Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia

BACKGROUND

The global COVID-19 pandemic has resulted in increased acute hospitalisations, a high demand for intensive care and high in-hospital mortality, placing a huge burden on healthcare systems.

OBJECTIVES

To assess in-hospital mortality outcomes and associated factors in acute hospitalised COVID-19 pneumonia patients in Zambia.

METHODS

We performed a retrospective cohort review of patients admitted to two tertiary-level hospitals in Zambia from 1 March 2020 to 28 February 2021. We examined the factors (demographic, clinical and laboratory) that were associated with in-hospital mortality using multivariate logistic analysis. Adjusted odds ratios with their 95% confidence intervals (CIs) are reported.

RESULTS

Of 350 patients, 59.4% were aged ≥55 years and 52.6% were male. The commonest comorbidities were hypertension, diabetes mellitus (DM), HIV/AIDS and chronic kidney disease (49.6%, 28.5%, 22.0% and 8.1%, respectively). The overall in-hospital mortality rate was 42.6%, and mortality was significantly increased in patients aged ≥55 years (52.0% v. 48.0%) and in those with DM (52.1% v. 47.9%), cardiac disease (68.0% v. 32.0%), a Quick Sequential (Sepsis-Related) Organ Failure Assessment (q-SOFA) score ≥2 (75.4% v. 24.6%), and admission blood glucose levels ≥7.0 mmol/L (66.3% v. 33.7%). Compared with patients who survived, who spent a median (interquartile range) of 6 (3 - 10) days in hospital, the median time between admission and death in those who died was 2.5 (1 - 6) days. In multivariate logistic analysis, age ≥55 years, a q-SOFA score ≥2 and a random blood sugar level ≥7.0 mmol/L were predictors of in-hospital mortality, with adjusted odds ratios of 1.54 (95% CI 1.09 - 2.17), 2.17 (95% CI 1.40 - 3.38) and 1.65 (95% CI 1.18 - 2.30), respectively. Raised serum creatinine was not associated with in-hospital COVID-19 mortality after adjusting for other confounders.

CONCLUSIONS

This study highlights that high in-hospital COVID-19 mortality was associated with a high q-SOFA score, hyperglycaemia on admission and older age. The study reinforces the need to invest in emergency healthcare services for optimal management of COVID-19 patients presenting with high q-SOFA scores in resource-limited countries.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

BACKGROUND

Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk.

METHODS

We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC.

RESULTS

The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women).

CONCLUSION

The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

District specific correlates for hypertension in Kaoma and Kasama rural districts of Zambia

INTRODUCTION

Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama.

METHODS

A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD-STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p-value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported.

RESULTS

In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p=0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p=0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min.

CONCLUSIONS

The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.

Correlates of diarrhoea among children below the age of 5 years in Sudan

BACKGROUND

The Millennium Development Goals recognise child health and survival as an important socio-development issue.

OBJECTIVES

To determine the correlates of diarrhoea among children aged below 5 years in north Sudan.

METHODS

We conducted secondary data analysis of the Sudan Multiple Cluster Indicators Survey II.

RESULTS

Altogether, 23,295 children were included in the survey. Half (50.0%) of the children were males, and 22.5% of them were of age less than one year. Boys were 3% (p=0.044) more likely to have diarrhoea compared to girls. Compared with the oldest age group (48-59 months), children less than 6 months of age and those aged 36-47 months had 25% and 18% lower prevalence of diarrhoea, respectively, while children aged 6-24 months and those aged 24-35 months had 1.5 fold and 1.17 fold higher prevalence of diarrhoea. Children in urban areas were 6% more likely to have diarrhoea. Children from households with 1 or 2 people per room were 8% less likely to have diarrhoea compared to children from households with more than 3 people per room.

CONCLUSIONS

Diarrhoea was associated with child's age, gender, and social status. Our findings provide a useful baseline for interventions and comparisons with future studies.

Prevalence and correlates of being bullied among in-school adolescents in Malawi: results from the 2009 Global School-Based Health Survey

BACKGROUND

Physical and emotional violence against adolescents is a neglected, but growing problem globally. Violence against adolescents negatively affects the victim in terms of physical health, school attendance and performance and social adjustment. The literature on the prevalence and associated factors of bullying against adolescents is sparse in southern Africa outside South Africa. Such data are even sparser for Malawi. The current study was conducted to estimate the prevalence of self-reported bullying and its personal and social correlates.

METHODS

A secondary analysis of the Malawi School-Based Student Health Survey (2009) was done. Descriptive analyses were done to describe the sample and estimate the prevalence of reporting history of bullying in the past 30 days preceding the survey. Logistic regression analysis was done to assess the association between several factors and being a victim of bullying. Crude and adjusted odds ratios are reported.

RESULTS

A total of 2,264 in-school adolescents participated in the Malawi School-Based Student Health Survey of 2009. Just under half (44.5%) reported having been bullied in the previous month to the survey (44.1% among boys versus 44.9% among girls). Compared to adolescents of age 16 years or older, those who were 12 years old or younger and those who were 14 years of age were more likely to be bullied (AOR=1.54; 95% CI [1.41, 1.76]) and OR=1.26; 95% CI [1.21, 1.31]) respectively. The other risk factors that were identified in the analysis were loneliness (AOR = 2.23; 95% CI [2.20, 2.27]), and being worried (AOR = 2.80; 95% CI [2.76, 2.85[). Adolescents who had no close friends were 14% (AOR = 1.14; 95% CI [1.11-1.17]) more likely to be reporting bullied compared to adolescents who reported having close friends. Adolescents who smoked cigarettes were more than three times more likely to reporting be bullied compared to non-smokers (AOR=3.97; 955 CI [3.83, 4.10]), while those who drank alcohol were more than twice as likely to be bullied as adolescents who did not take alcohol (AOR=2.26; 95% CI [2.16, 2.35]).

CONCLUSION

Malawian in-school adolescents report a high prevalence of having been bullied. Traditional associated factors such alcohol and smoking as well as emotional correlates (loneliness, worry) were associated with being a victim of bullying. School officials and health workers caring for adolescents should be sensitized to the frequent occurrence of bullying and to its correlates and consequences.

Exposure to occupational health hazards among Zambian workers

BACKGROUND

Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking.

AIMS

To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia.

METHODS

We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations.

RESULTS

Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed.

CONCLUSIONS

Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

Parity and maternal education are associated with low birth weight in Malawi

BACKGROUND

The consequences of low birth weight (LBW) include death and long-term health sequelae. Limited attention has been made towards the study of socio-demographic factors that may be associated with LBW in Malawi.

OBJECTIVES

To assess factors that may be associated with LBW.

METHODS

We used secondary data on the 2006 Malawi Multiple Indicator Cluster Survey (MICS). Logistic regression analyses were conducted.

RESULTS

A total of 26,259 females in the age group 15-49 years participated in the survey, and of these, 5024 had children who were reported to have been weighed at birth. Most (60.5%) of the respondents were in the 20-29 years age group. In multivariate analysis, the odds of LBW delivery were lower for women in higher wealth quintiles and those who had some education. Women who previously had a child were less likely to deliver a LBW baby.

CONCLUSION

The higher odds of delivering a LBW baby among women with no education, and lower wealth status may suggest that there is need to tailor pre-natal care based interventions on social status. This may involve creating education level-specific health messages.

Alcohol use among school-going adolescents in Harare, Zimbabwe: results from the 2003 Global School-Based Health Survey

Data from the Global School-Based Health Survey (2003) were analysed to estimate the proportions of relevant socio-demographic and behavioural characteristics. Of the 1997 students who participated in the survey, 15.6% (17.1% males and 14.0% females) reported alcohol consumption. Factors associated with consumption of alcohol use were being worried, bullied, smoking cigarettes, truant, and lack of parental supervision. Students who were never worried were 49% (AOR=0.51 [95% CI (0.36, 0.72)]) less likely to consume alcohol compared to students who were most of the time or always worried. Similarly, students who were never bullied were 42% (AOR=0.57 [95% CI (0.42, 0.77)]) less likely to take alcohol compared to students who were bullied at least six times in the previous one month to the survey. Compared to students who smoked cigarettes, non-smokers were 71% (AOR=0.29 [95% CI (0.21, 0.41)]) less likely to consume alcohol. Compared to students who always received parental supervision, students who rarely received parental supervision were more likely (AOR=1.85 [95% CI (1.19, 2.90)] to consume alcohol, and those students who sometimes received parental supervision were less likely (AOR=0.70 [95% CI (0.50, 0.98)] to consume alcohol. There is a need to implement public health interventions with special attention to the determinants of alcohol consumption in this age group.

Socio-demographic characteristics and sexual health related attitudes and practices of men having sex with men in central and southern Malawi

An exploratory study of men having sex with men (MSM) was conducted in central and southern Malawi in order to understand their socio-demographic characteristics, sexual behaviours, and perceptions about confidentiality and stigma. A total of 97 men participated in the study of whom 84 (86.6%) were in the age group 17-32 years. The majority, 73 (75.3%) of MSM had never married, 26 (32.5%) reported not always using condoms during sexual intercourse, and 23 (23.7%) had ever received money or gifts in exchange of sex. Only 17 (17.5%) of the participants reported being exposed to HIV prevention messages targeted at MSM. Fear of sexual orientation disclosure and discrimination were reported by 27 (30.7%) of MSM. Many of the study participants reported that HIV intervention programmes are not accessible to them. In conclusion, HIV intervention programmes may not be reaching out to the majority of MSM. We suggest an exploration of the feasibility of HIV prevention interventions targeting MSM in this country where the practice is illegal.

Prevalence and correlates of cigarette smoking among adolescents in Malawi: results from the Global Youth Tobacco Survey 2005

The majority of adults who smoke cigarettes initiated the habit when they were adolescents or young adults. While rates of smoking and associated factors are known among 13-15 year olds in Malawi, correlates of cigarette smoking among adolescents in a national representative sample in Malawi have not been studied. We, therefore, carried out this study to estimate the prevalence of current smoking and determine its correlates in a nationally representative sample of in-school adolescents in Malawi. An analysis of the Malawi Global Youth Tobacco Survey (GYTS) 2005 was conducted. Using logistic regression analysis, we estimated the association between current cigarette smoking and potential explanatory variables. Overall, 2.5% of adolescents (3.2% among males, and 1.8% among females) were current cigarette smokers. Smoking among parents was 9.6% with no significant difference between males and females (10.3% versus 10.1%). Stronger associations with smoking were observed for friends smoking status (AOR=3.07, 95%CI 2.99, 3.16), receiving pocket money (AOR=3.06, 95%CI 2.98, 3.14), and perception that smoking increases body weight (AOR=2.98, 95%CI 2.81, 3.16). Students who thought that cigarette smoking is harmful to health were 56% (AOR=0.44, 95%CI 0.43, 0.45) less likely to smoke than students who thought otherwise. Despite being the world's second leading grower of tobacco, the prevalence of cigarette smoking among adolescent is lower than has been reported elsewhere.

Prevalence and correlates of current cigarette smoking among adolescents in East Timor-Leste

OBJECTIVES

To determine the prevalence and correlates for current cigarette smoking.

DESIGN

Secondary analysis of the East Timor-Leste Global Youth Tobacco Survey conducted in 2006.

SETTING

Public and private schools registered with the Ministry of Education.

PARTICIPANTS

A two-stage cluster sample of 1790 students in Grades 7 to 9. Schools were selected with probability proportional to enrolment size, and classes were randomly selected in each school. All students in selected classes were eligible to participate in the survey. The school and student response rates were 96.0% and 84.5%, respectively.

MAIN OUTCOME MEASURE

Prevalence of current cigarette smoking.

RESULTS

Out of 1790 adolescents, 52.1% were of ages less than 15 years, 51.8% were males, 42.8% reported having some pocket money in a month, and 72.7% had at least a parent who was a smoker. Prevalence of current cigarette smoking was 40.3%. Current smokers also reported having bought cigarettes from peddlers (32.4%), someone bought for them (16.7%), got from someone older (13.7%), borrowed (13.3%), and stole (3.4%). Males were more likely to be smokers than females (59.0% versus 19.3%). Factors positively associated with current smoking were: parental smoking; closest friend smoking; amount of pocket money; and exposure to anti-tobacco messages.

CONCLUSIONS

East Timor has one of the highest prevalence of cigarette smoking among adolescents. The fact that exposure to anti-tobacco messages was associated with being a smoker may be evidence suggesting that anti-tobacco messages, especially from tobacco-related industry, may have unintended consequences.

Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda

OBJECTIVES

Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda.

METHODS

A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey.

RESULTS

Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision.

CONCLUSIONS

Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.

Factors associated with secular trends in mortality attributed to measles in Gweru, Zimbabwe, in 1967-89

A retrospective study conducted in Gweru, Zimbabwe, investigated the trend and its associated factors in measles mortality between 1967 and 1989. Measles and malnutrition surveillance data were analysed in SPSS version 8.0 using the Forward Stepwise Linear Regression method. Measles case fatality rates ranged from zero to 48.2% (median: 4.2, Q(1) = 1.2, Q(3) = 12.9) and they significantly linearly declined [slope = -1.686; 95% confidence interval (CI) -2.327, -1.044; R(2) = 59%]. Rates of mortality among complicated measles cases (slope = 0.546, 95% CI = 0.133-0.345) and rates of mortality from malnutrition among children aged <5 years (slope = 0.459, 95% CI = 0.031-0.099) independently predicted (R(2) = 87%) measles case fatality rates. It was concluded that decline in rates of mortality among complicated measles cases, probably due to good management of such cases, and decline in rates of malnutrition among children aged <5 years may have contributed to the decline in measles case fatality rates.

Suicidal ideation and associated factors among in-school adolescents in Zambia

A cross sectional study was conducted to estimate the prevalence and correlates of suicidal ideation among in-school adolescents in Zambia. Backward logistic regression analysis was conducted to assess the association between relevant predictor variables and suicidal ideation within the last 12 months. A total of 1970 in-school adolescents who participated in the Zambia Global School-Based Health Survey in 2004 responded to the question on suicidal ideation. Overall, 54.0% were males, 40.8% were current drinkers, and 35.9% ever smoked marijuana (cannabis). Altogether 31.3% reported suicidal ideation in the past 12 months (males = 31.1%; females = 31.4%). Being male (OR = 1.05; 95%CI 1.03, 1.05): being <14 years old (OR = 1.21; 95%CI 1.19, 1.23), having been drunk (OR = 1.28; 95%CI 1.27, 1.29). worried (OR= 1.05; 95%CI 1.04, 1.06), sad or hopeless in the past 12 months (OR = 1.02; 95%CI 1.01, 1.03) and ever used marijuana (OR = 1.18; 95%CI 1.17, 1.19) were positively associated with suicidal ideation. Loneliness appeared to be protective (OR = 0.92; 95%CI 0.91, 0.92). All the results, except for ever smoked marijuana and ever been drunk, may have been biased due to non-response to the question on suicidal ideation. A series of cross sectional studies should be conducted to monitor changes in behavioural factors among others ever smoked marijuana and ever been drunk in order to broaden our understanding of factors that may be causing adolescents to seriously consider committing suicide.

Prevalence of sexual intercourse among school-going adolescents in Coast Province, Kenya

A study was carried out to estimate the prevalence and associated factors of sexual intercourse among school adolescents in Coast Province, Kenya. Data were obtained through the Kenya Global School-Based Health Survey. Overall the prevalence of sexual intercourse within the last 12 months was 14.9% (22.2% in males and 5.0% in females). Among males, the protective factors against having sex were being of age < 15 years (OR = 0.60, 95% CI 0.58, 0.62) and ever been drunk (OR = 0.63, 95% CI 0.59, 0.67). The risk factors for having sex among males were ever smoked (OR = 2.05, 95% CI 1.92, 2.19), having close friends (OR = 1.68, 95% CI 1.56, 1.81), currently drinking alcohol (OR = 1.13, 95% CI 1.06, 1.20), ever used drugs (OR = 2.36, 95% CI 2.24, 2.49) and parental supervision (OR = 1.30, 95% CI 1.25, 1.34). Meanwhile among female respondents, parental supervision was protective (OR = 0.88, 95% CI 0.81, 0.94) and the only risk factor was ever used drugs (OR = 2.85, 95% CI 2.57, 3.15). It is suggested that public health interventions aimed to promote adolescent sexual health should be designed with the appreciation of the factors associated with sexual activity in due consideration.

Prevalence and determinants of adolescent cigarette smoking in Mongolia

INTRODUCTION

Cigarette smoking is the single most important risk factor for non-communicable chronic medical conditions. Estimating the prevalence of cigarette smoking and its determinants will aid in the design, implementation and evaluation of public health interventions. This study was conducted to estimate the prevalence and determinants of smoking among school-going adolescents in Mongolia.

METHODS

A cross-sectional study using standardised methodology was conducted among school-going adolescents in 2003 in Mongolia.

RESULTS

4,105 adolescents (mean age 14.1 years, standard deviation 0.8 year) participated in the study. Approximately 55 percent were females, 30.4 percent of the study population was 15 years old, 63.5 percent had never smoked and 93.2 percent perceived tobacco as harmful. About 58 percent had parents, and 52 percent had friends, who were smokers. The prevalence of current cigarette smoking was 9.2 percent; 15.4 percent among males versus 4.4 percent among females. Cigarette smoking was associated with the male gender, parental and peer influence and having spending power. The perception that smoking was harmful to health was associated with lower odds of smoking.

CONCLUSION

Cigarette smoking is prevalent among school-going adolescents in Mongolia. There is a need to implement public health interventions, with special attention to the determinants of smoking in this age group.

Sex differences in prevalence rates and predictors of cigarette smoking among in-school adolescents in Kilimanjaro, Tanzania

An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors.

Predictors of cigarette smoking among adolescents in rural Zambia: results from a cross sectional study from Chongwe [corrected] district

INTRODUCTION

Cigarette smoking is a leading cause of morbidity and mortality globally. There are limited data on the prevalence of and factors associated with smoking among in-school adolescents in developing countries.

OBJECTIVES

To estimate prevalence of those who have smoked cigarettes and to identify associated socio-demographic factors among adolescents in Chongwe district, Chongwe [corrected] Province, Zambia.

METHODS

Data used was from the Zambia Global Youth Tobacco Survey, which was conducted using standardized methodology among in-school adolescents in 2002. Data were analyzed to assess if selected socio-demographic variables were associated with having smoked cigarettes. Bivariate and multivariate logistic regression analysis was used to assess the associations.

RESULTS

A history of having smoked cigarettes ranged from 20.5% among 15 year olds to 37.2% among males younger than 12 years old. In females, 20.7% of 13 year olds and 37.7% of those less than 12 years old had smoked. Parental smoking, friends smoking, a lack of perception that smoking was harmful, and exposure to pro-tobacco advertisements were associated with having smoked cigarettes. Adolescents who had smoked cigarettes were more likely to allow others smoke in their presence.

CONCLUSIONS

Many adolescents in rural Chongwe[corrected], Zambia had tried cigarette smoking. The identification of predictors for smoking should guide the design and implementation of programs aimed to prevent initiation and maintenance of tobacco use among adolescents.

Assessment of routine inspection methods for porcine cysticercosis in Zambian village pigs

The value of tongue and meat inspection as diagnostic tools for porcine cysticercosis was assessed in 65 Zambian village pigs by comparing the results with carcass dissections. In addition, the intensity of infections, distribution and viability of cysts in infected pigs were measured. Five pigs (7.7%) were positive on tongue examination, while routine meat inspection showed 12 (18.5%) positives. However, carcass dissections detected cysticerci in 31 (47.7%) pigs. The range in number of cysticerci was 1 to 14,662 per carcass. Cysticerci were distributed throughout the carcass with the highest concentration in the heart, tongue and hind legs. In one animal 13 viable cysts were detected only in the brain. Fourteen pigs had more than 100 viable cysts, six between 2 and 100, and four had single cyst infections. Seven animals harboured only calcified cysts. These findings demonstrate the serious shortcomings of routine detection methods for porcine cysticercosis. While the specificity of tongue palpation and meat inspection was 100%, these tests failed to detect the infection in 83.9% and 61.3% of infected pigs, respectively.

Risk factors associated with porcine cysticercosis in selected districts of Eastern and Southern provinces of Zambia

To determine the risk factors associated with Taenia solium transmission in humans and pigs in the rural areas of Eastern and Southern provinces of Zambia, a questionnaire was administered in 788 households from 155 villages. Pigs were examined from 800 households. Tongue examination and enzyme-linked immunosorbent assay (Ag-ELISA) for the detection of circulating antigens of T. solium cysticerci were used to measure infection in pigs. A snowballing technique was utilised to select households with pigs. Prevalence of households with pigs infected with T. solium on tongue examination by district ranged from 12.7% to 32.1% with Ag-ELISA having a range of 30.0-51.7%. Of the total number of households visited, 18.8% and 37.6% had at least one pig positive for porcine cysticercosis on tongue examination and Ag-ELISA, respectively. Risk factors associated with T. solium infection were lack of pork inspection at slaughter (96.7%), consumption of pork with cysts (20.1%), selling of pork infected with T. solium cysticerci (18.3%), free-range husbandry system (83.2%) and absence of latrines (58.0). Free-range husbandry system (OR=1.68; 95% CI=1.36-2.07) was a significant risk factor for porcine cysticercosis in the surveyed areas. The result that pigs were mostly kept on free-range and semi-intensive husbandry systems may have permitted them to have access to eating human faeces that could be contaminated with tapeworm eggs. This study has shown that T. solium infection poses a high public health risk in the study areas and urban areas as well. We recommend that a human survey be conducted to verify the human exposure to taeniasis and/or cysticercosis in Zambia.

Seasonal pattern of bovine fasciolosis in the Kafue and Zambezi catchment areas of Zambia

In order to establish seasonality of bovine fasciolosis in the Southern province of Zambia, 288 cattle were examined at slaughter at Turnpike slaughter slab for 1 year. The examination involved liver inspection and coprological examination. Liver condemnation rates were relatively high at the beginning of both the cold dry season and the rainy season (May/June and December, respectively). All cattle, regardless of age, had higher fluke abundances in the post-rainy season (39.1% young and 42.1% adult) while the lowest rates were in the hot dry season (13.3% young and 14.3% adult). On coprological examination, the highest abundance was in the post-rainy season (45.0%) and the lowest in the cold dry season (24.9%). From November (end of dry season) to February/March (end of rains), more fluke eggs were found than in any other period. The distribution of fluke eggs was significantly different (p<0.001) among the four seasons. Identified associations were: egg counts were highest in post-rainy (mean abundance=146) and lowest in cold dry season (mean abundance=118) at 95% confidence (CI 0.64-1.25). Differences in abundance observed according to origin, sex and age of cattle were not significant on both methods. Based on these results, it may be concluded that Fasciola gigantica was present throughout the year in cattle in Zambia but the abundance was highest in the post-rainy season and lowest in the cold dry season.

Prevalence of HIV/AIDS and psychiatric disorders and their related risk factors among adults in Epworth, Zimbabwe

OBJECTIVES

To examine the prevalence of HIV infection, neuropsychiatric disorders, psychiatric symptoms/signs, alcohol use/misuse, CD4 cell counts and risk factors in adult patients.

DESIGN

Cross-sectional study.

SETTING

Epworth, which is about 15 km on the southeastern part of Harare, Zimbabwe.

SUBJECTS

Two hundred subjects were included in the study out of which six were excluded beacause of HIV-1 indeterminate results.

MATERIALS AND METHODS

A convenience sample of 200 subjects recruited in a cross-sectional study in Epworth, Zimbabwe. Six subjects had indeterminate HIV-1 antibody results and were excluded from the study. The remaining 194 subjects of whom 101 (52.1%) knew about their sero-status and were consecutively recruited, whereas, 93 (47.9%) did not know about their sero-status and were recruited by a systematic random sampling method (1-in-3). They were then interviewed about neuropsychiatric disorders using BPRS, MADRS, AUDIT and MINI Mental State Test, including the risk factors related to HIV infection. After ELISA tests' results, the two groups were combined and then categorised into HIV positive (n=115) and HIV negative (n=79) subjects.

MAIN OUTCOME MEASURES

Prevalence, neuropsychiatric disorders, increased CD4 cell counts and risk factors associated with HIV infection.

RESULTS

The findings were that the overall point prevalence of the HIV infection was 59.3% (115/194). Comparative analyses between seropositive and seronegative HIV/AIDS subjects showed: over two thirds (71.3%) of the HIV positive subjects suffered from psychiatric disorders, more than those with HIV negative 44.3% (OR=3.12, 95% CI=1.64-5.95, P=0.0002), and subjects aged 35 years and less were mostly HIV seronegatives (n=77.2%, OR=2.34, 95% CI=1.18-4.75, P=0.014). The overall prevalence of alcohol use/misuse was 41 (21.1%), with higher prevalence rate among HIV positive subjects, 28 (24.3%) than those who were HIV negative, 13 (16.5%). The commonest psychiatric symptoms/signs (P<0.05) were emotional withdrawal, depressed mood, suspiciousness, apparent sadness, reduced sleep and suicidal thoughts (especially among women).

CONCLUSION

There is very high point prevalence of HIV/AIDS and psychiatric disorders, including a moderate prevalence rate of alcohol use/misuse in this less affluent community that warranted intervention.

Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe

OBJECTIVE

To determine the association between HIV infection and progression of Plasmodium falciparum malaria illness in Hurungwe district, Zimbabwe.

DESIGN

Prospective cohort.

SETTING

Hurungwe Rural Hospital in Mashonaland West Province, Zimbabwe.

SUBJECTS

Blood slide positive P. falciparum malaria patients.

MAIN OUTCOME MEASURES

Development of severe and complicated malaria.

RESULTS

A total of 659 clinical malaria cases were investigated and 237 (36.0%) confirmed cases entered the study. The total HIV positive malaria patients were 82 (34.6%) of confirmed cases or 12.4% of the total clinical cases. The case fatality rate was 5.9% (14 deaths) in the confirmed cases and 11 of these deaths were HIV positive. The commonly reported complications were high parasite count of 2% or more (38.5%), anaemia (29.0%), cerebral malaria (23.1%), low blood pressure (8.3%) and renal failure (1.2%). The HIV positive cases which developed severe and complicated malaria were 72, 30.4% of the sample studied or 55.8% of the total severe and complicated cases. The mode of transport to the nearest health centre was the only confounding factor identified during the analysis. After adjusting for this confounding factor, the risk of developing severe and complicated malaria was 2.35 (95% CI 1.85 to 2.98) times more in the HIV positive malaria patients than in HIV negative patients.

CONCLUSION

We conclude that HIV infection is significantly associated with the development of severe and complicated malaria. There is need for future studies to determine whether HIV positive malaria patients require different management protocol from HIV negative malaria patients.

Minimum incidence of congenital talipes equino-varus (CTEV) and post treatment evaluation of residual deformities in a population in Zimbabwe

OBJECTIVE

To determine the minimum incidence (MI) of congenital talipes equino-varus (CTEV) in children; evaluate the association between CTEV and other congenital anomalies, and to assess the presence of residual deformities after conservative management at the physiotherapy department of Harare Central Hospital (HCH), Zimbabwe.

DESIGN

A three year retrospective study.

SETTING

Physiotherapy Department, HCH, Harare, Zimbabwe.

SUBJECTS

Eighty-two children with CTEV who were assessed and treated at HCH Physiotherapy Department from January 1994 to December 1996.

MAIN OUTCOME MEASURE

MI of club foot and degree of correction of the club foot after conservative management of the deformity by the physiotherapist.

RESULTS

An MI rate of about 0.9 per 1000 was found over a three year period. It was also found that 30.5% of these children had other associated congenital abnormalities. There was no significant association between gender and severity of deformity (P = 0.326). A significant association between the severity of CTEV and the presence of other associated congenital deformities was found (P = 0.013). 91% of the feet were found to have a satisfactory result of treatment using the Wynne Davis scoring system (WDSS). 52% of the patients with residual deformity after discharge from physiotherapy presented with limitation in ankle and sub-talar movements. This study also indicated that children with grade 2 type of deformities were more likely to have other congenital abnormalities than those with grades 1 or 3.

CONCLUSION

The MI of CTEV in the studied population was found to be lower than other countries. The WDSS indicated that a great majority of the feet examined scored above average score.

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.