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A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
(2020) Ngulube, A.; Ntoto, C.O.M.; Matsika, D.; Ndebele, W.; Dube, N.S.; Gapu, P.
INTRODUCTION: Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. PRESENTATION OF CASE: A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. DISCUSSION: Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully under stood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. CONCLUSION: Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
(Elsevier, 2020) Ngulube, A.; Ntoto, C.O.M.; Ndebele, W.; Matsika, D.; Dube, N.S.; Gapu, P.
Abstract Introduction Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. Presentation of case A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. Discussion Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully understood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. Conclusion Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
Accessibility to and utilization of maternal, neonatal and child health (MNCH) services by rural women: A case study of health centres in Mutare district based on the 3 delays model
(Academic Journals, 2022) Ndhlovu-Ncube, N.P.; Mavondo, G.A.; Moyo, O.; Chikuse F. F.; Ndhlovu, T.C.; Mavondo, J.; Mkhwanazi, B. N.; Musarurwa, C.; Chaibva, C.N.
High maternal, neonatal and child mortality rate constituting about 70% of the population in Zimbabwe. Zimbabwean rural women have faced challenges in accessing and utilizing Maternal, Neonatal and Child Health (MNCH) services. Rural areas in Zimbabwe have had high prevalence of home deliveries and pregnancy related complications associated with lack of access to and utilization of MNCH services, resulting in high maternal, stillbirths, new-born, neonatal and infant mortality rates. Access to and utilisation of MNCH services and facilities by rural based pregnant women has been limited by several issues that have been explored and assessed in the Primary Health Care clinics. However, the 3 delays (seek, access and receive health service) effects on the factors affecting health care and outcomes remain largely unclear in rural settings. Qualitative and quantitative methods research was conducted in Mutare district, Manicaland Province, Zimbabwe. Data collection tools including interviews questionnaires and focus group discussion guides were used to show how the three delays affected health service access in the district. GraphPad InStat Software and Statistical Package for Social Science were used for data analysis. Religious and cultural beliefs contributed to patient delays in seeking healthcare. With long distances and lack of transport attributed to Delays 1 and 2 with, drug unavailability, up-to date equipment and delay causing Delay 3. The patient, the provider and health systems were critical in accessibility, utilization and linkages of MNCH with other health services being crucial for achieving 4th and 5th Millennium Development Goals the targets.
Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement
(World Health Organisation, 2013-11-27) Crofts, J.; Moyo, J.; Ndebele, W.; Mhlanga, Samson; Draycott, T.; Sibanda, T.
Problem:The Commission on Information and Accountability for Women’s and Children’s Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and “not timely enough for practical use by health planners and administrators”. Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Approach: Clinical “dashboards” based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility’s clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. Local setting: An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Relevant changes: Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Lessons learnt: Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.
Antimalarial Phytochemicals: Delineation of the Triterpene Asiatic Acid Malarial Anti-Disease and Pathophysiological Remedial Activities - Part I
(Scholarena, 2018-05) Mavondo, Greanious Alfred; Kasvosve, Ishmael
Malaria is a composite condition of the Plasmodium parasite infection and accompanying pathologies. Parasite induced red blood cell perturbations and immunological response to infection drive various organ-specific syndromes accounting for a huge percentage of deaths amongst children <5 years and pregnant women. The multi-factorial pathophysiology includes acute renal failure, hypoglycaemia, severe malaria anaemia, acute respiratory distress syndrome/ acute lung injury and cerebral malaria as some of the prominent presentations of the disease. Current malaria treatment has largely remained “anti-parasite” or “anti-infection” necessitating discovery of “anti-disease” drugs that will ameliorate immunological aberrations, inflammation and metabolic disturbances which are ultimately the cause of high morbidity and mortality. Asiatic acid, a phytochemical, has well known curative properties on other conditions which share disease manifestations with malaria. However, the influence of Asiatic acid on malaria has not yet been reported. This review unravels the different facets of Asiatic acid and their possible remedial effects on molecular and biological changes introduced by the disease with emphasis on how this relates to glucose metabolism, acute renal failure, severe malaria anaemia, acute respiratory distress syndrome/ acute lung injury and cerebral malaria.
Asiatic acid-pectin hydrogel matrix patch transdermal delivery system influences parasitaemia suppression and inflammation reduction in P. berghei murine malaria infected Sprague-Dawley rats
(Elsevier, 2016-10-12) Mavondo, Greanious Alfred Alfrd; Tagumirwa, Musabayane Cephas
Objective: To report the influence of transdermal delivery of asiatic acid (AA) in Plasmodium berghei-infected Sprague Dawley rats on physicochemical changes, %parasitaemia and associated pathophysiology. Methods: A topical once-off AA (5, 10, and 20 mg/kg)- or chloroquine (CHQ)-pectin patch was applied on the shaven dorsal neck region of Plasmodium berghei-infected Sprague Dawley rats (90- 120 g) on day 7 after infection. Eating and drinking habits, weight changes, malaria effects and %parasitaemia were compared among animal groups over 21 d. Results: AA-pectin patch application preserved food and water intake together with %weight gain. All animals developed stable parasitaemia (15%-20%) by day 7. AA doses suppressed parasitaemia significantly. AA 5 mg/kg patch was most effective. AA and CHQ displayed bimodal time-spaced peaks. CHQ patch had a longer time course to clear parasitaemia. Conclusions: AA influences bio-physicochemical changes and parasitaemia suppression in dose dependent manner. In comparison by dose administered, AA has much better efficacy than CHQ. AA may be a useful antimalarial. AA and CHQ displays bimodal peaks suggesting possible synergism if used in combination therapy
Association of academic stress, anxiety and depression with social-demographic among medical students.
(Redfame Publishing, 2018) Dube, A.; Chamisa, J.A.; Gundani, P.M.; Bako, C.; Lunga, M.C.
Background: Medical education programmes aim at producing wholesome of competent and skilled graduates, research have shown that students experience stress which impacts on their health, academic performance and social functioning. This paper aims to determine the extent of academic stress, depression and anxiety among medical undergraduates and to explore the correlation between academic stressors, psychological stress and socio-demographic background among first year medical students at National University of Science and Technology. Method: This descriptive cross-sectional study was undertaken by first-year medical students in 2016 at NUST Division of Social Medical Sciences. A validated and standardised survey Depression Anxiety Stress Scale (DASS 42) questionnaire was used. Data was analysed by SPSS version 21.0. Results: Nineteen first-year midwifery students participated in the study. Males were 63.1% while females were 38.8%. Seventy-three per cent of the participants experienced stress during the programme, of which forty-nine percent were females. Female students showed severe stress of 6±1.15 as compared to their male counterparts who scored extremely severe stress of 3.81±1.53. Academic, health-related and psychosocial problems were the chief sources of stress. Conclusion: Stress impacts negatively on undergraduate students. Midwifery students need guidance, mentorship and educational integration support to identify and monitor their own well-being. These measures should promote a balance in selection of positive strategies to overcome stress, managing workload and time effectively during study period.
Chlorpyrifos- and dichorfos-induced oxidative and neurogenic damage elicits neuro-cognitive deficits and increases anxiety-like behaviors in wild-type rats
(Creative commons, 2018-10-16) Imam, Aminu; Sulaiman, Nafeesah Abdulkareem; Oyewole, Aboyeji Lukuman; Chengetanai, Samson; Williams, Victoria; Ajibola, Musa Iyiola; Folarin, Royhaan Olamide; Muhammad, Asma’u Shehu; Shittu, Asma’u Shehu; Ajao, Salihu Moyosore
The mechanization of agricultural activities has led to indiscriminate deposition of toxic xenobiotics, including organophosphates in the biomes, and this has led to intoxication characterized with deleterious oxidative and neuronal changes. This study investigated the consequences of oxidative and neurogenic disruptions that follow exposure to two organophosphates, chlorpyrifos (CPF) and dichlorvos (DDVP) on neuro-cognitive performance and anxiety-like behaviors in rats Thirty-two adult male Wistar rats (150 – 170g) were randomly divided into 4 groups, orally exposed to normal saline (NS), DDVP (8.8mg/kg), CPF (14.9mg/kg) and DDVP+CPF for 14 consecutive days. On day 10 of exposures, anxiety-like behaviors andamygdala dependent fear learning were assessed using Open Field and Elevated Plus Maze paradigms respectively, while spatial working memory was assessed on day 14 in the Morris water maze paradigm, following 3 training trials each on days 11, 12 and 13. On day 15, the rats were euthanized, and their brains excised, hippocampus and amygdala removed, 5 of which were homogenized and centrifuged to analyze nitric oxide (NO) metabolites, total reactive oxygen species (ROS), and acetylcholinesterase (AChE) activity, and the other three processed for histology 43 (cresyl violet stain) and proliferative marker (Ki67 immunohistochemistry). Marked (p≤0.05) loss in 44 body weight, AChE depletion, and overproduction of both NO and ROS were observed after repeated exposure to individual and combined doses of CPF and DDVP. Insults from DDVP exposure appeared more severe owing to the observed greater losses in the body weights of exposed rats. There was also a significant (p≤0.05) effect on the cognitive behaviors recorded from the exposed rats, and these deficits were related to the oxidative damage and neurogenic cell loss in the hippocampus and the amygdala of the exposed rats. Taken together, these results provided an Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 16 October 2018 doi:10.20944/preprints201810.0359.v1 © 2018 by the author(s). Distributed under a Creative Commons CC BY license.2 of 16 insight that oxidative and neurogenic damages are central to the severity of neuro-cognitive dysfunction and increased anxiety-like behaviors that follow organophosphate poisoning
The contributions of muscarinic receptors and changes in plasma aldosterone levels to the anti-hypertensive effect of Tulbaghia violacea
(Biomed Central, 2013) Raji, Ismaila A.; Mugabo, Pierre; Obikeze, Kenechukwu
Background: Tulbaghia violacea Harv. (Alliaceae) is used to treat various ailments, including hypertension (HTN) in South Africa. This study aims to evaluate the contributions of muscarinic receptors and changes in plasma aldosterone levels to its anti-hypertensive effect. Methods: In the acute experiments, methanol leaf extracts (MLE) of T. violacea (30–120 mg/kg), muscarine (0.16-10 μg/kg), and atropine (0.02 - 20.48 mg/kg), and/or the vehicle (dimethylsulfoxide (DMSO) and normal saline (NS))were respectively and randomly administered intravenously in a group of spontaneously hypertensive (SHR) weighing 300 to 350 g and aged less than 5 months. Subsequently, T. violacea (60 mg/kg) or muscarine (2.5 μg/kg) was infused into eight SHRs, 20 min after atropine (5.12 mg/kg) pre-treatment. In the chronic (21 days) experiments, the SHRs were randomly divided into three groups, and given the vehicle (0.2 ml/day of DMSO and NS), T. violacea (60 mg/kg/day) and captopril (10 mg/kg/day) respectively into the peritoneum, to investigate their effects on blood pressure (BP), heart rate (HR), and plasma aldosterone levels. Systolic BP and HR were measured using tail-cuff plethysmography during the intervention. BP and HR were measured via a pressure transducer connecting the femoral artery and the Powerlab at the end of each intervention in the acute experiment; and on day 22 in the chronic experiment. Results: In the acute experiments, T. violacea, muscarine, and atropine significantly (p < 0.05) reduced BP dose-dependently. T. violacea and muscarine produced dose-dependent decreases in HR, while the effect of atropine on HR varied. After atropine pre-treatment, dose-dependent increases in BP and HR were observed with T. violacea; while the BP and HR effects of muscarine were nullified. In the chronic experiments, the T. violaceatreated and captropril-treated groups had signicantly lower levels of aldosterone in plasma when compared to vehicle-treated group. Compared to the vehicle-treated group, significant reduction in BP was only seen in the captopril-treated group; while no difference in HR was observed among the groups. Conclusion: The results obtained in this study suggest that stimulation of the muscarinic receptors and a reduction in plasma aldosterone levels contribute to the anti-hypertesive effect of T. violacea.
Effects of aqueous leaf extract of Asystasia gangetica on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats
(BioMed Central, 2013-09-26) Mugabo, Pierre; Raji, Ismaila A.
Background: Asystasia gangentica (A. gangetica) belongs to the family Acanthaceae. It is used to treat hypertension, rheumatism, asthma, diabetes mellitus, and as an anthelmintic in South Africa, India, Cameroun, Nigeria, and Kenya respectively. It has also been reported to inhibit the angiotensin I converting enzyme (ACE) in-vitro. Therefore, the aim of this study is to investigate the in-vivo effect of aqueous leaf extract (ALE) of A. gangetica on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive rats (SHR); and to elucidate possible mechanism(s) by which it acts. Methods: The ALE of A. gangetica (10–400 mg/kg), angiotensin I human acetate salt hydrate (ANG I, 3.1–100 μg/kg) and angiotensin II human (ANG II, 3.1–50 μg/kg) were administered intravenously. The BP and HR were measured via a pressure transducer connecting the femoral artery to a Powerlab and a computer for recording. Results: A. gangetica significantly (p<0.05), and dose-dependently reduced the systolic, diastolic, and mean arterial BP. The significant (p<0.05) reductions in HR were not dose-dependent. Both ANG I and ANG II increased the BP dose-dependently. Co-infusion of A. gangetica (200 mg/kg) with either ANG I or ANG II significantly (p<0.05) suppressed the hypertensive effect of both ANG I and ANG II respectively, and was associated with reductions in HR. Conclusions: A. gangetica ALE reduced BP and HR in the SHR. The reduction in BP may be a result of actions of the ALE on the ACE, the ANG II receptors and the heart rate.
Effects of concurrent chloroquine and ethanol administration on the rat kidney morphology
(African Field Epidemiology Network, 2018-01-18) Abdulkadir, Abdurrahman; Mbajiorgu, Ejikeme. F; Nyirenda, Trust
The use of antimalarial chloroquine in malaria-endemic regions of Africa is rampant and it is not uncommon to find individuals taken the drug concurrent with alcohol. Effects of anti-malarial drug chloroquine (Chq) and ethanol (Et) combination on kidney volume and function using rat model was investigated. Methods: 32 adult male rats were randomly distributed into four groups of 8 rats each. Group C serve as control and received vehicle only, while Q is Chq treated only, E is Et treated and QE is Et and Chq treated. Chq was administered intraperitoneally at 1mg/100g body weight weekly and 6% Et in drinking water provided ad libitum. Urine volume was collected before the treatment began and after the treatment. After eight weeks, all animals were euthanized; kidneys were harvested and fixed in 10% neutral formalin. The fixed left kidneys were scanned with computed tomography and the scan slices were used to estimate 3-dimensional kidney volume on ImageJ. Results: Total kidney volume was none significantly increased in Q, E and QE treated compared to control groups (p = 0.5150). Also, microscopic analysis showed increased proximal tubule diameter (p = 0.1426) and epithelial hypertrophy (p = 0.2530) and significant urinary space shrinkage (p = 0.00001). The initial urine volume was not significantly different between the control and treated groups (p = 0.9864) however, following treatment urine volume was significantly reduced in QE rats group (p = 0.0029). Conclusion: The results suggest chloroquine and ethanol combination as potential cause of kidney injury through structural damage and function derangement
Foreign body of the spleen from percutaneous entry
(Elsevier, 2019) Mungazi, S.G.; Ndebele, W.; Zimunhu, T.; Magara, M.; Mbuwayesango, B.; Muchuweti, D.; Muguti, E.G.; Gwini, G.; Gandanhamo, D.
Foreign body (FB) aspiration and ingestion are fairly common in children. Sharp foreign bodies may also enter the body by penetration. In penetrating foreign bodies, commonly skin and the gastrointestinal tract are the affected organs. An impacted foreign body in the spleen is rare. The diagnosis can be challenging without a history of penetration. Herein, we report a case of an infant with a sewing needle that accidentally punctured the spleen after penetrating through the skin of the subscapular area. A history of FB penetration and imaging were essential to confirm the diagnosis. The sewing needle was successfully removed laparoscopically.
HIV knowledge, risky behaviours and public health care services attendance among adolescents from the Grassroot soccer Zimbabwe programme
(2020) Mzingwane, M.L.; Mavondo, G.A.; Mantula, F.; Mapfumo, C.; Gwatiringa, C.; Moyo, B.; Dube, P.; Chaibva, C.N.
Background: Interventions aimed at improving accessing of health care services, including HIV testing, remain a priority in global HIV eradication efforts. Grassroot Soccer Zimbabwe (GRSZ) is an adolescent health organisation that uses the popularity of soccer to promote healthy behaviours. We assessed HIV knowledge levels, riskybehaviours and attitudes in school going adolescents and young adults who attended GRSZ programmes and determined if HIV knowledge levels were associated with increased levels of accessing of health care services by youths. Methods: This was a cross-sectional study carried out on 450 participants aged 13–30 years who attended at least one of the three programmes offered by GRSZ. Self-administered and self-reporting questionnaires were used to collect information on participants’ demographics, knowledge on HIV and reproductive health, sources of information, access to HIV and reproductive health services and attitudes and risky behaviours. Results: A total of 392 (87.1%) responses were received. High HIV and reproductive health knowledge levels were recorded (77.7%) on our scale with females recording higher levels (81.1%) than males (71.1%). The majority of participants (72%) indicated willingness to abstain from risky behaviours such as use of drugs and attending youth sex parties. However about 33.3% of the participants who had sexual intercourse reported having condomless sex. There was marginal association between high HIV and reproductive health knowledge levels and accessing health care services in the past 24 months (p = 0.045). Conclusions: HIV and reproductive health knowledge levels were relatively high among adolescents and were associated with accessing health care services in the past 24 months. There however are some gaps associated with engaging in risky sexual behaviours such as condomless sex which could be addressed by using these findings to assist organizations working with adolescents, educators and policy makers in developing programmes that address adolescent sexual behaviours.
Human immunodefciency virus associated pulmonary conditions leading to hospital admission and the pulmonary rehabilitation services received by patients at two central hospitals in Harare.
(BMC, 2018-06-25) Tadyanemhandu, C.; Mupanda, C.; Dambi, J.; Chiwaridzo, M.; Chikwasha, V.; Chengetanai, S.
Objective: Use of highly active antiretroviral therapy has led to marked reductions in the incidence of HIV-associated opportunistic infections but has had comparatively less impact on the incidence of some pulmonary diseases. This study was done to determine the pulmonary conditions leading to hospital admissions in people living with HIV/AIDS at two central hospitals in Zimbabwe and the pulmonary rehabilitation intervention received. Results: A total of 92 participants were recruited of which 60 (65.2%) were females. The mean age of the participants was 41.3 years (SD=9.1). The most common pulmonary condition leading to hospital admission was tuberculosis in 53 (57.6%). About 52 (56.6%) of the participants sufered from pulmonary complications in the last 6 months, 48 (92.3%) were admitted and 26 (50.0%) of the participants received physiotherapy treatment during their admission. None of the participants indicated that they once attended an outpatient pulmonary rehabilitation clinic. Respiratory complication is one of the leading causes of morbidity associated with HIV but no pulmonary rehabilitation services are being ofered to these patients. There is need for introduction of pulmonary rehabilitation programs for people living with HIV/AIDS in the current setting
Investigating Avian Influenza Infection Hotspots in Old-World Shorebirds.
(Public Library Science, 2012-09-28) Gaidet, Nicolas; Ould El Mamy, A.B.; Capelle, J.; Caron, Alexandre; Cumming, G.S.
Heterogeneity in the transmission rates of pathogens across hosts or environments may produce disease hotspots, which are defined as specific sites, times or species associations in which the infection rate is consistently elevated. Hotspots for avian influenza virus (AIV) in wild birds are largely unstudied and poorly understood. A striking feature is the existence of a unique but consistent AIV hotspot in shorebirds (Charadriiformes) associated with a single species at a specific location and time (ruddy turnstone Arenaria interpres at Delaware Bay, USA, in May). This unique case, though a valuable reference, limits our capacity to explore and understand the general properties of AIV hotspots in shorebirds. Unfortunately, relatively few shorebirds have been sampled outside Delaware Bay and they belong to only a few shorebird families; there also has been a lack of consistent oropharyngeal sampling as a complement to cloacal sampling. In this study we looked for AIV hotspots associated with other shorebird species and/or with some of the larger congregation sites of shorebirds in the old world. We assembled and analysed a regionally extensive dataset of AIV prevalence from 69 shorebird species sampled in 25 countries across Africa and Western Eurasia. Despite this diverse and extensive coverage we did not detect any new shorebird AIV hotspots. Neither large shorebird congregation sites nor the ruddy turnstone were consistently associated with AIV hotspots. We did, however, find a low but widespread circulation of AIV in shorebirds that contrast with the absence of AIV previously reported in shorebirds in Europe. A very high AIV antibody prevalence coupled to a low infection rate was found in both first-year and adult birds of two migratory sandpiper species, suggesting the potential existence of an AIV hotspot along their migratory flyway that is yet to be discovered.
Loss to follow-up among children and adolescents growing up with HIV infection: age really matters
(Wiley Open Access, 2017-07-17) Kranzer, Katharina.; Bradley, John.; Musaazi, Joseph; Ferrand, Rashida.A; Ndhlovu, Mbongeni; Apollo, Tsitsi
Introduction: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence. Methods: Individuals aged 5–19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5–9 (children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups. Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.
Malaria Disease Perspective and an Opinion: Should Malaria Treatment Target the Parasite or the Malarial Pathophysiology Generated by the Parasite or Both?
(EC MICROBIOLOGY, 2017-04-15) Mavondo, Greanious Alfred Alfrd
The malaria disease is caused by primarily four protozoan microorganisms of the Plasmodium genus transmitted by the female Anopheles mosquito namely: P. falciparum, P. vivax, P. Malariae, P. ovalae. A fourth one, P. knowlesi is known natural pathogen of the marquis but can also infect human. With its ability to infect both mature and immature red blood cells (RBC’s), multiply rapidly, cause severe malaria anaemia (SMA), adhere to blood vessels endothelium, cause cerebral malaria, P. falciparum causes the most complications of the disease with high fatality rates. The most prevalent human malaria parasite is P. vivax with a propensity to relapse when dormant liver stages (hypnozoites) are activate to reinvade RBC’s many months to years after the initial malarial infection. The other parasites cause varying disease manifestation with less fatalities.
Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report.
(BioMed central., 2013-08-22) Masukume, Gwinyai; Sengurayi, Elton; Moyo, Phinot; Feliu, Julio; Gandanhamo, Danboy; Ndebele, W.; Ngwenya, Solwayo; Gwini, Rudo
Background: We report an extremely rare case of massive hemoptysis and complete left-sided lung collapse in pregnancy due to pulmonary tuberculosis in a health care worker with good maternal and fetal outcome. Case presentation: A 33-year-old human immuno deficiency virus seronegative African health care worker in her fourth pregnancy with two previous second trimester miscarriages and an apparently healthy daughter from her third pregnancy presented coughing up copious amounts of blood at 18 weeks and two days of gestation. She had a cervical suture in situ for presumed cervical weakness. Computed tomography of her chest showed complete collapse of the left lung; subsequent bronchoscopy was apparently normal. Her serum â-human chorionic gonadotropin, tests for autoimmune disease and echocardiography were all normal. Her lung re-inflated spontaneously. Sputum for acid alcohol fast bacilli was positive; our patient was commenced on anti-tuberculosis medication and pyridoxine. At 41 weeks and three days of pregnancy our patient went into spontaneous labor and delivered a live born female baby weighing 2.6 kg with APGAR scores of nine and 10 at one and five minutes respectively. She and her baby are apparently doing well about 10 months after delivery. Conclusion: It is possible to have massive hemoptysis and complete unilateral lung collapse with spontaneous resolution in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome.
May Measurement Month 2021: an analysis of blood pressure screening results from Zimbabwe
(2024) Gwini, R.; Beaney, T.; Kerr, G.; Poulter, N.R.; Mwembe, D.; Chifamba, J.
The May Measurement Month 2021 campaign in Zimbabwe was aimed at assessing the frequency of hypertension and improving awareness among the population of the sequelae of elevated blood pressure (BP). Participants aged 18 years and above were recruited at outdoor booths to fill out a questionnaire and provide three BP measurements with 1-min intervals. Of the 2094 participants, over one-third (37.3%) were hypertensive, half of hypertensives (49.7%) were aware they had elevated pressure, and less than half (45.0%) of the hypertensive patients were on antihypertensive medications. Increasing age was directly proportional to hypertension with a large leap from 9.5 to 27.7% between the 18–29 and 30–39 age groups. Hypertension remains a major public health challenge in Zimbabwe. Improving access to preventive health screening services as well as treatment facilities is essential to early detect and control hypertension.
Midwife led maternity care models: A scoping review
(2023) Danda, G.; Chaibva, C.N.; Chauraya, Y.; Gwatiringa, C.; Chamisa, J.A.; Dabengwa, I.M.; Moyo, H.; Mantula, F.; Sibanda, E.
Introduction: Midwife led maternity care models focus on normality, continuity of care and being cared for by trusted midwives from preconception throughout pregnancy, labour and the postnatal period. The aim of this model is to provide care either in community or hospital settings, normally to healthy women with uncomplicated pregnancies. Methods: The scoping review used search terms for the PICO components with synonyms, related terms and specialist terms were harvested from the Medical Subject Headings (MeSH)© and Embase© using Rayyan. Database searches were from PubMed, EBSCO-CINAHL, Dimensions, Web of Science, SCOPUS, and the Cochrane Library of Systematic reviews and African Journals Online (AJOL). A total of 17 058 citations were identified and 69 remained for analysis after removing duplicates and others which did not meet the criteria. Results: Of the 69 included studies, 14 were qualitative, 34 were quantitative, 19 were RCTs and 2 were mixed methods. Only 13% of the studies were from Africa and the rest were from the developed world. Six themes emerged as follows: reduced interventions in labour; positive birth outcomes; satisfaction with care; cost effectiveness of services; autonomous practice and quality midwifery services; good woman–midwife relationship and several subthemes. Discussion: Midwife-led care had a significant positive effect on physiological outcomes for women when compared to physician-led care, had reduced surgical interventions and augmentation, as well as less usage of pharmacological analgesia. This may also assist in acceptability, accessibility and availability of such a model in all maternity care units and community settings in LMICs.

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