Determinants of nondisclosure of HIV status among women attending the prevention of mother to child transmission programme, Makonde district, Zimbabwe, 2009

Introduction: The 2007 United Nations General Assembly Report on HIV/AIDS in Zimbabwe reported nondisclosure of HIV status as a challenge in the PMTCT programme. Preliminary investigations on nondisclosure among 21 women tested for HIV at Chinhoyi Hospital showed that only six had disclosed their HIV status. We investigated the determinants of nondisclosure of HIV status. Methods: A cross sectional analytic study was conducted at six health facilities in Makonde district. The Theory of Planned Behaviour was adapted to guide socio-cultural variables assessed. Antenatal and postnatal women tested for HIV in the PMTCT program who consented to participate were interviewed. Results: We enrolled 334 women. Thirty four percent (114) did not disclose their HIV status. Among HIV positive respondents, 43% (25) did not disclose their status. Women who believed disclosure caused physical abuse (OR=1.81, 95% CI: 1.17-2.90), caused divorce (OR=2.01, 95% CI: 1.25-3.22) and was unimportant (OR= 2.26, 95% CI: 1.33-3.87) were two times less likely to disclose their status. Respondents who received group HIV pre-test counselling were 2.4 times more likely not to disclose. Receiving ANC HIV education at least twice and referral for psychosocial support were significantly protective [OR 0.54 (95% CI 0.24-0.63) and 0.16 (95% CI: 0.06-0.41) respectively. Independent determinants of nondisclosure among HIV positive women were perception that disclosure would cause divorce (AOR=7.82, p=0.03), living with an extended family (AOR=10.3, p=0.01) and needing spousal approval of HIV testing (AOR= 0.11, p<0.001). Conclusion: Lack of psychosocial support and counselling for women and belief that disclosure causes divorce, abuse or is unimportant contributes to nondisclosure. Identifying women with social challenges and strengthening their referral for psychosocial support can improve disclosure of HIV status and reduce mother to child transmission of HIV.Key words: Prevention of mother to child transmission, HIV Status, Determinants, Wome

Numerical simulation of shrinkage and creep in patch-repaired axially loaded reinforced concrete short columns

This paper presents numerical results obtained from finite element simulations of the time-dependent behaviour of moderately loaded patch-repaired reinforced concrete short columns. Patch repair is a structural concrete repair method in which damaged concrete is replaced with one of a wide range of materials. Relative to the concrete substrate, the patch repair materials used in this study had different properties, such as the elastic modulus, shrinkage and creep. A priori, it would appear that simple theory such as the engineer's theory of bending cannot be used to quantify the behaviour of the patch-repaired member. Experimental evidence needed to clarify such issues remains scarce. The finite element simulations performed in this study indicate that shrinkage and creep cause the progressive shedding of the load carried by the patch repair to the concrete substrate. Finite element results compare favourably with the predictions of the engineer's bending theory. Relative to test results some qualitative agreement is observed though there is significant quantitative deviation. © 2001 Elsevier Science Ltd. All rights reserved

Factors associated with occupational injuries at a bevarage manufacturing company in Harare, Zimbabwe - 2008

No Abstract

Risk factors for contracting anthrax in Kuwirirana ward, Gokwe North, Zimbabwe

Background: A report of an anthrax outbreak was received at Gokwe district hospital from the Veterinary department on the 23 rd January 2007. This study was therefore conducted to determine risk factors for contracting anthrax amongst residents of Kuwirirana ward. Methods: We conducted a 1:1 unmatched case control study. A case was any person in Kuwirirana ward who developed a disease which manifested by itching of the affected area, followed by a painful lesion which became papular, then vesiculated and eventually developed into a depressed black eschar from 12 January to 20 February 2007. A control was a person resident of Kuwirirana ward without such diagnosis during the same period. Results: Thirty-seven cases and 37 controls were interviewed. On univariate analysis, eating contaminated meat (OR = 7.7, 95% CI 2-29.8), belonging to a household with cattle deaths (OR= 9.7, 95% CI 2.9-33), assisting with skinning anthrax infected carcasses (OR= 5.4(95% CI 1.7-17), assisting with meat preparation for drying (OR = 5(95%CI 1.9-13.9), assisting with cutting contaminated meat (OR = 4.8(95% CI 1.7-13.2), having cuts or wounds during skinning (OR = 19.5, 95% CI 2.4-159) and belonging to a village with cattle deaths (OR = 6.5(95%CI 1.3-32) were significantly associated with anthrax. Conclusion : Anthrax in Kuwirirana resulted from contact with and consumption of anthrax infected carcasses. We recommend that the district hold regular zoonotic committee meetings and conduct awareness campaign for the community and carry out annual cattle vaccinations

Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection.Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe.Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews.Results: Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects.Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background: Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.Objective: To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.Methods: A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities  for other ailments. We interviewed 77 cases and 154 controls.Results: Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42-20.85), relationships less than one year, OR= 9.33 (95% CI 3.53-24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64-16.25) and paying for sex OR= 23.65 (95% CI 6.23-89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02-6.04) and relationships less than one year OR=3.19 (95% CI 1.41-7.23). Significant differences in attitudes were evident among cases and controls.Conclusion: Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women

Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection. Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe. Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews. Results: Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Risk factors associated with cholera in Harare City, Zimbabwe, 2008

Objective: Two suspected cholera cases at Beatrice Road Infectious Diseases Hospital were reported to Harare City Health on 14 October 2008 setting in motion investigation and control measures. We determined the extent of the epidemic and risk factors for contracting cholera.Methods: An unmatched 1:1 case-control study was conducted. Case: Any resident of Harare City, 2years and above, with acute watery diarrhoea, with or without vomiting from 30 October 2008 to 01 December 2008. Control: Any resident of Harare City, 2years and above, neighbour to a case, who did not contract cholera during the same period.Results: From 14 October 2008 to 21 January 2009, 11203 cases and case fatality rate (CFR)= 3.98%. We interviewed 140 cases and 140 controls. Median age was 28years (Q1= 20; Q3= 37.5) and 28.5years (Q1= 23; Q3= 38) for cases and controls respectively. Having a diarrhoea contact at home [AOR= 12.02; 95% CI (5.46 - 26.44)], having attained less than secondary education [AOR= 4.40; 95% CI (2.28 - 8.48)]; eating cold food [AOR= 4.24; 95% CI (1.53 - 11.70)] were independent risk factors while drinking tap water [AOR= 0.05; 95% CI (0.03 - 0.11)], washing hands after using toilet [AOR= 0.19; 95% CI (0.09 - 0.39)]; eating hot food always [AOR= 0.29; 95% CI (0.17 - 0.49)] were independently protective.Discussion: The high CFR may be due to poor case management and staff shortage in treatment camps. The cholera outbreak in Harare resulted from poor personal and hygiene practices that occur when water supplies are cut. Lack of water, low knowledge on cholera prevention measures and delays in community health education campaigns contributed to the protracted outbreak. Having a diarrhoea contact at home increases chances of household members acquiring infection. Provision of safe drinking water, community health education, recruitment of staff and training of health workers on cholera case management must be prioritized

Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012

Background: Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT. Methods: A UAT dataset was created by capturing socio-demographic, testing practices from the woman’s booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites. Results: Pooled HIV prevalence was 15.8 % (95 % CI 15.3–16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %–16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %–19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %–19.5 %) among acceptors in ANC registers. There were variations in prevalence by site. Conclusion: Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning.National Research Foundation (South Africa

Additional file 1: Table S1. of Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012

Merged Data Set. (PDF 26 kb