Parirenyatwa Group Of Hospitals Research Articles

Assessment of lipid profiles in HIV patients on Dolutegravir based antiretroviral therapy at Parirenyatwa group of hospitals in Zimbabwe

Assessment of lipid profiles in HIV patients on Dolutegravir based antiretroviral therapy at Parirenyatwa group of hospitals in Zimbabwe

Assessing the acceptability of, adherence to and preference for a dual prevention pill (DPP) for HIV and pregnancy prevention compared to oral pre-exposure prophylaxis (PrEP) and oral contraception taken separately: protocols for two randomised, controlled, cross-over studies in South Africa and Zimbabwe

IntroductionOral pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, uptake and persistence have been low among southern African women. A dual prevention pill (DPP) that combines PrEP...

Multiple Myeloma in Zimbabwe. Knowledge Levels, Age and Sex as Risky Factors. Insights from Zimbabwe Multiple Myeloma Consortium

Multiple myeloma is a serious cancer of the blood affecting millions of people across the world and is the second most prevalent hematological disease accounting for 10% of hematological disease cases while representing 1% of all serious diseases in the world. Multiple myeloma is also a major threat in Sub-Saharan Africa as revealed by the statistics provided by the Ríos-Tamayo, Rodríguez, Chang-Chan, & Pérez (2018) . On average, according to Globocan (2020), 3.2 per 100 000 have MM in Southern Africa, while there are 0.98 and 0.83 per 100 000 people with MM in Eastern Africa and Western Africa respectively. This indicates that Southern Africa is disproportionately affected by multiple myeloma. This is particularly the cases with Zimbabwe in which the number of people with MM is estimated to be 2.69 per 100 000 people along with a 5-year prevalence of 400 new cases every year (Globocan, 2020). It is from this background that, the Zimbabwe multiple myeloma consortium funded by the Bristol Myers Squib Foundation implemented the multiple myeloma project in Zimbabwe since April 2022. Objectives of the project include the need to improve patients’ quality of life, to improve multiple myeloma service delivery systems and effects of multiple myeloma, where patients efficiently and effectively get diagnostic and palliative care services as well as increasing multiple myeloma awareness and knowledge levels among the general population and health workers of Zimbabwe. This article provides statistics to give insights of multiple myeloma in Zimbabwe in terms of case findings conducted to date as well as number of MM patients identified. Mixed method was employed where data was collected and captured using Qualtrics system integrating both qualitative and quantitative. Thematic analysis was incorporated to analyse qualitative data using 5 different steps namely: familiarization, generating initial codes, search for themes, reviewing of themes and write up. Participants for this research were drawn from a caseload of 181 patients. These patients received their services from Parirenyatwa Group of Hospitals, Gweru Provincial Hospital and Mpilo Hospital in Bulawayo. Findings of this research indicated that, there is deaths of multiple myeloma information among health care workers, professionals such as physicians and orthopaedics as well as general population. Late diagnosis has seen to be a cause for concern among mm patients. Males are the most vulnerable population to be affected by the disease and again ageing is a contributing factor. Recommendations made include but not limited to; targeted sensitisation reaching out to oncologists, physicians, orthopaedics health care workers, workplaces and tertiary institutions. This will translate to early diagnoses thereby improving quality of life. More funding is needed to support treatment of mm patients and as enablers to conduct home visits in relation to palliation activities by service providers. Social media engagement to be an ongoing endeavour packaged with mm risk factors, signs and symptoms related information.

Evaluation of Clinical Indications and the Reviewed Diagnoses from Bone Marrow Aspirate Examinations in Paediatric Patients at a Central Hospital in Zimbabwe

Objectives: To evaluate the correlation between clinical suspicion and the final laboratory diagnosis after the bone marrow examination Design: A 6year retrospective cross-sectional study Setting: Parirenyatwa Group of Hospitals, Zimbabwe Subjects: Seventy-six pediatric bone marrow aspirate (BMA) examination cases from 2016 to 2022 that had data that suited the study available were included in the study. Results: The 76 case participants had median age of 7 (age range 1-12). Six-two (81.6%) cases were found to have a complete BMA examination report while fourteen (18.4%) cases had technical errors reported and therefore excluded from the analysis of case results. Amongst the 14 excluded cases; 10(71.4%) were reported as unsuitable for diagnosis and 4(28.6%) reported as haemodilute for diagnosis. The triggers for BMA examination were grouped as; aplastic anaemia 5(6.6%), anaemia with variations 21(27.6%), pancytopenia 14(18.4%), and suspected haematological malignancies 36(47.4%). Analysis of the complete 62 case reports found; 34(54.8%) haematological malignancies, 2(3.2%) no diagnostic features, 5(8.1%) aplastic anaemia, 17(27.4%) no evidence of neoplasm/ infiltration, 3(4.8%) bone marrow hypoplasia, and 1(1.6%) non haematological metastasis. The percentage diagnostic yield between triggers for BMA examination and the BMA examination reports was 62/76 (81.6%0. However, there was no statistically significant correlation (p=0.275) to conclude that there is concordance between triggers for BMA examination and BMA examination diagnosis. Conclusion: Haematological malignancies were the commonest triggers for BMA examination in this study. Haematological malignancies were also found to be the commonest outcome in BMA reports done in pediatric patients with the major form being all.

Risks of oesophageal cancer in Zimbabwe: Eating habits and indoor air pollution from firewood smoke

Background: Oesophageal cancer is among the top five (5) cancers in Zimbabwe, and it has a high mortality rate. Several studies have alluded to the association between exposure to firewood smoke and this cancer. This study assessed the association between firewood smoke exposure, consumption of hot beverages, and food with oesophageal cancer among cancer patients in Zimbabwe. Methods: This study was quantitative in nature and adopted a cross-sectional design. A matched case-control approach with 95 pairs of cases and controls from Parirenyatwa Group of Hospitals' Radiotherapy Centre, a major referral hospital in Zimbabwe was used. A total of 190 participants were interviewed using a questionnaire administered via telephone by trained interviewers. Secondary data using histology results and radiology reports were obtained from the patient's medical records. SPSS version 27 was used to perform the descriptive analysis for variables such as age, marital status, exposure to firewood smoke, and thermal burns. Bivariate and multivariate analyses were used to examine the relationship between oesophageal cancer and dependent variables. Results: The ratio of male to female OC cases was 1.4 to 1, with a mean age of 63 for males and 60 years for females. The OC was significantly associated with the usage of firewood smoke as a major source of cooking energy (OR: 2.961; 95 % CI 1.46 - 6.03) (AOR: 4.22; 95% CI 1.22 - 14.59) with a p - value of 0.043. Also, the OC was significantly associated with high consumption of sweet potatoes (OR: 3.26; 95 % CI:1.67 - 6.55) (AOR: 3.47; 95% CI: 1.07 - 11.23) with a p - value of 0.001. The co-usage of the kitchen as a dining room was associated with OC (OR: 2.65; 95% CI: 1.44 - 4.88), no association was found (AOR: 0.98; 95% CI: 0.34 - 2.72) after adjusting for confounders. Risk factors such as age, alcohol intake, smoking, HIV status, and marital status were not associated with OC. Conclusion: The use of firewood for cooking and the consumption of sweet potatoes are the major contributors to OC among Zimbabweans. Awareness of the eating habits of sweet potatoes and using the kitchen as a dining area could significantly reduce cases of OC among Zimbabweans.

Characterizing HIV status documentation among cancer patients at regional cancer centers in Malawi, Zimbabwe, and South Africa

IntroductionIn East and Southern Africa, people with HIV (PWH) experience worse cancer-related outcomes and are at higher risk of developing certain cancers. Siloed care delivery pathways pose a substantial barrier to co-management of HIV and cancer care delivery.MethodsWe conducted cross-sectional studies of adult cancer patients at public radiotherapy and oncology units in Malawi (Kamuzu Central Hospital), Zimbabwe (Parirenyatwa Group of Hospitals), and South Africa (Charlotte Maxeke Hospital) between 2018 and 2019. We abstracted cancer- and HIV-related data from new cancer patient records and used Poisson regression with robust variance to identify patient characteristics associated with HIV documentation.ResultsWe included 1,648 records from Malawi (median age 46 years), 1,044 records from South Africa (median age 55 years), and 1,135 records from Zimbabwe (median age 52 years). Records from all three sites were predominately from female patients; the most common cancers were cervical (Malawi [29%] and Zimbabwe [43%]) and breast (South Africa [87%]). HIV status was documented in 22% of cancer records from Malawi, 92% from South Africa, and 86% from Zimbabwe. Patients with infection-related cancers were more likely to have HIV status documented in Malawi (adjusted prevalence ratio [aPR]: 1.92, 95% confidence interval [CI]: 1.56–2.38) and Zimbabwe (aPR: 1.16, 95%CI: 1.10–1.22). Patients aged ≥ 60 years were less likely to have HIV status documented (Malawi: aPR: 0.66, 95% CI: 0.50–0.87; Zimbabwe: aPR: 0.76, 95%CI: 0.72–0.81) than patients under age 40 years. Patient age and cancer type were not associated with HIV status documentation in South Africa.ConclusionDifferent cancer centers have different gaps in HIV status documentation and will require tailored strategies to improve processes for ascertaining and recording HIV-related information in cancer records. Further research by our consortium to identify opportunities for integrating HIV and cancer care delivery is underway.

Ocular trauma among patients attending a tertiary teaching hospital in Zimbabwe.

To investigate the trends, prevalence and distribution of ocular trauma in a Zimbabwean Tertiary Teaching Hospital (Parirenyatwa). A hospital-based retrospective cross-sectional study was conducted at the Parirenyatwa Group of Hospitals, Sekuru Kaguvi Eye Department in Harare, Zimbabwe, to review medical records of patients with ocular trauma visiting for treatment at the outpatient department between January 2017 and December 2021. Information on patients' demographics, presenting visual acuity, type of ocular trauma, and the number of eyes affected were collected and analysed using descriptive and inferential statistics. A total of 863 patients (1007 eyes) were identified to have experienced ocular trauma of one kind or another, with the youth (18-35 years) reporting with most cases (331, 38.4%). About 71.2% of patients were classified as having open-globe injuries and of that number, 90% were caused by blunt trauma, while the rest were caused by penetrating, intraocular, and perforating injuries. Patients with open-globe injuries were about 10 times more likely to develop blindness than those with closed-globe injuries after adjusting for age and gender, and this was statistically significant (ARR = 9.65, 95% CI: 5.53-16.84, p < 0.001). The prevalence of distance vision impairment due to ocular trauma was 60.1% (95% CI: 56.8%-63.4%), with majority resulting in blindness (22.0%, 95% CI: 19.4%-24.9%). There is a high prevalence of open-globe injuries in Zimbabwe with blunt trauma being the most significant cause. This suggests the need to promote and intensify public eye health awareness and sensitisation on safety strategies for the prevention of ocular trauma throughout the country.

Burden of Paediatric Kidney Diseases in a Tertiary Care Hospital in Harare, Zimbabwe.

The pattern of paediatric kidney diseases across different regions is influenced by genetic, racial, and environmental differences. The aim of this study was to review the current spectrum and outcome of childhood kidney diseases at Parirenyatwa Group of Hospitals and highlight the challenges of care. Retrospective observational study. Data on all children below 16 years of age hospitalised for any kidney disease over an 8-month period (1 January-31 August 2022) were retrieved and retrospectively analysed. Kidney diseases were categorised as per standard definitions. Kidney disease accounted for 2.2% (n = 50) of all 2264 admissions in the paediatric unit, with males constituting 60% (n = 30). Age ranged from 2 weeks to 13 years (mean 5.5 ± 3.5 years) with 58.0% being under 5 years. The commonest diagnoses in the unit were acute kidney injury (AKI) (n = 16, 32%) nephrotic syndrome (n = 16, 32%), hypertension (n = 12, 24%) and end stage kidney disease (ESKD) (n = 11, 22%) with some children presenting with more than 1 diagnosis. Only 3 out of 11 children with ESKD and 3 out of 8 children with AKI who required dialysis could be offered dialysis due to limited resources. Overall mortality rate was 32% (16/50): 5 children with AKI, 2 with nephrotic syndrome and normal kidney function, 8 with ESKD and 1 with Fanconi syndrome. Childhood kidney disease contributes significantly to hospitalisations at our institution with highest mortality among children with ESKD. The study highlighted the need for provision of essential drugs and kidney replacement therapy for children with kidney disease at our institution.

Perceptions of diabetes patients and their caregivers regarding access to medicine in a severely constrained health system: A qualitative study in Harare, Zimbabwe.

Nearly half of all sub-Saharan African countries lack operational Diabetes Mellitus policies. This represents an opportunity to build reliable evidence to underpin such policies when they are eventually developed. Representing the interests of those with the experience of living with the condition in national diabetes policies is important, particularly the interests regarding medicine access, a key pillar in diabetes management. One way to achieve this representation is to publish patient perceptions. Patient perspectives are especially valuable in the context of diabetes in Sub-Saharan Africa, where much of the empirical work has focused on clinical and epidemiological questions. We therefore captured the challenges and suggestions around medicine access articulated by a population of diabetes patients and their caregivers. This was a qualitative interpretivist study based on data from focus group discussions with adult diabetes patients and their caregivers. Eight FGDs of 4-13 participants each whose duration averaged 13.35 minutes were conducted. Participants were recruited from diabetes outpatient clinics at two health facilities in Harare. One site was Parirenyatwa Hospital, the largest public referral and teaching hospital in Zimbabwe. The other was a private for-profit facility. Ethics approval was granted by the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: JREC 295/18). Diabetes patients and their caregivers are interested in affordable access to medicines of acceptable form and quality with minimum effort. Yet, they often find themselves privileging one dimension of access over another e.g. prioritising affordability over acceptability. Based on participants' articulations, a sound diabetes policy should: 1. provide for financial and consumer protections, 2. regulate healthcare business practices and medicine prices, 3. provide for a responsive health workforce attentive to patient problems, 4. accord the same importance to diabetes that is accorded to communicable diseases, 5. decentralize diabetes management to lower levels of care, 6. limit wastage, corruption, bad macro-financial governance and a lack of transparency about how funding for health is used, and 7. provide support to strengthen patients' and caregivers' psychosocial networks. A diabetes policy acceptable to patients is one infused with principles of good governance, fairness, inclusiveness and humanity; characterised by: financial protection and price regulation, consumer protection, equity in the attention accorded to different diseases, decentralized service delivery, inclusion of patient voice in political decision-making, a responsive compassionate health workforce, psychosocial support for patients and their caregivers and allocative efficiency and transparency in public expenditure.

Standardization and strengthening the functionality of hospital management boards in central hospitals: Evidence of a developing economy

Zimbabwe’s public hospitals have been criticised for the declining standard of health service delivery for the past three decades with fingers pointed towards the hospital governance system. In response to the criticism, the government of Zimbabwe, through the Ministry of Health, has begun the process of making structural changes to the entire hospital governance system (Moyo, 2016; Sikipa, Osifo-Dawodu, Kokwaro, &amp; Rice, 2019). The aim of the study is to examine the processes of appointing hospital management board (HMB) members in central hospitals of Zimbabwe. The study sought to explore the standardization, strengthening, and performance of HMBs in central hospitals of Zimbabwe with a focus on six central hospitals which include Harare, Chitungwiza, Parirenyatwa Group of Hospitals, United Bulawayo Hospitals (UBH), Mpilo, and Ingutsheni. The study employed a mixed-method design using the questionnaire and interviews to collect data. The target population included 66 board members. The census approach was used meaning that all members of the population formed the sample size. The study revealed that 67% of hospitals had functional HMBs with a quorum despite lacking a clear policy to evaluate their performance. The gaps identified required policy review to strengthen the appointment and performance of HMBs

The Impact Of Flexitime On Motivation And Work Performance Of Health Workers In Zimbabwe: Evidence From Parirenyatwa Group Of Hospitals

This article studies the impact of flexitime on health workers’ motivation and work performance at Parirenyatwa Group of Hospitals. Despite the positive contribution of flexitime on motivation and work performance, adequate academic articles are yet to be published in Zimbabwe’s public sector on this subject. The thrust of this article was to close this gap in knowledge by determining the impact of flexitime on motivation and work performance at Parirenyatwa Group of Hospitals. Emailed self-administered questionnaires, telephone interviews as well as documentary research were used to find out the relationship between flexitime, motivation and work performance. Results from the research painted a close relationship between flexitime motivation and work performance. The study indicated that flexitime improves work- life balance and the physical health of the health workers at Parirenyatwa Group of Hospitals. Organisational commitment evidenced by reduced absenteeism was also achieved due to the implementation of flexitime. Flexitime requires professional administration and top management support for best results. The Ministry of Health and Child Care should adopt flexitime as a long term policy to motivate employees and line managers require adequate training to implement flexitime.

Ileo-sigmoid knotting: the Parirenyatwa hospital experience

Ileo-sigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to prevent mortality. The aim of this study was to determine the characteristics, presentation, morbidity and mortality associated with ileo-sigmoid knotting at Parirenyatwa Group of Hospitals (PGH). To determine the preoperative diagnostic precision and management patterns of ileo-sigmoid knotting cases at PGH. A retrospective analysis was performed on patients operated on at Parirenyatwa Hospital with a diagnosis of ileo-sigmoid knotting between April 2011 and April 2018. Data inclusive of demographics, time to presentation and surgery, preoperative diagnosis, complications and in-hospital mortality was collected. The relationship between the duration of symptoms prior to surgery and incidence of both septic shock and transfusion were analysed. Twenty-one cases of ileo-sigmoid knotting were identified for analysis. The median age was 37 years (range 18-65 years) with a 6:1 male to female ratio. Two of the three females included were pregnant. Twenty patients (95.2%) described an acute onset abdominal pain, with 83.3% experiencing the pain nocturnally, while asleep. The median duration of symptoms at presentation was 12.5 hours (range 2-39 hours). At admission, leucocytosis (WCC > 11x10³/dl) was noted in eleven patients (52.4%). Seventy-three per cent of patients were noted to have electrolyte derangements at presentation. Seven patients (33.3%) had recorded episodes of severe hypotension (SBP < 90) prior to surgery. The most common preoperative diagnosis, based on both clinical assessment and plain x-ray evaluation, was sigmoid volvulus (52.4%), with no preoperative diagnosis of ileo-sigmoid knotting being made. All patients had gangrenous small bowel, with 81% having a gangrenous sigmoid colon. All cases underwent small bowel resection and primary anastomosis plus Hartmann's procedure. Postoperatively, eleven patients (52.4%) developed septic shock, while 62% required blood transfusion. There was one (4.8%) early postoperative mortality. To avoid mortality, the diagnosis of ileo-sigmoid knotting should be entertained and the imperative of emergency surgery recognised in the young male or pregnant female patient with acute nocturnal onset abdominal pain, a rapidly deteriorating small bowel obstruction clinical picture and with radiological features suggestive of both small and large bowel obstruction.

Effect of HIV Infection on Growth and Bone Density in Peripubertal Children in the Era of Antiretroviral Therapy: A Cross-Sectional Study in Zimbabwe

Background: Poor linear growth and pubertal delay, both common in children with HIV (CWH) in sub-Saharan Africa, may affect adolescent bone accrual and future fragility fracture risk. We investigated the association of HIV with size-adjusted bone density in peri-pubertal children in Zimbabwe. Methods: CWH aged 8-16 years taking ART for ≥2 years from public-sector HIV clinics in Harare, and HIV-uninfected children from schools in the same catchment area, were recruited into a cross-sectional study. Sociodemographic, clinical and anthropometric data were collected. Outcomes were dual-energy X-ray absorptiometry (DXA) measured total-body less-head bone mineral content-for-lean mass adjusted for height (TBLH-BMCLBM) and lumbar spine bone mineral apparent density (LS-BMAD). Linear regression models using multiple imputation for missing data, assessed relationships between risk factors and DXA measures by HIV status, and interaction by sex and pubertal (Tanner) stage. Findings: We recruited 303 CWH and 306 without HIV, mean (SD) age 12.5 (2.5) years and 50% female. Mean ART duration was 7.9 (2.6) years; for 34% ART included tenofovir disproxil fumarate (TDF). The prevalence of low TBLH-BMCLBM and LS-BMAD (Z-Score<-2) was higher in children with than without HIV (10.4% vs. 6.2%, p=0.066; 14.3% vs. 5.8%, p=0.001 respectively). HIV and male sex were associated with earlier Tanner stage. The negative effects of HIV on TBLH-BMCLBM and LS-BMAD were more pronounced with pubertal maturation, particularly in females. Among CWH, years of TDF exposure and orphanhood were strongly associated with lower TBLH-BMCLBM Z-Score in both unadjusted and adjusted analyses. Current TDF use was associated with 0.40 (95%CI 0.07, 0.73; p=0.018) and 0.31 (0.07, 0.69; p=0.110) lower TBLH-BMCLBM and LS-BMAD Z-Scores respectively. Interpretation: Despite ART, HIV is associated with substantial skeletal deficits by the end of puberty. The size of bone deficits associated with TDF and its widespread use in children in sub-Saharan Africa raise concern for future adult fracture risk. Funding Statement: Wellcome Trust. Declaration of Interests: RR (206764/Z/17/Z) RAF (206316/Z/17/Z) are funded by the Wellcome Trust. CK is funded by a National Institute of Health (NIH) Fogarty Trent Fellowship. AMR is partially supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union Grant Ref: MR/R010161/1. All other authors declare no competing interests. Ethics Approval Statement: Ethical and governance approvals were granted by the London School of Hygiene and Tropical Medicine Ethics Committee (Ref: 15333), the Institutional Review Board of the Biomedical Research and Training Institute in Harare (Ref: AP145/2018), the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: 11/18), Harare Central Hospital Ethics Committee (Ref: 170118/04), the Medical Research Council of Zimbabwe (Ref: MRCZ/A/2297) and the Ministry of Primary and Secondary Education Zimbabwe (Ref: C/426/Harare). Guardians provided written informed consent and children provided written assent.

Chemoradiation in Stage IIIB Cancer of the Uterine Cervix: A Review of the Zimbabwean Experience.

PURPOSECervical cancer remains the leading cause of cancer morbidity and mortality among Zimbabwean women. Many patients present with stage IIIB disease. Although definitive concurrent chemoradiation (CCRT) is the standard of care, there is a paucity of data on the effect(s) of this intervention in resource-constrained and high HIV-prevalence settings. We investigated the differences in CCRT initiation practices, tolerability, and outcomes in this group.PATIENTS AND METHODSWe performed a retrospective analysis of data from hospital records for patients with stage IIIB disease who were treated over a 2-year period at Parirenyatwa Group of Hospitals. Outcome measures were documented treatment-related adverse events and early clinical tumor response.RESULTSOne hundred twenty-eight (37%) of 346 patients received CCRT, and 65 (51%) of 128 patients were infected with HIV. CCRT was prescribed mostly in patients with less extensive disease—not involving lower third vaginal walls, minimal pelvic sidewall involvement (P = .002), and higher CD4+ count (P = .02). Eighteen percent of recorded adverse events were high grade (≥ 3). One patient did not complete treatment, and 68.5% achieved complete clinical tumor response at 3 months post-CCRT. A higher proportion of complete clinical tumor response was noted in those patients who were young, HIV uninfected, had less extensive disease, CD4+ of 500 cells/mm3 or greater, received four or more cycles of chemotherapy, received brachytherapy, and had no treatment breaks.CONCLUSIONThe study revealed that the use of CCRT to treat stage IIIB cervical cancer is low in Zimbabwe. Although several factors contribute, low CCRT uptake is mostly attributed to financial barriers. Well-selected patients tolerate the treatment and have good early clinical tumor response as expected. The role of CCRT for this patient group (and methods to make it available in resource-limited settings) must be further evaluated.

Uptake of Screening for Diabetic Retinopathy and Associated Factors among Adults with Diabetes Mellitus Aged 18-65 Years: A Descriptive Cross Sectional Study

The prevalence of diabetes in Zimbabwe has increased significantly in the past three decades posing serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting. Studies conducted in Zimbabwe have reported prevalence of 16% to 38%. Diabetic retinopathy, a major complication of diabetes, is a leading cause of blindness globally and of an estimated 285 million people with diabetes worldwide approximately 33.3% have signs of diabetic retinopathy and of these a further 33.3% have vision threatening diabetic retinopathy. The purpose of this study is to examine uptake of screening for diabetic retinopathy and associated factors among adults aged 18-65 years with diabetes at Parirenyatwa Group of Hospitals. This was a cross sectional analytical study on a random sample of 83 adults aged 18-65 years with diabetes mellitus. The study was conducted according to the requirements of the Declaration of Helsinki. A structured questionnaire was used to collect data in strict privacy and confidentiality. Uptake of screening was 53%. The chi-square test was done to analyse demographic factors associated with uptake of screening. Male gender and being married were significantly associated with higher uptake of screening (p=0.029 and p=0.037 respectively). Logistic regression was done to determine predictors of uptake of screening services for diabetic retinopathy. On logistic regression, gender (OR=0.241, 95% CI [0.079 – 0.735]) and misinformation (OR=0.280, 95% CI [0.081 – 0.974]) were significant predictors of uptake of screening. Uptake of diabetic retinopathy screening was sub-optimal. Gender and misinformation were significant barriers to uptake of screening. There is need to address barriers to uptake of retinopathy screening to promote timely identification and management of complications in people with diabetes mellitus.

Utilisation of Medical Services and Outcomes at Adult Rape Clinic at Parirenyatwa Group of Hospitals, Zimbabwe.

Sexual violence is a major public health problem due to the associated risk of acquiring sexually transmitted infections, behavioural disorders and risk of committing suicide. The Adult Rape Clinic (ARC) was established at Parirenyatwa Hospital, Harare in 2009 with the objective of providing medical and support services for survivors of sexual violence in a safe and private environment. The data collected had never been analysed since the establishment of the clinic. We described the clients' profile and the services offered at the clinic to identify gaps in service provision and areas of improvement. A retrospective record review of data was carried out from the ARC collected from February 2009 to December 2017. We analyzed 2343 affidavits that were available. Out of 2343 records analysed, (2190) 93.5% were female and 6.5 % (153) were male. The median age was 23years (Q1=21; Q3= 29) for males and 19 years (Q1= 17; Q2=25) for females. Among the clients, 2164 (92.4%) received a baseline HIV test, and 263 females and 6 males tested positive. From 2010 to 2017, six clients' seroconversion was recorded. Only 863(36.8%) clients presented within 3 days after the sexual assault. About 40% of male victims were assaulted by someone they knew and 27% were married. The study recommends further research on the determinants of late presentation after sexual assault.

183 Review of the Management of Patients with Advanced Esophageal Cancer at Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe

183 Review of the Management of Patients with Advanced Esophageal Cancer at Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe

Practices in Preventing Pneumonia by Caregivers of Under-5 Children Attended at a Referral Hospital in Zimbabwe

Pneumonia is the foremost cause of mortality in children under the age of 5, with most deaths occurring in the sub-Saharan Africa and South Asia. In Zimbabwe pneumonia continues to be one of the chief causes for admissions of pediatric patients, with majority presenting with severe form. Since access to health facilities is limited to some areas in many developing countries such as Zimbabwe, the caregivers’ practices in pneumonia prevention can help reduce the occurrence of pneumonia in children who are under five years. The aim of the study is to determine the practices in pneumonia prevention by caregivers as it is an important tool in reducing morbidity and mortality. This study utilized a descriptive cross sectional design. The target population was caregivers of children under five who visited the pediatric casualty department at Parirenyatwa Group of Hospitals. Simple random sampling was used in the study. A structured questionnaire with two sections of demographic characteristics and pneumonia prevention practices was used to measure the preventive measures done by caregivers. All participants gave an informed consent to participate in the research study after the researcher had fully explained to them the purpose of the study using the language they are well conversant with. Permission to execute this study was granted by the head of Department of Nursing Science and Joint Research Ethics Committee. Descriptive statistics were used to analyze data. Computerized Statistical Microsoft Excel and Package for Social Sciences was also used to analyze numerical data to obtain percentages, mean, modes, averages and frequencies. Data was presented in graphs and tables. Twenty-eight (70%) participants exhibited average levels of practicing pneumonia prevention and the least number (7.5%) of the participants showed high levels of preventing pneumonia. This may be due to absenteeism of caregivers when pneumonia health education is given, it might be also due to the fact that the majority of the participants were first time mothers and fathers and also might be as a result of neglecting pneumonia preventive measures when health education is being given. The findings can be said to be a better outcome as the majority are averagely preventing pneumonia, but for pneumonia and associated deaths to be decreased to an insignificant rate, the majority should be highly practicing pneumonia prevention. Therefore, health education need to be given more regularly to cater for first time mothers and fathers, and those who would be absent when previous sessions are done. Further studies should be done on factors that might hinder proper implication of pneumonia prevention practices.

Determinants of Periodontal Disease in Pregnancy in an Urban Setting in Zimbabwe

Periodontal disease is one of the most common infectious diseases in pregnancy. The disease is caused by bacteria that produce inflammation of gingiva through production of inflammatory mediators that may have direct insult on amnion. Untreated and chronic dental infections have a possibility of causing harm to both the mother and the baby. This was an analytical cross-sectional study the purpose of which was to determine the prevalence and risk factors for periodontal disease in pregnancy. The study was conducted on a random sample of 350 postnatal mothers at Harare city Primary Care clinics. Study approval was granted by the Joint Research Ethics Committee of the University of Zimbabwe, College of Health Sciences and Parirenyatwa Group of Hospitals (JREC), the Medical Research Council of Zimbabwe (MRCZ) and Harare City Directorate. All participants gave informed consent. Code numbers were used to identify participants and interviews and oral assessments were conducted in private rooms. Data was collected through face to face interviews following a structured questionnaire, clinical intraoral examination and from clinical records. Data was captured using research electronic data capturing (RedCap) and was analyzed using the Statistical Package for Social Sciences (SPSS). Mean maternal age was 25.9 years, SD 5.7. prevalence of periodontal disease was 48.7%. No significant factors were associated with periodontal disease in the current study. However, other studies have reported significant risk factors for periodontal disease such as gestation age of the pregnancy and place of residence periodontal disease was significantly associated with the following birth outcomes. Periodontal health is the relatively neglected area in perinatal care. Health care professionals should be trained in screening for periodontal disease and giving health education in order to reduce adverse perinatal outcomes.

An Assessment of the Effectiveness of Warfarin Therapy Monitoring Systems on Thrombophilic Patients in Zimbabwe.

Introduction Thrombophilia describes conditions that predispose individuals to increased blood clotting and includes conditions such as deep vein thrombosis and pulmonary embolism. Thrombophilia is associated with high morbidity and mortality rates, and is commonly treated by warfarin anticoagulation. However, warfarin may cause both bleeding and clotting episodes if the therapy is not monitored and managed effectively. Objectives The main objective of this study was to assess the effectiveness of warfarin monitoring systems on thrombophilic patients at a major hospital in Zimbabwe. Material and Methods A clinical and laboratory prospective and retrospective study was performed on patients who had been on warfarin therapy for at least 1 year. Questionnaires were administered to participants on warfarin from outpatients clinics at Parirenyatwa Group of Hospitals. Their international normalized ratio (INR) results were also accessed from the laboratory information system and captured in the Epi info and Microsoft Excel for analysis. Results Fifty questionnaires were administered and 47 (94%) participants responded adequately. Twenty-nine (61.1%) participants on warfarin were females. The majority of them were elderly and in the 31 to 40 age groups. Eighteen (38.3%) participants missed their medication at some point, while 12 (25.5%) had warfarin overdose. Sixteen (34%) and 11 (23.4%) admitted to taking alcohol and smoking, respectively, while on warfarin. Thirty-five (74.5%) did not change their medication nor were advised on the right diet. Thirty-four (72.3%) had appointments set after every month. Some participants indicated that they had symptoms of both clotting and bleeding. There were statistically significant differences ( p < 0.0001) between INRs for 3 monthly intervals from the initiation of warfarin therapy. Conclusion Women and the elderly formed the majority of the patients on warfarin, indicating gender and advanced age susceptibility to thrombophilia, respectively. The effectiveness of the warfarin monitoring systems appeared to be hampered by lack of a coordinated system that adequately monitors anticoagulant therapy in the country.