Centre In Zimbabwe Research Articles

Analysing lapsing rates among first-time blood donors at a blood centre in Zimbabwe using survival analysis.

blood centres are often faced with the problem of donor lapsing resulting in loss of donors from the already strained donor pool. In Zimbabwe, 70% of the donated blood comes from younger donors aged 40 years and below, who at the same time, have high attrition rates. This study seeks to apply the concept of survival analysis in analysing blood donor lapsing rates. in analysing the donor lapsing and retention rates, data on 450 first-time blood donors at the National Blood Service Zimbabwe, in Harare´s blood bank for the period 2014 to 2017 was extracted from the donors´ database. The Cox proportional hazards (Cox PH) and Kaplan-Meier methods were applied in the analysis. Donor demographic characteristics suspected of having effect on donor lapsing and retention were identified and analysed. the study findings show that 56.9% of the donors had lapsed by the end of the four-year study period. Results from the multiple Cox PH model indicate that donor age had a significant effect on blood donor retention time (p = 0.000918 < 0.05). The hazard ratio (HR) = 0.615 with 95% CI: (0.461; 0.820) shows that the relatively older donors had a lower hazard (38.5% lower) of lapsing compared to the hazard for younger donors. The effect of gender, blood donor group and donation time interval on donor retention and attrition were not statistically significant. Male donors had HR = 1.03; 95% CI (0.537; 1.99) with (p = 0.922 > 0.05) and donors with a 4-month interval between donations had HR = 1.31; 95% CI (0.667; 2.59) with (p = 0.430 > 0.05). the study confirmed the problem of donor attrition faced by blood centres. The age of the donor had a significant effect on the retention time of blood donors before lapsing. The older the blood donor, the lower the risk of lapsing. The Zimbabwe National Blood Service (NBSZ) Blood Centre authorities should have a critical mass of individuals above 40 years as potential blood donors because of their reliability in blood donation according to the study findings.

Quality and Inclusive Education in Zimbabwean Rural Early Childhood Development Centres

Globally, inclusive education lays a central role in improving and sustaining quality in Early Childhood Development (ECD) settings. Children with diverse needs and challenges are most vulnerable, marginalised and denied access to early education, especially in rural communities. This article explored the implementation of inclusive education towards achieving quality education in rural ECD settings of Mashonal and East schools of Zimbabwe. Grounded in the interpretivist philosophy, the study adopted a qualitative approach. Qualitative data from participants were gathered though semi-structured interviews and observations. The participants included three ECD teachers from three rural schools with ECD classes. The findings revealed that inclusive education is one of the measurement of quality in ECD centres. Despite being a crucial measure, data shows that rural ECD centres in Zimbabwe are not prepared for inclusive education. Although there are existing policies and acts on disability there was also a lack of support from the centres’ leadership and administration on the implementation. Our recommendations are that all stakeholders in ECD centres should support the implementation of inclusive education.

Knowledge Acquisition for Development in Selected Public Service Training Centres in Zimbabwe

Knowledge Acquisition for Development in Selected Public Service Training Centres in Zimbabwe

Implementation and evaluation of an ergonomic training program and stretch exercises among welders in the informal sector in three urban centres in Zimbabwe

Implementation and evaluation of an ergonomic training program and stretch exercises among welders in the informal sector in three urban centres in Zimbabwe

A Markov Chain Approach to the Pattern of Blood Donation Status at a Blood Service Centre in Zimbabwe

Background: Blood donors’ behaviour towards blood donation is not easily predictable and can be considered a stochastic random variable. A four-state Markov chain technique was defined and adopted in this study. The transition probabilities of blood donation within the four identified states, viz: new, regular, occasional, and lapsed donors were used to making further inferences about the dynamics in blood donation in Harare, Zimbabwe. Objectives: The paper presents a four-state Discrete Time Markov Chain (DTMC) model in analysing the changes in blood donation status over the four-year study period. Methodology: A transition probabilities matrix was developed and parameters estimated using the maximum likelihood method and two other approaches, and inferences were made based on the resultant transition matrix. Results: About 56% of new donors made at least one repeat donation and became regular donors within the first year, and the numbers gradually declined with time, whilst the lapsed donors increased from 35.6% in the second year to 55.6% in year 4. The long-run probabilities tell the same, with 80.9% of blood donations becoming lapsed in the long run. Depending on the current state of donation, new or regular donations will likely move to the regular donation state in the following time step (year). On the other end, occasional and lapsed donations have a higher probability of entering the lapsed donation state in the following time step (year). Conclusion: The paper provides useful insights into the Markovian transition probabilities among the blood donation states, and this has implications on future blood donors’ pool and blood bank inventory in Zimbabwe. The decline in the number of donors who make repeat donations is a worrisome trend since regular donations are the lifeline of any blood service centre.

Sustainable E-waste Management at Higher Education Institutions’ Data Centres in Zimbabwe

Sustainable E-waste Management at Higher Education Institutions’ Data Centres in Zimbabwe

Frontline healthcare workers' experiences of providing care during the COVID-19 pandemic at a COVID-19 centre in Bulawayo, Zimbabwe: A phenomenological study.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching, negative impact on healthcare systems worldwide. Healthcare workers play a critical role in the country’s healthcare delivery system, as they facilitate a continuum of care and containment of diseases such as the COVID-19 pandemic.ObjectivesThe aim of this study was to explore and describe the experiences of healthcare workers who provided care to COVID-19 patients at a central hospital in Zimbabwe.MethodThe researchers used an interpretative phenomenological analysis design. In-depth interviews were conducted virtually with 10 frontline healthcare workers working at a COVID-19 centre in Zimbabwe. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. An expert in qualitative research acted as an independent co-coder and conducted the open coding of each transcript.ResultsFindings reveal inadequate preparation and training of healthcare providers before the commencement of duty, resources-related challenges and a lack of support as significant experiences of healthcare providers. Moreover, healthcare providers have been subjected to stigma and discrimination attached to COVID-19, resulting in psychological effects on frontline healthcare providers.ConclusionThe COVID-19 pandemic brings unique and challenging experiences for frontline healthcare workers, resulting in a physically and emotionally drained workforce. This study calls for comprehensive support in the form of counselling, reasonable work schedules, training and adequate provision of personal protective equipment.

Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe.

Although pay-for-performance (P4P) schemes have been implemented across low- and middle-income countries (LMICs), little is known about their distributional consequences. A key concern is that financial bonuses are primarily captured by providers who are already better able to perform (for example, those in wealthier areas), P4P could exacerbate existing inequalities within the health system. We examine inequalities in the distribution of pay-outs in Zimbabwe’s national P4P scheme (2014–2016) using quantitative data on bonus payments and facility characteristics and findings from a thematic policy review and 28 semi-structured interviews with stakeholders at all system levels. We found that in Zimbabwe, facilities with better baseline access to guidelines, more staff, higher consultation volumes and wealthier and less remote target populations earned significantly higher P4P bonuses throughout the programme. For instance, facilities that were 1 SD above the mean in terms of access to guidelines, earned 90 USD more per quarter than those that were 1 SD below the mean. Differences in bonus pay-outs for facilities that were 1 SD above and below the mean in terms of the number of staff and consultation volumes are even more pronounced at 348 USD and 445 USD per quarter. Similarly, facilities with villages in the poorest wealth quintile in their vicinity earned less than all others—and 752 USD less per quarter than those serving villages in the richest quintile. Qualitative data confirm these findings. Respondents identified facility baseline structural quality, leadership, catchment population size and remoteness as affecting performance in the scheme. Unequal distribution of P4P pay-outs was identified as having negative consequences on staff retention, absenteeism and motivation. Based on our findings and previous work, we provide some guidance to policymakers on how to design more equitable P4P schemes.

Design of an individualised questionnaire to measure the impact of cancer on quality of life: The cancer dependent quality of life (CancerDQoL) questionnaire.

To design an individualised questionnaire to measure the impact of cancer and its treatments on quality of life (QoL). MATERIALS& METHODS: Design of the Cancer-Dependent Quality of Life (CancerDQoL) questionnaire was based on the Audit of Diabetes Dependent QoL (ADDQoL) questionnaire and related -DQoLs for other conditions. Item selection, face validity and content validity were established through clinician and patient ratings of the importance and relevance of 60 domains from the -DQoL Item Library, and semi-structured interviews with 25 English-speaking participants with a range of cancers attending a cancer centre in Zimbabwe (age range: 25-78 years; 16 women, 9 men). Ten interviews were subsequently conducted with UK English-speaking participants with a range of cancers attending Maggie's Centres in London and Dundee (age range: 40-76; 5 women, 5 men) to adapt the CancerDQoL for UK use. The first draft of the CancerDQoL contained 25 domain-specific items from the -DQoL Item Library plus four overview items. Zimbabwean participants indicated that cancer negatively impacted on all life domains included, except 'having children'. Weighted impact (impact ratings multiplied by importance) was most negative for 'sex life', 'depend on others' and 'physical capability'. The least negative weighted impact was found for 'having children', 'spiritual/religious life' and 'past medical/self-care'. UK interviews confirmed no new items were required. Face and content validity of the CancerDQoL is established for an adult sample of English-speaking cancer patients in Zimbabwe and confirmed in an adaptation following UK interviews.

Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe.

PURPOSEIn sub-Saharan Africa, radiotherapy (RT) utilization and delivery patterns have not been extensively studied in patients with metastatic breast cancer.METHODSA retrospective cohort study of female patients with metastatic breast cancer seen at Parirenyatwa Radiotherapy Centre in Zimbabwe from 2014 to 2018 was conducted. Demographics, pathology, staging, and treatment data were abstracted through chart review. Fisher's exact test and chi-squared test of independence were used to compare proportions, and independent two-sample t-tests were used to compare means.RESULTSOf 351 patients with breast cancer, 152 (43%) had metastatic disease, median age 51 years (interquartile range: 43-61 years). Of those with metastatic disease, 30 patients (20%) received radiation to various metastatic sites: 16 spine; three nonspine bone metastases; six whole brain; and five chest wall or supraclavicular. Patients who received radiation were younger (46 v 52 years; P = .019), but did not differ significantly by performance status than those who did not. The most common dose prescription was 30 Gy in 10 fractions (33%). Five (17%) patients had treatment interruption and two (7%) had treatment noncompletion. Province of origin and clinical tumor stage were significant predictors of RT receipt (P = .002; and P = .018, respectively).CONCLUSIONA minority of patients with metastatic breast cancer received RT (20%), and these were likely to be younger, with advanced tumor stage, and resided in provinces where RT is available. Conventional courses were generally prescribed. There is a need to strongly consider palliative RT as an option for patients with metastatic breast cancer and use of hypofractionated courses (e.g. 8 Gy in one fraction) may support this goal.

High dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

Background and purposeCervical cancer is the fourth commonest cancer in women in the world with the highest regional incidence and mortality seen in Southern, Eastern and Western Africa. It is the commonest cause of cancer morbidity and mortality among Zimbabwean women. Most patients present with locally advanced disease that is no longer amenable to surgery. Definitive concurrent chemoradiation (CCRT), which is the use of external beam radiotherapy (EBRT) and weekly cisplatin, includes use of intracavitary brachytherapy, as the standard treatment. In the setting of this study, cobalt-60 (Co60)-based high dose rate brachytherapy (HDR-BT) has been in use since 2013. This study sought to review practices pertaining to use of brachytherapy in Zimbabwe, including timing with external beam radiotherapy, adverse effects and patient outcomes.MethodsA retrospective analysis of data from records of patients with histologically confirmed cervical cancer treated with HDR-BT at the main radiotherapy centre in Zimbabwe from January 2013 to December 2014 was done. Outcome measures were local control, overall survival as well as gastro-intestinal and genito-urinary toxicity.ResultsA total of 226 patients were treated with HDR-BT during the study period, with a 97% treatment completion rate. All patients received between 45-50Gy of pelvic EBRT. Seventy-four percent received concurrent platinum-based chemotherapy. In 52% of the patients, HDR-BT was started when they were still receiving EBRT. The commonest fractionation schedule used was the 7Gy × 3 fractions, once a week (87%). Clinical complete tumour response was achieved in 75% at 6 weeks post treatment, 23% had partial response. Follow-up rates at 1 year and 2 years were 40 and 19% respectively. Disease free survival at 1 year and 2 years was 94 and 95% respectively. Vaginal stenosis was the commonest toxicity recorded, high incidence noted with increasing age. Four patients developed vesico-vaginal fistulae and two patients had rectovaginal fistulae.ConclusionOne hundred and seventeen patients patients started HDR-BT during EBRT course, with a treatment completion rate of 97%. The overall treatment duration was within 56 days in the majority of patients. Early local tumour control was similar for all the HDR-BT fractionation regimes used in the study, with a high rate (75%) of complete clinical response at 6 weeks post-treatment. Prospective studies to evaluate early and long-term outcomes of HDR-BT in our setting are recommended.

Implementation and evaluation of an ergonomic training program and stretch exercises among welders in the informal sector in three urban centres in Zimbabwe.

Implementation and evaluation of an ergonomic training program and stretch exercises among welders in the informal sector in three urban centres in Zimbabwe.

Development and validation of risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

Hypertensive disorders of pregnancy are major causes of global maternal and neonatal morbidity and mortality. This study aimed to develop and validate models to predict composite adverse maternal and neonatal outcome in severe preeclampsia in low-resource settings. A retrospective cross-sectional study of women with severe preeclampsia giving birth in a tertiary referral centre in Zimbabwe between 01/01/2014-31/12/2018. Candidate variables identified from univariable logistic regression (p<0.2) were entered into stepwise backward elimination logistic regression models to predict composite adverse maternal and neonatal outcomes. Models' performance was assessed by the area under the curve of the receiver operator characteristic (AUC ROC). The models were validated internally using bootstrap-based methods and externally using the Preeclampsia Integrated Estimate of RiSk dataset. The co-primary outcomes were composite adverse maternal outcome and composite adverse neonatal outcome. 549 women had severe preeclampsia from whom 567 neonates were born. The predictive model for composite adverse maternal outcome included maternal age, gestational age on admission, epigastric pain, vaginal bleeding with abdominal pain, haemoglobin concentration and platelets; the AUC ROC was 0.796 (95% CI 0.758-0.833). External validation showed poor discrimination (AUC ROC 0.494, 95% CI 0.458-0.552). The model for composite adverse neonatal outcome included: gestational age, platelets, alanine transaminase and birth weight; the AUC ROC was 0.902 (95% CI 0.876-0.927). While the models accurately predicted composite adverse maternal and neonatal outcomes in the study population, they did not in another cohort. Understanding factors which affect model performance will help optimize prediction of adverse outcomes in severe preeclampsia.

Burial of oscillating rural-urban and oscillating rural-diasporic indigenous Zimbabweans at dilapidated rural homes (matongo): a case study of the genesis of tent huts and kinship funeral expense fund groups in Buhera District, Zimbabwe

ABSTRACT I argue that an increase in the number of oscillating rural-urban (ORU) and oscillating rural-diasporic (ORD) indigenous Zimbabweans’ interments at dilapidated homes has resulted in the genesis and upsurge in temporary tent huts in which African Indigenous Religion (AIR) burial and funeral rituals are performed. Research findings conclude that there is an increasing number of ORU and ORD indigenous Zimbabweans who respectively after their deaths in urban centres and in the diaspora have AIR burial rites performed in tent huts at their deceased parents’ ruined homes in the rural areas. Research findings also reveal that traditional burial societies died in Zimbabwe due to economic hardships and that necessitated the formation of Kinship Funeral Expenses Fund Groups (KFEFG) in urban centres by the ORU Zimbabweans and Funeral Insurance Policies (FIP) by Zimbabwean diasporians which replaced burial societies. The conclusion is that despite an increasing number of Zimbabweans living, educated and owning houses in urban centres in Zimbabwe and in foreign countries, they still regard their decrepit rural abodes as their spiritual home and a place for their burials when they die.

EMERGENCY AND DISASTER PREPAREDNESS AT RURAL HEALTH CENTRES IN MASVINGO PROVINCE, ZIMBABWE

The word disaster evokes vivid and painful memories for most Zimbabwean citizens. While for many the word brings to mind images of cyclone IDAI that recently affected various communities in Zimbabwe, Mozambique and Malawi, for others it might trigger memories of other major disasters that have occurred in the country. Regardless of the type of disaster and the differing memories each may evoke, citizens of Zimbabwe inevitably revert back to one central question: “Why were we not better prepared?” In response, scholars have increasingly begun to explore the area of disaster management including, in the context of one of largest and most cherished institution, the health centre (hospital or clinic). When disasters occur, health centres are among the most important institutions as they are viewed as sanctuaries where victims seek solace. This study explores the emergency and disaster preparedness at rural health centres in Zimbabwe specifically in Masvingo province. Data for the study were collected through questionnaires and other secondary sources. It emerged from this study that generally the state of disaster preparedness in the rural areas of Masvingo province is poor.

An Assessment of the Community Antiretroviral Refill Groups. (CARGs) An Experience from Rural Zimbabwe

Community ART Refill Groups are fairly a new concept in Zimbabwe which s being rolled out in rural areas as way for strengthening HIV care and treatment. The number of PLHIV on ART has tremendously grown in Zimbabwe to more 1,2 million owing to the deliberate efforts by the government to scale up access to HIV treatment. CARGs have become a mechanism to improve management of PLIHV on ART at the same time effectively engaging the community and PLHIV in the continuum of HIV treatment care. This assessment of CARGs was based on qualitative and quantitative data collected from 10 CARGs at rural health centre in Zimbabwe. The study sought to establish the value and contribution of CARGs towards improving the care of PLHIV on ART. The major findings of this assessment are: reduction of the cost accessing ART medicines for PLHIV, improved treatment adherence as well as improvement in psychosocial support and well- being of PLHIV in CARGs. In addition to this CARGs helps the health facility in efficiently managing the ART workload. CARGs are indeed proving to be good sound model for improving HIV treatment and care for PLHIV.

Factors influencing e-health implementation by medical doctors in public hospitals in Zimbabwe

Background: Improving access to health care services in both developed and developing countries through information communication technology (ICT) has been getting particular attention from government, medical researchers and practitioners. This has seen many governments proposing the implementation of healthcare systems that are centred on technology, while researchers and practitioners have been arguing for policies that promote the use of technology in healthcare provision. Objective: The main objective of this study was to determine the factors influencing implementation of e-health by medical doctors in public hospitals in Zimbabwe. Methods: The study was guided by a qualitative research in conjunction with multiple-case studies. Qualitative data were collected using 20 semi-structured interviews from selected hospitals concerning the implementation of e-health by medical doctors in public hospitals. Hospitals were selected using random sampling, while purposive sampling was used to select the 20 doctors. In addition, the researcher conducted direct observations at five hospitals. Furthermore, data concerning policy issues in Zimbabwe’s e-health were collected using document review process. Data from the interviews were analysed using data-driven thematic coding. This solo approach was conducted because the researcher intended to reveal e-health influencing factors that could not be revealed by related literature. Results: This study reveals that the implementation of e-health by medical doctors in public hospitals in Zimbabwe is influenced by both internal and external factors. Internal factors include ICT infrastructure and e-health technologies, ICT skills and knowledge, technical support, security concerns, lack of basic medical facilities, demographic factors such as age and doctor–patient relationship. External factors are health policy, funding and bureaucracy. Conclusion: The idea of e-health is relatively new to healthcare centres in Zimbabwe. Its application has not been sufficiently addressed. The study shows that the success of an e-health system depends on internal and external factors. There is a great potential for implementing e-health in Zimbabwe if these factors are taken into consideration. Otherwise, Zimbabwe will continue to lag behind in the implementation of e-health systems in public hospitals.

Management of Records in Adapted Buildings as Records Centres in Zimbabwe

This paper discusses the challenges of records management that arise from the use of adapted buildings as records centres in Zimbabwe, despite the advantages of using such buildings. A qualitative research approach was used as well as a case study research design. Data were collected from seven officers of the Gweru Records Centre through semi-structured interviews. Personal observation was used to triangulate findings from interviews. It was found that the use of adapted buildings as records centres was a cheaper and quicker way of establishing records centres throughout the country. However, a number of preservation, security and management challenges cropped up as the conditions of the buildings and the environment of the adapted buildings were not conducive to the proper and professional management of records. This study is important in that it explores the prospects and challenges of using adapted buildings as records centres in Zimbabwe, an area that has not been researched by many authors. This provokes archival authorities and the government to seriously consider establishing purpose-built records and archival centres.

Blurring the Lines between Aid and Business: An Ethnographic Study of the Chinese Agricultural Technology Demonstration Centre in Zimbabwe

Blurring the Lines between Aid and Business: An Ethnographic Study of the Chinese Agricultural Technology Demonstration Centre in Zimbabwe

Challenges and Opportunities Related to Quality Distance Higher Education in Zimbabwe

Zimbabwe has managed to respond to the movement in support of UNESCO’S lifelong learning concept and strategy that seeks to widen and deepen access to higher education through distance education initiatives. Despite the significant increase in students enrolling in distance education institutions, the gold standard of excellence that is sought by many nations has gradually been compromised. There are symptoms of a downward trend in terms of quality in open distance learning institutions. The qualitative study analysed major factors affecting the provision of quality distance higher education with specific reference to the Zimbabwe Open University, the sole provider of university distance education in Zimbabwe. The study focused on three Zimbabwe Open University regional centres in Zimbabwe. The paper seeks to identify major factors contributing to the declining quality of distance education and discusses measures that distance education providers in Zimbabwe can undertake in order to promote excellence for effective learning in the 21st century. The study established that several factors are affecting the quality of distance education in Zimbabwe. The lack of Information Communication Technologies (ICTs) facilities at regional and district centres was a major hindrance to effective teaching and learning.