Care In Zimbabwe Research Articles

PADV-01 CHALLENGES OF NEURO-ONCOLOGY CARE IN ZIMBABWE

Abstract Due to the advent of covid 19 coupled with the socio-economic crisis in Zimbabwe, this has resulted in numerous challenges in terms of health care access and resultant diagnostic and treatment barriers for neuro-oncology cases. A retrospective analysis of the burden of neuro-oncology cases which have been seen at a single center in Zimbabwe over the past 5 years and the resultant diagnostic and treatment barriers that have incurred. METHODS An audit of brain tumor cases was done through the analysis of Outpatient department records, Neurosurgery Admission records, and Neurosurgery theatre records at Sally Mugabe Central hospital. RESULTS Total number of cases recorded for the period were 71. Meningiomas 11 (15,5%), Posterior fossa tumors 12 (17%), Gliomas 6 (0.08%), Craniopharyngiomas 6(0.08%), Metastasis 5(0.07%), Pituitary tumors 4(0.06%), choroid plexus papilloma 3(0.04%), Lymphoma 2(0.03%), Pineal region tumor 1(0.01%). 21(30%) tumors were unclassified. Posterior fossa tumors were most common in the pediatric population less than 10years of age. Meningiomas had a female to male ratio of 1.75: 1. 9 (12%) patients were operated on during the same period mostly pediatric tumors. CONCLUSION There is a great deal of institutional as well as patient related factors affecting the diagnosing and treatment of neuro-oncology care in Zimbabwe. This includes lack of operating time, inadequate intensive care facilities, a general unavailability of medical imaging services, delay in pathological reporting, unavailability and costly adjuvant treatment. This is leading to late diagnosis and suboptimal treatment of the various tumors. Although brain tumors are rare, they are not uncommon and there is thus need to improve service delivery to ensure early diagnosis and treatment to have good outcomes.

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Patient held medical records in public hospitals in Bulawayo

The purpose of the study was to examine the use and handling of PHMRs by patients and the clinical staff at public hospitals in the Bulawayo Province. The study employed a qualitative research methodology in which open ended questionnaires were used to collect data. Data were collected from doctors, nurses, records clerks and patients at 2 of the 4 targeted major public hospitals in Bulawayo, giving a total of 150 participants. This study revealed that PHMRs contained vital patient health information such as diagnosis, patient name, and prescribed medications. PHMRs did not have an official uniform structure, and patients used whatever booklets that were affordable to them. In some cases, patients used pieces of paper, although this was not encouraged. PHMRs were considered as legal records that are admissible in courts of law on the basis of them being authenticated by dating, officially stamped and signed by the attending medical practitioner. However, there were cases of unlawful manipulation of PHMRs through editing by patients, and in some cases, documentation incompleteness of the PHMR. The study further found out that the biggest challenge faced in the use of PHMRs was their loss by patients, which negatively impacted health care service delivery. The study recommends that patients be continuously educated about the importance of, and effectively managing their PHMRs for the purposes of continued health care delivery and accessibility. The study further recommended the use of structured hospital-designed booklets that patients can purchase at the hospital. This would avoid the use of any type of book/booklets and pieces of paper. The Ministry of Health and Child Health Care in Zimbabwe needs to consider introducing personalised electronic health records as alternatives to physical PHMRs.

Bidirectional needs assessment of otolaryngology-head and neck surgery short-term surgical trips in Zimbabwe.

To describe findings from an otolaryngology-specific needs assessment tool in Zimbabwe. Surveys were developed and shared with Low-Middle Income Country (LMIC) hosting institutions in Zimbabwe and to High-Income Country surgical trip participants (HIC). Respondents were otolaryngologists identified online and through professional networks who had participated in a surgical trip. The most common procedures Zimbabwe otolaryngologists reported treating were adenotonsillectomy (85.7%), chronic rhinosinusitis (71.4%), chronic otitis (57.1%), and head and neck tumor intervention (57.1%). The most common untreatable conditions that host physicians wanted to treat were skull base surgery (71.4%), flap reconstructions (57.1%), and laryngotracheal reconstruction (57.1%). The largest discrepancy between host desires and visiting team offerings were flap reconstruction (57.1%), nasal bone deformities (37.1%), and laryngotracheal reconstruction (17.1%). Perceptions of short-term surgical trips (STST) were recorded for host and visiting teams, and important differences between the public and private sectors of care in Zimbabwe were also identified. The surveys utilized in this study served as a bidirectional needs assessment of the requirements and care goals of host institutions and visiting teams in Zimbabwe. Differences between public and private sectors of care, particularly regarding infrastructure, resources, and surgical goals, were revealed, and the results can be utilized as part of efforts to maximize efforts within global surgical partnerships. VI.

Customer-Care Initiatives of Service Providers and the Uptake of Breast and Cervical Cancer Screening Services in Mutare, Zimbabwe

Social marketing globally promotes social mobilization to increase uptake of recommended health services. The Ministry of Health and Child Care in Zimbabwe markets breast and cervical cancer screening for reproductive-age women. Despite efforts, uptake remains low, particularly in Mutare district. To address this, an analytical cross-sectional study was conducted in Dangamvura suburb to explore the relationship between service providers' customer-care initiatives and screening uptake. Qualitative and quantitative data was collected via interviews with 96 women aged 18 to 49, randomly selected from Dangamvura Poly-Clinic departments. Of these women, 13.5% were screened for breast cancer, 30.3% for cervical cancer, and 78.8% expressed intent to screen. 90.3% had accurate knowledge of breast and cervical cancer, but only 30.3% could identify screening sites. Among those screened, 75.8% intended to retest. Primary motivations for screening included a desire for health status knowledge (39.2%) and reproductive system issues (32.1%). Main barriers for non-screened women were lack of motivation (56%) and fear of positive results (16.7%). Logistic regression indicated protective factors for screening uptake: history of reproductive issues (AOR: 9.0678, p: 0.0029), prior breast cancer screening (AOR: 21.4347, p: 0.0006), and age 31 to 49 (AOR: 0.1754, p: 0.0066). Overall, uptake was low, influenced by customer factors (age, reproductive issues, prior breast cancer screening) and cost factors (perceived wait times, screening duration, perceived costs). Future interventions aimed at improving uptake of screening services should be tailored to address fears, misconceptions, and lack of motivation to screen among women of reproductive age.

Prevalence and predictors for cisplatin-induced toxicities in Zimbabwean women with cervical cancer.

Aim: To describe treatment-induced toxicities (TITs) and associated factors in Zimbabwean cancer patients receiving cisplatin.Methods: In total, 252 Zimbabwean women with cervical cancer, receiving cisplatin were followed up over 12months for TITs and disease status.Results: Peripheral neuropathy (70%) and ototoxicity (53%) were most prevalent. Advanced disease (OR=1.3; 95% CI=1.1-1.5; p=0.02), pain comedications (OR=1.3; 95% CI=1.1-1.5; p=0.03), alcohol (OR=2.8; 95% CI=1.1-7.5; p=0.04) and comorbidities (OR=1.2; 95% CI=1.1-1.4; p=0.04) increased peripheral neuropathy and ototoxicity risk. Older age increased risk of disease progression (OR=1.9; 95% CI=1.4-3.0; p=0.033).Conclusion: High peripheral neuropathy and ototoxicity prevalence were observed, which are not routinely monitored in Zimbabwe. There is a need for capacity building to incorporate comprehensive TIT testing and optimize cancer care in Zimbabwe.

Investigating point-of-care diagnostics for sexually transmitted infections and antimicrobial resistance in antenatal care in Zimbabwe (IPSAZ): protocol for a mixed-methods study

IntroductionSexually transmitted infections (STIs) can cause serious morbidity, including pelvic inflammatory disease, and adverse pregnancy outcomes. In low/middle-income countries, limited laboratory infrastructure has resulted in a syndrome-based approach being used...

The Economic Crisis (2008-2019) and Health Care in Zimbabwe: A Structured Literature Review

Background: The multi-prolonged nature and severity of the economic crisis (2008-2019) in Zimbabwe provided a distinct prospect to analyse the impact of economic crisis on the healthcare system. According to the System Model, the possible effect on health infrastructure, material resources, human resources, and financial resources is relevant. Aim: The structured literature review aimed to conduct an analysis of available evidence referring to the impact of economic crisis on health care in Zimbabwe between 2008 and 2019. Methods: A search of publications in English with inclusion criteria of timeframe between January, 2008 and December, 2019 that referred to the effect or impact of the economic crisis on health care was conducted utilising databases, such as Google Scholar, EBSCOhost, Pubmed, and UNISA repository. A thematic analysis for data extraction and synthesis was carried out. Exclusion criteria referred to irrelevance to the objectives and inappropriateness. Results: A total of 87 research publications were identified on various databases for analyses, 75 were excluded at different stages of screening, and 12 were included in the study. The thematic analysis, conducted according to the steps explained by Tesch (in Creswell 2014), revealed economic effects on health care in four themes: public health infrastructure, health workers, medical drugs, and public health expenditure and management, which were affected by an economic crisis. Conclusion: The effects of the economic crisis were evident in terms of negative changes in the healthcare delivery system, including a reduction in medical drug supply, loss of human resources, reduced financial resources, and an increase in the disease burden.

A critical review of health marketing in Zimbabwe during COVID-19

The coronavirus befell the world in late 2019 resulting in the World Health Organisation declaring a global pandemic in March 2020. As governments and health authorities around the world struggled to control the pandemic, key components of their efforts include the publicizing of their services, informing citizens of good hygiene practices, keeping the nation informed of the spread of the virus and generally keeping citizens in a positive and focused frame of mind. These efforts fall within the definition of health marketing which applies marketing principles and theories combined with health strategies to promote people’s health. These efforts also draw on both traditional and new digital channels, including online and social media, to carry across the health-marketing message to citizens. Zimbabwe is no different. The Ministry of Health and Child Care in Zimbabwe is the public authority responsible for healthcare in the country. This study reviews the three main digital channels used by the Ministry to communicate with Zimbabwean citizens, namely, their website, Facebook and Twitter. The review involves a longitudinal dissection of the communications shared across these three channels for the period from May to August 2020 and uses both content and thematic analysis to understand and critique the health communications being put out by the Ministry to its citizens. The review also takes into consideration the public comments on these communications to present a critical review of the effectiveness of these communications from a health-marketing perspective. The findings provide useful insight into the positive aspects and shortcomings of these communications and contribute to a conceptual framework for managing health-marketing communications in a time of crisis.

Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale – Revised in primary care in Zimbabwe, a non-war-affected African country

A critical step in research on the epidemiology of post-traumatic stress disorder (PTSD) in low-resource settings is the validation of brief self-reported psychometric tools available in the public domain, such as the Impact Event Scale - Revised (IES-R). We aimed to investigate the validity of the IES-R in a primary healthcare setting in Harare, Zimbabwe. We analysed data from a survey of 264 consecutively sampled adults (mean age 38 years; 78% female). We estimated the area under the receiver operating characteristic curve and sensitivity, specificity and likelihood ratios for different cut-off points of the IES-R, against a diagnosis of PTSD made using the Structured Clinical Interview for DSM-IV. We performed factor analysis to evaluate construct validity of the IES-R. The prevalence of PTSD was 23.9% (95% CI 18.9-29.5). The area under the curve for the IES-R was 0.90. At a cut-off of ≥47, the sensitivity of the IES-R to detect PTSD was 84.1 (95% CI 72.7-92.1) and specificity was 81.1 (95% CI 75.0-86.3). Positive and negative likelihood ratios were 4.45 and 0.20, respectively. Factor analysis revealed a two-factor solution, with both factors showing good internal consistency (Cronbach's factor-1 α = 0.95, factor-2 α = 0.76). In a post hoc analysis, we found the brief six-item IES-6 also performed well, with an area under the curve of 0.87 and optimal cut-off of 15. The IES-R and IES-6 had good psychometric properties and performed well for indicating possible PTSD, but at higher cut-off points than those recommended in the Global North.

Performance management challenges in the Ministry of Health and Child Care in Zimbabwe

Performance management challenges in the Ministry of Health and Child Care in Zimbabwe

Performance management challenges in the Ministry of Health and Child Care in Zimbabwe

Performance management challenges in the Ministry of Health and Child Care in Zimbabwe

Fostering Ostering Strategic Synergies for Availibility of Public Quinary Hospitals with Super Medical Specialist Treatment Services and Care in Zimbabwe in the era of Working from Home

Fostering Ostering Strategic Synergies for Availibility of Public Quinary Hospitals with Super Medical Specialist Treatment Services and Care in Zimbabwe in the era of Working from Home

Use of herbal, complementary and alternative medicines among pregnant women in Makoni District, Zimbabwe

Use of herbal, complementary and alternative medicines during pregnancy, labour and delivery is common in Zimbabwe. This study aimed at documenting herbal, complementary and alternative medicines used during pregnancy in Makoni District in Zimbabwe. Snowballing was used to select 66 participants which included herbalists (45.5%), traditional birth attendants (18.2%), traditional healers (15.2%), and assistant traditional healers and herbal medicine vendors (10.6% each). Pregnant women in the study areaused a total of 47 plant species from 27 families, and 14 non-plant products as herbal, complementary and alternative medicines by. A total of 26 medical cases were treated with the majority of medicinal plants and non-plant products,used to dilate or widen the birth canal (55.3%) and to augment labour or speed up the delivery process (46.8%). This study showed that herbal, complementary and alternative medicines play an important role in the provision of basic health care in Zimbabwe.

Climate change, disaster management and primary health care in Zimbabwe.

The health crises related to climate change in African countries are predicted to get worse and more prevalent. The response to catastrophic events such as cyclones, flooding and landslides must be rapid and well-coordinated. Slower adverse events such as droughts, heat stress and food insecurity must similarly be anticipated, planned for and resourced. There are lessons to be learnt by the health system following the crisis created by Cyclone Idai in Zimbabwe during March 2019, which required a massive humanitarian response to mitigate the impact of torrential rainfall on lives and livelihoods. Several researchers and organisations documented the emergency response in detail. They reported that the government response was hampered by a lack of preparedness, poor planning, inadequate resource mobilisation and weak coordination. Rural communities did not access the early warning cyclone alerts disseminated through television, print and social media, nor did they appreciate the seriousness of events until it was too late. Primary health care (PHC) teams are familiar and trusted by the communities they serve and have a critical role in raising public awareness and in documenting the evolving impact of climate change, using established health indicators and local narratives. PHC leaders and providers have the knowledge and skills to mediate between government bodies, international agencies, other stakeholders and communities on the predicted impact of climate change on health outcomes, highlighting the vulnerability of disadvantaged and impoverished groups. They are also able to work with community leaders, using indigenous knowledge on weather patterns, to build local engagement in protection plans.ContributionThis article describes the role health professionals and civil society can play in educating the public on the dangers faced in the near future as a result of climate change and actions that can be taken to become more resilient and to mitigate this impact.

Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial.

IntroductionMost Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings.MethodsInterventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped‐wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within‐clinic correlations.ResultsA total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post‐intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66–3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11–273%), p = 0.02) post‐intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33–3.24], p = 0.001). Post‐intervention, non‐significant decreases in 90‐day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38–1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85–2.20], p = 0.20) were estimated.ConclusionsKS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90‐day return rates or survival.

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

BackgroundReducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19.MethodsWe performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths.ResultsWe identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19.ConclusionZimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.

Linguistic strategies used by the Ministry of Health and Childcare in Zimbabwe to sensitise citizens on COVID-19

This study explores the use of Shona and English in COVID-19 pandemic adverts by the Ministry of Health and Child Care in Zimbabwe. Specifically, the research establishes and explains the significance of linguistic strategies which were used by the Ministry of Health and Child Care when disseminating information to reduce the risk of COVID-19 infection, spread and management in the print media. The purpose of the study is to demonstrate that language use in this context is an act of cognitive manipulation where the reader is strategically coerced to take up the message. The study is a qualitative research enterprise and it used document analysis as the method of data collection. Data is analysed using Discourse Analysis and conceptual metaphor theory. The study established that the Ministry of Health and Child Care employed metaphors, slang, code switching, interrogatives, translation and borrowing to guide interpretation and conceptualisation of information in their adverts. The study concludes that by using these devices, the ministry exploits shared knowledge and then appeals to cognition through interrogatives to subtly garner support, manipulate opinion and manufacture compliance through the adverts.

Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses

BackgroundNon-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe.MethodsIn-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational analysis of NCDs care in Zimbabwe and views from patients with lived experiences.ResultsSaturation was reached after interviewing 10 participants from five busy urban clinics. For all three NCDs, we identified four cross-cutting barriers, a) poor access to medication and functional equipment such as blood pressure machines, urinalysis strips; b) high cost of private care; c)poor working conditions; and d) poor awareness from both patients and the community which often resulted in the use of alternative potentially harmful remedies. Participants indicated that empowering communities could be an effective and low-cost approach to positive lifestyle changes and health-seeking behaviours. Participants indicated that the Friendship bench, a task-shifting programme working with trained community grandmothers, could provide a platform to introduce NCDs care at the community level. Also, creating community awareness and initiating screening at a community level through community health workers (CHWs) could reduce the workload on the clinic nursing staff.ConclusionOur findings reflect those from other LMICs, with poor work conditions and resources shortages being salient barriers to optimal NCDs care at the facility level. Zimbabwe's primary health care system faces several challenges that call for exploring ways to alleviate worker fatigue through strengthened community-led care for NCDs. Empowering communities could improve awareness and positive lifestyle changes, thus optimising NCD care. Further, there is a need to optimise NCD care in urban Zimbabwe through a holistic and multisectoral approach to improve working conditions, basic clinical supplies and essential drugs, which are the significant challenges facing the country's health care sector. The Friendship Bench could be an ideal entry point for providing an integrated NCD care package for diabetes, hypertension and depression.

Poor cancer care in Zimbabwe

Zimbabwe is facing a critical situation with respect to cancer care as a consequence of the country's inadequate health-care delivery system, with the chances of survival of patients with cancer being very low in the country owing to the failure of the health sector. Justice Mudavanhu (Ministry of Health and Child Care, Harare, Zimbabwe) has expressed concerns regarding the management of cancer care in Zimbabwe.