of mobile phone usage are high.MethodsA blast SMS text informing local populations of upcoming cleft lip-palate (CLP) surgical services was distributed to 25% of the subscriber base 1 week prior to arrival of a (CLP) surgical team in Zimbabwe. A retrospective cohort analysis comparing characteristics of patients presenting to the CLP clinic in the year prior to (2016) and 2 years following (2017-2018) the implementation of the blast SMS text messaging system is performed to assess its impact.ResultsPatients presenting to a single Zimbabwean CLP surgical program in the years with SMS messaging notifications were significantly more likely (52 [64%] vs. 5 [17%], P < .001) to have been informed of surgical services through their mobile phones. The average distance traveled per patient was not significantly different prior to implementation of mass text messaging (180.4 km [SD114.8] vs. 167.4 km [SD105.9], P = .580). The average patient age was significantly higher following the implementation of mass text messaging (7.4 [SD8.7] vs. 3.0 [SD2.8] years, P = .010).ConclusionsSMS messaging is an effective method of informing patients of CLP surgical services in resource-limited settings. After implementation of SMS text notifications, surgical patients were of increased age, but showed no difference in distance traveled.Level of evidenceIV

Extremely depleted lithospheric mantle and diamonds beneath the southern Zimbabwe Craton

Inclusion-bearing diamonds, mantle xenoliths, and kimberlite concentrates from the Cambrian-aged Murowa and Sese kimberlites have been studied to characterise the nature of the lithospheric mantle beneath the southern Zimbabwe Craton. The diamonds are mostly octahedral, moderately rich in nitrogen with moderate to high aggregation, and contain mainly dunite–harzburgite mineral inclusions. Similarly, dunite xenoliths predominate over harzburgite and lherzolite and carry olivines with Mg/Mg + Fe (Mg#) values of 0.92–0.95, spanning the average signatures for Kaapvaal Craton peridotites. Eclogitic xenoliths are extremely rare, in contrast to the Kaapvaal mantle lithosphere. The Zimbabwe mantle assemblage has been only slightly affected by later silicic metasomatism and re-fertilisation with re-introduction of pyroxenes in contrast to the Kaapvaal and many cratonic lithospheric blocks elsewhere where strong metasomatism and re-fertilisation is widespread. Pyroxene, garnet and spinel thermobarometry suggests an ambient 40 mW m− 2 geotherm, with the lithosphere extending down to 210 km at the time of kimberlite eruption. Whole rock peridotite Re–Os isotope analyses yield TRD model ages of 2.7 to 2.9 Ga, providing minimum estimates of the time of melt depletion, are slightly younger in age than the basement greenstone formation. These model ages coincide with the mean TRD age of > 200 analyses of Kaapvaal Craton peridotites, whereas the average Re–Os model age for the Zimbabwe peridotites is 3.2 Ga. The Os data and low Ybn/Lun ratios suggest a model whereby thick lithospheric mantle was stabilised during the early stages of crustal development by shallow peridotite melting required for formation of residues with sufficiently high Cr/Al to stabilise chromite which then transforms to low Ca, high Cr garnet. Sulphide inclusions in diamond produce minimum TRD model ages of 3.4 Ga indicating that parts of the lithosphere were present at the earliest stages of crust formation in this area. Published mineral analyses for mantle xenoliths, diamonds and concentrate macrocrysts from the Venetia, River Ranch, Mwenezi and Chingwizi pipes which intrude the Limpopo Mobile Belt show strongly depleted peridotitic mantle signatures matching with the mantle beneath southern Zimbabwe. Published seismic velocity imagery suggests the presence of a deep lithospheric mantle keel beneath the Limpopo Mobile Belt today and Re–Os analyses of peridotite xenoliths from Venetia have previously yielded an Archean age. The Limpopo Mobile Belt is therefore interpreted as a product of thin skin crustal tectonics with the underlying lithospheric mantle linked to that of the southern Zimbabwe Craton and unaffected by the overlying crustal events

Role of mobile health on patient enrollment for cleft lip-palate surgery: A comparative study using SMS blast text messaging in zimbabwe.

BackgroundPatients' lack of awareness of available services is a significant barrier to delivering surgical care in resource-limited settings. Short message service (SMS) text messaging is a potential means to disseminate this information in resource-limited settings, where rates of mobile phone usage are high.MethodsA blast SMS text informing local populations of upcoming cleft lip-palate (CLP) surgical services was distributed to 25% of the subscriber base 1 week prior to arrival of a (CLP) surgical team in Zimbabwe. A retrospective cohort analysis comparing characteristics of patients presenting to the CLP clinic in the year prior to (2016) and 2 years following (2017-2018) the implementation of the blast SMS text messaging system is performed to assess its impact.ResultsPatients presenting to a single Zimbabwean CLP surgical program in the years with SMS messaging notifications were significantly more likely (52 [64%] vs. 5 [17%], P < .001) to have been informed of surgical services through their mobile phones. The average distance traveled per patient was not significantly different prior to implementation of mass text messaging (180.4 km [SD114.8] vs. 167.4 km [SD105.9], P = .580). The average patient age was significantly higher following the implementation of mass text messaging (7.4 [SD8.7] vs. 3.0 [SD2.8] years, P = .010).ConclusionsSMS messaging is an effective method of informing patients of CLP surgical services in resource-limited settings. After implementation of SMS text notifications, surgical patients were of increased age, but showed no difference in distance traveled.Level of evidenceIV