The prevalence of Herpes simplex virus type-2 infection in blood donors in Harare, Zimbabwe

OBJECTIVE

To determine the prevalence of HSV-2 infections in a population of blood donors.

DESIGN

Cross sectional study.

SETTING

Harare Blood Transfusion Service (BTS) Centre.

SUBJECTS

314 serum specimens of voluntary blood donors.

MAIN OUTCOME MEASURES

HSV-2 sero-prevalence.

RESULTS

The median age (Q1, Q3) of the blood donors was 18 (17,27) years and 65% of them were males. HSV-2 infection was detected in 29 (9.7%) of the 299 specimens that were analyzed. There was a strong association between age of blood donors and HSV-2 seropositivity (p < 0.001). Older blood donors tended to be positive while younger donors tended to be negative for HSV-2 antibodies. Though not as strong, there was also an association between HSV-2 and HIV seropositivity (p = 0.048).

CONCLUSION

The prevalence of HSV-2 infections in blood donors in Harare is high, considering the nature of the population studied. Therefore, the testing for HSV-2 in the serum of prospective blood donors should be included in the screening profiles used at the BTS centre in Harare, Zimbabwe to improve blood and blood products.

A clinical evaluation of children under the age of five years who are household contacts of adults with sputum positive tuberculosis in Harare, Zimbabwe

OBJECTIVE

To determine the prevalence and risk factors for transmission of tuberculosis in children under five years of age who are household contact of sputum smear positive tuberculosis adults in Harare, Zimbabwe.

DESIGN

Cross sectional study.

SETTING

City Health Infectious Diseases Hospital Outpatient Department.

SUBJECTS

174 children in contact with 102 index cases.

MAIN OUTCOME MEASURES

TB infection status in children according to modified WHO classification of tuberculosis.

METHODS

Under five year old contacts of sputum smear positive TB adults were recruited over a three month period. A coded questionnaire was used to document the following: socio-demographic profile of caregivers, duration of stay with the index case and presenting complaints. Contacts were evaluated by clinical examination, Mantoux testing, HIV antibody testing and chest radiographs.

RESULTS

Of the 174 children in contact with 102 index cases evaluated, 109 (62.6%) were Mantoux positive (> or = 10 mm), 42% had abnormal chest X-ray, with hilar lymphadenopathy being the commonest abnormality. Forty nine percent of the children evaluated had probable TB, 28% had suspected TB and 23% had no TB. High alcohol acid fast load (AAFB) in the index case was independently associated with probable and suspected TB (OR 2.27 95% CI (1.05 to 4.87).

CONCLUSION

The documented high transmission rate among under five years contacts in the study justifies the need for strengthening contact tracing and appropriate therapeutic management of identified children.

Impact of multiple dose measles vaccination on measles transmission patterns in Gweru, Zimbabwe

Multiple dose measles vaccination was applied in Gweru, Zimbabwe in 1990-1996. This included (a) a vaccine administered to children at 9 months of age and revaccination of the same children at any point between the ages of 12 and 23 months, and (b) a single mass vaccination campaign targeted at children aged 12-119 months (who were vaccinated irrespective of vaccination status or disease history) run in early 1990. This study describes the impact of this schedule on measles transmission patterns. Using measles disease surveillance data the study compared measles transmission patterns under single dose vaccination in 1983-1989 and under multiple dose vaccination in 1990-1996. Median measles incidence rates were 261.0 and 19.0/100000 population in 1983-1989 and 1990-1996, respectively, and these were different (p = 0.002). Vaccinated cases (vaccine failures) among children aged 10-119 months significantly increased from 49.6 to 70.4 per cent of all reported cases in 1983-1989 and had a median incidence rate of 480.4/100000. In 1990-1996 the median incidence rate was 12.8 and these incidence rates were different (p = 0.002). Cases aged 60-119 months significantly increased from 14.3 to 62.2 per cent of all reported cases in 1983-1989 and had a median incidence rate of 654.1/100000. In 1990-1996 the median incidence rate was 21.4 and these incidence rates were different (p = 0.004). It was concluded that under multiple dose vaccination, lower measles incidence rates occurred most likely due to reduction of both vaccine failures and cases aged 60-119 months.

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

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 seven 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.

Factors associated with measles complications in Gweru, Zimbabwe

OBJECTIVE

To investigate factors associated with complications or death among measles cases.

DESIGN

A cross-sectional study.

SETTING

Health facilities in the city of Gweru, Zimbabwe.

SUBJECTS

Six hundred and thirty seven measles cases randomly selected from measles surveillance data.

MAIN OUTCOME MEASURES

(a) Associations of respiratory complications and diarrhoea with death among complicated cases; (b) associations of age at infection, gender of cases and vaccination status of cases with occurrence of either respiratory complications or diarrhoea or death among measles cases.

RESULTS

Among cases with respiratory complications, twenty two (29%) had died, while five (5%) had died among those with diarrhoea (OR=7.06,95% CI=2.55-22.35, p<0.001). On rates of respiratory complications among cases, age groups 24-59 and 60+ months were protective by 57% (95% CI=11-79%) and 76% (95% CI=52-88%) respectively compared to the age group <24 months, and vaccination was protective by 42% (95% CI=2-65%) compared to those unvaccinated. Concerning rates of diarrhoea among cases, the age group 60+ months was protective by 80% (95% CI=62-89%) compared to age group <60 months, while vaccination was protective by 64% (95% CI=42-77%) compared to those unvaccinated. With respect to rates of mortality among cases, age was protective by six per cent (95% CI=3-9 %) for every year older.

CONCLUSION

It was concluded that: (a) the risk of death was higher in cases with respiratory complications than diarrhoea; (b) the risk of complications and death was inversely related to age at infection and older age groups were protective against occurrence of complications or death; (c) the risk of complications was higher in unvaccinated cases and vaccination was protective against occurrence of complications.

Thyroid status and the levels of thyroid auto-antibodies in the sera of hyperthyroid and goitrous subjects

OBJECTIVES

To determine the prevalence of thyroid auto-antibodies in specimens sent to Parirenyatwa hospital laboratory for thyroid function testing and to compare the thyroid status of these patients with that of apparently healthy subjects.

DESIGN

Cross sectional study.

SETTING

Immunology and radio-immunoassay laboratories, Parirenyatwa hospital, Department of Chemical Pathology, and Blood Transfusion Services, Harare.

SUBJECTS

212 blood samples submitted for thyroid function testing and 230 blood samples from apparently healthy blood donors.

MAIN OUTCOME MEASURES

Serum concentrations of free triiodothyronine (FT3), thyroxine (FT4), thyrotropin (TSH), and thyroid auto-antibodies; anti microsomal (M Ab) and antithyroglobulin (Ag Ab) antibodies.

RESULTS

The hyperthyroid subjects had median serum TSH level of 0.027 mIU/L (Q1 = 0.006, Q3 = 0.052), median serum FT3 level of 15.895 pmol/L (Q1 = 10.563; Q3 = 30.111), and a median serum FT4 level of 45.513 pmol/L (Q1 = 30.256; Q3 = 63.910). The goitrous subjects had median serum TSH level of 0.390 mIU/L (Q1 = 0.157; Q3 = 0.745). The blood donor group had median TSH value of 0.724 mIU/L (Q1 = 0.471; Q3 = 1.170). (Normal ranges: TSH = 0.167 to 2.80) Amerlite TSH-30 diagnostic kit; FT3 = 3.4 to 7.2 pmol/L; FT4 = 11 to 24 pmol/L) Amelex-MAB diagnostic kits) Thirty nine percent of the hyperthyroid subjects had either positive M Ab or Tg Ab or both. None of the goitrous subjects and the blood donors tested positive for neither M Ab, nor Tg Ab. No significant difference was found between the blood donors and the goitrous subjects for serum FT4 (P = 0.51). However, significant differences were found between the goitrous, the blood donor and the hyperthyroid groups with regards to serum TSH, serum FT4, and serum FT3 levels (p = 0.001).

CONCLUSION

Our findings indicate that the occurrence of thyroid auto-antibodies among the blood donors and the goitrous population was uncommon, but high in the hyperthyroid subjects. The increase of iodine intake through iodine prophylaxis could have had the side effects of iodine induced hyperthyroidism.

Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients

OBJECTIVE

To determine the effect of adjunctive prednisolone on morbidity, pericardial fluid resolution, and mortality in HIV seropositive patients with effusive tuberculous pericarditis.

DESIGN

Double blind randomised placebo controlled trial.

SETTING

Two medical school affiliated referral hospitals in Harare, Zimbabwe.

PATIENTS

58 HIV seropositive patients aged 18-55 years with tuberculous pericarditis.

INTERVENTIONS

All patients received standard short course antituberculous chemotherapy and were randomly assigned to receive prednisolone or placebo for six weeks.

MAIN OUTCOME MEASURES

Clinical improvement, echocardiographic and radiologic pericardial fluid resolution, and death.

RESULTS

29 patients were assigned to prednisolone and 29 to placebo. After 18 months of follow up there were five deaths in the prednisolone treated group and 10 deaths in the placebo group. Mortality was significantly lower in the prednisolone group (log rank chi(2) = 8. 19, df = 1, p = 0.004). Resolution of raised jugular venous pressure (p = 0.017), hepatomegaly (p = 0.007), and ascites (p = 0.015), and improvement in physical activity (p = 0.02), were significantly more rapid in the prednisolone treated patients. However, there was no difference in the rate of radiologic and echocardiographic resolution of pericardial effusion.

CONCLUSIONS

Adjunctive prednisolone for effusive tuberculous pericarditis produced a pronounced reduction in mortality. It is suggested prednisolone should be added to standard short course chemotherapy to treat HIV related effusive tuberculous pericarditis.

Was there evidence of occupational exposure to human immunodeficiency virus (HIV) infection among nurse midwives ten years into the epidemic in Zambia?

A cross sectional study was conducted to determine occupational factors associated with the human immunodeficiency virus (HIV)) infection. The survey covered 30 health institutions throughout Zambia. A total of 370 consenting midwives took part in the study. The main outcome measures were percentage of midwives reporting adverse occupational exposures and HIV status. Out of 370 midwives, 146 (39.5%) were positive for HIV infection. Of the 370 respondents, 48 (13.0%) thought that they were HIV infected. None of these 48 midwives thought she became infected because of occupational exposure to HIV infected blood. A total of 324 (87.6%) said that they were concerned about becoming HIV positive at work. ;Needle stick injury' was reported by 321 (88.2%) midwives. The percentages of midwives reporting hand washing after every contact with a patient, using gloves all of the time and wearing aprons were 54.0%, 53.7% and 44.1% respectively. None of the occupational factors was associated with HIV infection. In conclusion, although there was no evidence to suggest occupational exposure to HIV among midwives, adherence to universal precautions was poor. Midwives should be educated about these precautions.

Determinants of contraceptive knowledge among teenagers in Zimbabwe

An analysis was conducted using the Zimbabwe 1994 demographic health survey data to determine social and demographic factors associated with the knowledge of contraceptive methods among teenagers. The sample comprised of 1486 teenagers. The condom (89.1%) and the pill (88.8%) were the most commonly known contraceptive methods . Teenagers with up to seven years of education were 90% (95%CI 60 %to 98%) and 84% (95% CI 58% to 93%) less likely to have the knowledge of the condom and the pill, respectively, compared to teenagers who had 11 or 12 years of education. Compared to teenagers who were not sexually active, teenagers who were sexually active were 2.94 ((95% CI 1.94 to 4.46) and 4.33 (95% CI 2.73 to 6.86) times more likely to have the knowledge of the condom and the pill, respectively. Listening to the radio everyday was associated with the knowledge of the condom (OR = 1.65, 95% CI 1.07 to 2.55) and the pill. (OR= 1.51,95%CI 1.04 to 2.21). Watching television every week was only associated with the condom knowledge (OR = 2.81, 95 % CI 1.47 to 5.39). In conclusion, sex education in schools should start early before girls become sexually active. Continued use of electronic media to disseminate information on contraceptives is strongly recommended.

An outbreak of dysentery in a rural district of Zimbabwe: the role of personal hygiene at public gatherings

OBJECTIVES

To characterize the nature and extent of the outbreak; to determine the risk factors associated with contracting shigellosis; and to institute disease control and preventive measures.

DESIGN

Case control study.

SETTING

Nyaure Ward, Goromonzi District, Mashonaland East Province, Zimbabwe.

SUBJECTS

52 cases and 52 controls. A case was defined as any resident of Nyaure Ward who presented with bloody diarrhoea (three or more loose stools/day) between 25 July and 25 October 1997.

MAIN OUTCOME MEASURES

Frequencies of symptoms, types of treatment received, risk factors for contracting the illness.

RESULTS

The median age was 17 (Q1 = 8, Q3 = 30) years for cases and 19 (Q1 = 7, Q3 = 28) years for controls. Prominent symptoms were abdominal cramps (96.2%), malaise and fever (92.3%), nausea and vomiting (50.0%). The median duration of diarrhoea was 13 (Q1 = 6, Q3 = 14) days. Eighteen (34.6%) cases were admitted and of these five were referred to a central hospital and two of them complicated with haemolytic uraemic syndrome. The case fatality rate was 1.6%. Twenty four(46.1%) of the cases had Shigella dysenteriae type I, sensitive to Nalidixic acid, Kanamycin, and Doxycycline but resistant to Metronidazole, isolated from the stool specimen. Water samples did not yield any pathogens. Significant risk factors associated with contracting dysentery were shared hand washing in the same standing water at gatherings[OR = 8.47, 95% CI: (2.43-31.33)] or within homes[OR = 60.43, 95% CI: (15.73 to 256.00)]. The use of Blair toilets was a protective factor[OR = 0.03, 95% CI: (0.01 to 0.11)].

CONCLUSION

The epidemiologic evidence implicated contamination of water used for shared hand washing before meals as the source of the infection. The common practice of shared hand washing in standing water should be discouraged at all gatherings and within households to avoid future outbreaks.

Haematology reference values for healthy elderly blacks residing in Harare, Zimbabwe

OBJECTIVES

To determine reference values for elderly blacks and to compare them to those in use in local hospitals and in other countries in the region.

DESIGN

Cross sectional study.

SETTING

Sekuru Kaguvi Hospital, Harare, Zimbabwe.

SUBJECTS

151 persons of age 45 years or more.

MAIN OUTCOMES MEASURES

Haematological parameters investigated were Hb, Hct, MCV, MCH, MCHC, Plt, RBC and WBC.

RESULTS

56 males and 95 females tok part in the study. RBC, Hb and Hct mean values were significantly higher (p=0.004, p<0.001 and p<0.001, respectively) in males than in females. However, no significant differences between sexes were found in WBC (p=0.137), MCHC (p=0.273), MCV (p=0.090) and MCH (p=0.074). Platelet counts were significantly higher (p=0.040) in females [median (Q1, Q3): 251 (117, 478)] than in males, 226 (122, 251). These haematogological vales were notably different compared with those in current use in local hospitals. The mean values obtained for each index were comparable with those obtanied in other countries in the same region (Southern Africa) as Harare. The reference values for the elderly blacks are presented.

CONCLUSION

The importance of gender and population specific reference values cannot be over emphasised. The reference values obtained in the current study should be appropriate for evaluating haematological test results in elderly blacks in Zimbabwe.

Comparison of wheelchair accessibility of public buildings pre and post the International Year of Disabled Persons (IYDP) in Harare, Zimbabwe: a case study

OBJECTIVE

To compare the accessibility to wheelchair users of public buildings built pre and post the International Year of the Disabled Persons (1981) in Harare central business district in Zimbabwe.

DESIGN

A case study.

SETTING

Harare central business district.

SUBJECTS

20 public buildings with at least two floors open to all users in the central business district of Harare, Zimbabwe.

MAIN OUTCOME MEASURES

Wheelchair accessibility of public buildings.

RESULTS

There were no significant differences in the median percentage compliance of parking areas (p = 0.546), ramps (p = 0.155) and toilets (p = 0.648) between the buildings built before the International Year of the Disabled Persons (IYDP) and those built after the IYDP. The overall median compliance of parking areas, ramps and toilets was 14% (Q1 = 14, Q3 = 21), 54% (Q1 = 43, Q3 = 62) and 45% (Q1 = 31.5, Q3 = 70), respectively. However, there was some evidence (p = 0.067) to suggest that compliance of entrances was better IYDP [median = 100% (Q1 = 90, Q3 = 100)] than pre IYDP [median = 80% (Q1 = 70, Q3 = 100)]. Meanwhile there was a significant difference in the median percentage compliance of elevators (p = 0.014) between pre[median = 90% (Q1 = 80, Q3 = 90)] and post [median = 100% (Q1 = 100, Q3 = 100)] IYDP.

CONCLUSION

Overall compliance was poor. It is recommended that people with disabilities and the experts in the area of physical ability management be consulted and involved in the design and construction of these buildings.

Risk awareness of HIV/AIDS among commercial farm workers in Zimbabwe

OBJECTIVE

To determine levels of perceived risk of HIV infection and the determinants of these perceptions among commercial farm workers.

DESIGN

Cross sectional.

SETTING

Commercial farms in Manicaland, Mashonaland Central, Mashonaland West and Mashonaland East provinces of Zimbabwe.

SUBJECTS

406 male and 411 female adults.

MAIN OUTCOME MEASURES

Perceived risk of HIV infection.

RESULTS

Out of 33 female respondents aged less than 20 years, 19 (57.6%) reported that they had no chance of acquiring the HIV infection. The majority (15) of these 19 teenagers indicated that they had no chance of being HIV infected because they had sex only with their spouses. Of the respondents aged 20 years or more, 235 (64.6%) males and 182 (55.3%) females reported that they had no chance of being HIV infected (OR = 1.47, 95% CI 1.07 to 2.02, p = 0.016). Most males (57.0%) and females (59.9%) of age 20 years or more said that they had no chance of being HIV infected because they had sex with only their spouses. Among the respondents of age 20 years or more who indicated they had a moderate to high chance of being infected or were already infected, 35 (33.3%) of the males reported that they had multiple partners and 41 (40.6%) of the females reported that their spouses had multiple partners.

CONCLUSION

In general, despite high seroprevalence rates in Zimbabwe, many individuals do not perceive themselves at risk. Future health education intervention studies should seek to increase the general perception of low risk so that adequate precaution can be taken against being infected.

A comparison of nutritional indices of children in Chitungwiza, Zimbabwe, with the international reference standard

OBJECTIVES

To examine the hypothesis that, the fifth, 50th and 95th percentiles of the weights and heights of primary school children of Chitungwiza Municipality, (a town 30 km south west of Harare, Zimbabwe), did not differ from those of the NCHS reference population of children.

DESIGN

A descriptive cross sectional study.

SETTING

Chitungwiza Municipality.

SUBJECTS

Primary school children aged five to 16 years.

MAIN OUTCOME MEASURES

Height for age < 90%, weight for height < 80% and the comparability of mean weights and heights between the study children and the NCHS reference children.

RESULTS

Low rates were found for height for age < 90% (stunting) and for weight for height < 80% (wasting) among the Chitungwiza children, 3.5% (95% CI 2.8%, 4.7%) and 1.9% (CI 0.9%, 3%), respectively. The differences between age and sex matched pairs of the sample mean heights and reference mean heights, and of the sample mean weights and reference mean weights at the fifth, 50th and 95th percentiles, were significant. Chitungwiza children consistently dropped below the NCHS mean weight and height for all three percentiles.

CONCLUSION

This study has demonstrated that stunting and wasting is low among Chitungwiza primary school children but that the spread of their heights and weights lies lower than the spread of the heights and weights of the NCHS reference children. We recommend that wider cross sectional and longitudinal anthropometric assessments in a nation wide sample of primary school children be carried out to shed more light on the growth potential of Zimbabwean children.

The impact of an inadequate municipal water system on the residents of Chinhoyi town, Zimbabwe

OBJECTIVE

To assess the use and impact of the water reticulation system in Chinhoyi on its residents.

DESIGN

Cross sectional and case series studies.

SETTING

Chinhoyi town.

SUBJECTS

600 Chinhoyi residents.

MAIN OUTCOME MEASURES

Practices and perceptions of Chinhoyi residents on the water system, and distribution of water-related diseases per area of residence.

RESULTS

Out of 600 respondents, 565 (99.3%) had access to piped water and 558 (98.0%) to flush toilets. Breakdowns of water supply and functioning of toilet facility were reported by 308 (77.0%) and 110 (28.0%) respondents in the previous six months, respectively. Main complaints of Chinhoyi residents were about low water quality (36.2%), inadequate sewage system (31.3%) and environmental pollution (26.5%). Cases of water-related diseases were not associated with natural water bodies.

CONCLUSIONS

Chinhoyi residents have good access to the municipal water and an adequate sanitation system. However, low quality of the water, frequent system breakdowns and the degradation and loss of amenity of the environment impair their quality of life.

Lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood

OBJECTIVE

To determine the lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood.

DESIGN

Case control study.

SETTING

Ibaka, Utaewa and Ikanga fishing settlements.

SUBJECTS

183 males and 192 females engaged in fishing, aged 20 to 45 years who have been exposed for a minimum of five years as cases. The control group comprised sex matched male (142) and female (152) Nigerians from the same area who were not exposed to any known air pollutant.

MAIN OUTCOME MEASURES

Lung function indices: FVC, FEV1, FEV1% and PEFR.

RESULTS

Lung function indices were significantly lower in men engaged in fishing than in their controls: FVC [mean (SD): 2.98 (0.20) vs 3.52 (0.29), p < 0.001]; FEV1 [2.08 (0.18) vs 2.82 (0.25), p < 0.001]; FEV1% [69.8 (3.1) vs 80.2 (6.7), p < 0.001]; and PEFR [335 (22) vs 592 (99), p < 0.001], respectively. Similarly, lung function indices were lower in females in the fishing industry than in their controls; FVC [2.42 (0.17) vs 3.02 (0.24), p < 0.001]; FEV1 [1.70 (0.19) vs 2.55 (0.21), p < 0.001]; FEV1% [72.9 (3.2) vs 84.4 (6.7), p < 0.001]; and PEFR [298 (22) vs 418 (34), p < 0.001]. All the lung function indices (except FEV1%) of the fishermen and women declined significantly (p < 0.001) with their duration of exposure. The results showed a predominantly mixed pattern (restrictive and obstructive) of respiratory defect. There were higher prevalences of respiratory and other symptoms among the cases than the controls. The respiratory symptoms included cough with sputum, chest pain, dyspnoea catarrh and sneezing and unproductive cough. Other symptoms were eye and skin irritation, internal heat and headache.

CONCLUSIONS

Chronic exposure to fish drying using burning firewood can impair lung function and cause respiratory and other symptoms.

Insulin secretion, clearance and sensitivity in black pregnant and non-pregnant women in Harare, Zimbabwe

OBJECTIVE

To assess whether reported gestational differences in glucose tolerance in Caucasian and Black women could be due to alterations in insulin secretion, clearance or sensitivity.

DESIGN

Cross sectional survey.

SETTING

Antenatal Clinic, Harare; Department of Medical Laboratory Sciences, University of Zimbabwe.

SUBJECTS

90 healthy women in all the trimesters of pregnancy and 30 healthy non-pregnant women of reproductive age.

MAIN OUTCOME MEASURES

Fasting (basal) plasma insulin, C-peptide and glucose concentration. Fasting plasma C-peptide, C-peptide to insulin ratio and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance and insulin sensitivity respectively.

RESULTS

Not all means of the fasting plasma glucose levels amongst the four groups of women were equal (p < 0.001), with all possible comparisons being significant except for the first and second trimester groups. Among the comparisons of the means of the glucose:insulin ratio in the four groups of women, only the means of the first and second trimester women differed (mean difference = 0.23, honestly significance difference = 0.20). All groups were comparable in the means of plasma insulin, C-peptide levels and the C-peptide:insulin ratio.

CONCLUSION

Since fasting plasma insulin, C-peptide and C-peptide:insulin ratio were not significantly altered in all trimesters of pregnancy, these data suggest normal basal insulin secretion and clearance during gestation in these sub-Saharan African women.

Secular changes in rates of respiratory complications and diarrhoea among measles cases

It has been observed that the occurrence of respiratory complications and diarrhoea among measles cases has changed over time but this change has not been quantified. A study was carried out in the city of Gweru, Zimbabwe, to quantify these changes. Rates of respiratory complications and diarrhoea among measles cases were determined in each year for the period 1968-89. It was found that mean rates of respiratory complications and diarrhoea during 1968-78 were 17.2 per cent (95 per cent CI = 11.6-22.8) and 5.2 per cent (95 per cent CI = 0-11) respectively while during 1979-89, mean rates of respiratory complications and diarrhoea were 6.5 per cent (95 per cent CI = 1-12.1) and 16.4 per cent (95 per cent CI = 10.1-22.0) respectively. Analysis of variance (ANOVA) to determine the main effects and the interaction showed that the main effects were not statistically significant (F = 0.01, d.f.1,2 = 1,40, p = 0.935; and F = 0.13, d.f.1,2 = 1,40, p = 0.725 respectively) Meanwhile the interaction term of complications and period was statistically significant (F = 15.7, d.f.1,2 = 1,40, p < 0.001). It was concluded that a change in rates of respiratory complications and diarrhoea had occurred among measles cases. It is suggested that the increase in vaccination coverage in 1979-89 and the shift in age at infection to older age groups in the same period may have brought about this change through selective suppression of respiratory complications among measles cases.

Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe

OBJECTIVES

To document the pattern of complications and identify risk factors for subsequent mortality in a hospitalized paediatric population during a Shigella dysenteriae type 1 epidemic.

DESIGN

Hospital based prognostic study.

SETTING

Paediatric wards in Harare and Parirenyatwa tertiary referral hospitals.

SUBJECTS

All children aged one month to 12 years admitted to the wards with a history of bloody diarrhoea between January 1993 to June 30 1994 were included in the study (n = 312).

MAIN OUTCOME MEASURES

Patterns of complications and predictors of mortality.

RESULTS

The peak age group of the patients was 12 to 23 months. Ninety five children died giving an overall case fatality rate (CFR) of 30.4% (95% CI, 25.3 to 35.6). One third (n = 107) had haemolytic uraemic syndrome (HUS), among whom the CFR was 43%. Other complications included altered consciousness (35%), seizures (12%), coma (4.5%), severe dehydration (14%), abdominal distention (17%), rectal prolapse (5%) and ileus (6%). In a multivariate analysis, temperature < 36 degrees C (OR 2.12; 95% CI, 1.33 to 3.39), severe dehydration (OR, 1.70; 95% CI, 1.15 to 2.53), hyperkalemia (> 5.5 mmol/L) (OR, 1.74; 95% CI, 1.01 to 1.97), hyponatremia (< 120 mmol/L) (OR, 1.57; 95% CI, 1.17 to 2.11), urea (> 8 mmol/L) (OR, 1.74; 95% CI, 1.29 to 2.36), and abdominal distention (OR, 1.67; 95% CI, 1.16 to 2.41) were found to be predictors of mortality.

CONCLUSION

Some of the major clinical and laboratory features allowing the early identification of children at increased risk of dying during dysentery outbreaks have been delineated. The high fatality associated with complicated dysentery highlights the need for preventive strategies which are sustainable in the region.

Use of seclusion and restraint in psychiatric patients in Harare Hospital Psychiatric Unit, Zimbabwe: gender differences

OBJECTIVE

To examine the frequency and indications for use of seclusion and restraint of psychiatric patients in relation to gender differences and risk factors in Harare Hospital Psychiatric Unit.

DESIGN

Descriptive study.

SETTING

Harare Central Hospital Psychiatric Unit, Harare, Zimbabwe.

SUBJECTS

95 consecutively secluded/restrained patients were recruited for the study.

MAIN OUTCOME MEASURES

The frequency of seclusion and the characteristics of patients secluded/restrained.

RESULTS

54 (56.8%) patients were males and 41 were females. They had a median (Q1, Q3) age of 30 (Q1, = 24, Q3 = 36) years. Over two thirds (70.5%) of them were aged 35 years or less. The frequency of seclusion and restraint was 8.5% (95% CI 6.9 to 10.1) of the population of 1,115 patients admitted during the study period. The groups (male versus female) differed significantly with respect to marital status; single patients being 4.66 (95% CI 1.17 to 19.96) times more likely to be males when compared to the divorced/separated patients. Male patients were more likely to have been brought by police than by their relatives or friends (OR 3.30; CI 1.19 to 9.73; p = 0.020).

CONCLUSION

Seclusion/restraints of psychiatric patients were common in a psychiatric unit. Male patients were more likely to be brought by police. Female patients resorted more to physically assaulting staff/other patients than did male patients.

Seroprevalence of human immunodeficiency virus type 1 infection in childhood malignancy in Zimbabwe

OBJECTIVES

To determine the association between malignancy and the Human Immunodeficiency Virus type 1 (HIV-1) infection in children.

DESIGN

Case series.

SETTING

The Paediatric Oncology Unit at Parirenyatwa Teaching Hospital.

SUBJECTS

76 consecutive newly diagnosed cases of malignancy between May 15 and November 15 1997.

MAIN OUTCOME MEASURES

HIV serostatus.

RESULTS

27 out of 64 children were HIV seropositive, giving a seroprevalance rate of 42.2% (95% CI 30.1 to 54.3%). The four commonest diagnosed malignancies were non-Hodgkin's lymphoma (22.4%), acute lymphoblastic leukemia (19.7%), Wilm's tumour (19.7%) and Kaposi's sarcoma (15.8%). These tumours accounted for 77.6% of all malignancies. Nine of a total of 17 patients with non-Hodgkin's lymphoma were HIV positive and all 12 patients with Kaposi's were also HIV positive. No cases of Burkitt's lymphoma were seen. Although there was increased incidence of non-Hodgkin's lymphoma (NHL) compared to previous years, there was no significant association with the HIV serostatus. A significant association between Kaposi's sarcoma (KS) and HIV serostatus was observed (p < 0.001). Children with KS were more likely to be HIV seropositive. Children with acute lymphoblastic leukemia (ALL) and Wilm's tumours (WT) were 83 and 88% less likely to be HIV seropositive, respectively.

CONCLUSIONS

HIV has transformed the pattern of childhood malignancy in Zimbabwe. The two tumours mostly affected are NHL and KS.

Adolescent pregnancy in Zimbabwe: distribution by socio-demographic factors

We conducted a further analysis of the Zimbabwe 1994 demographic health survey data to determine demographic and social factors associated with adolescent pregnancies in Zimba notbwe. Out of a total of 1486 female adolescents sampled, 12 did not provide information on whether they had begun child bearing, and were therefore excluded from the analysis. Significantly elevated odds ratios (OR) were noted for age (OR=2.27,95% confidence interval (CI) 2.01-2.58) and having primary or no education (OR=1.58, 95%CI 1.35,1.87). Watching television every week was protective (OR=0.69, 95%CI 0.57-0.83). Heads of households with less than 25 years of age were 2.10 (95%CI 1.54-2.87) times more likely to have adolescents who were pregnant when compared with heads of households of age 35 years or more. We conclude that electronic media should be continued to be used to deliver sex education messages to adolescents in order to curb the adolescent pregnancy epidemic.

Study of psychiatric consequences of closed head injury at the Kenyatta National Hospital

This was a study to compare the psychiatric consequences of closed head injury (CHI) in 37 patients with 39 demographically similar patients with fractured lower limb injury (FLLI), aged 16-55 years. The outcome measures were the Clinical Interview Schedule-Revised, the Bender Gestalt Test and the WHO AUDIT Core for alcohol abuse. The final diagnoses were made according to DSM-III-R diagnostic criteria. The findings indicated that CHI patients suffered more psychiatric consequences than FLLI controls (OR = 4.07; 95% CI = 1.30:13.14; p = 0.013). Depression and anxiety disorders were the most common problems encountered in these subjects.