Population In Zimbabwe Research Articles

Evaluating the feasibility and attitudes towards SARS-CoV-2 self-testing in a rural population in Zimbabwe: a cross-sectional survey

ObjectivesThe widespread adoption of self-testing for SARS-CoV-2 has proven effective in curbing the virus’ spread, particularly in Western countries. However, significant knowledge gaps persist regarding the feasibility, acceptance and factors...

Using Wash'Em to Design Handwashing Programmes for Crisis-Affected Populations in Zimbabwe: A Process Evaluation.

Wash'Em is a process that supports humanitarians in assessing and designing rapid but context-specific hygiene programmes in crises or outbreaks. The process consists of training implementers, using tools to learn from populations, and entering findings into a software which generates contextualised activities. A process evaluation of Wash'Em use was conducted in a drought-affected area in Midland province, Zimbabwe. Data were collected during the programme design and following implementation using a mix of qualitative methods. Findings were classified against the intended stages of Wash'Em, and the evaluation domains were defined by the UKRI Medical Research Council. The Wash'Em process was not fully implemented as intended. An abridged training was utilised, some of the tools for learning from populations were omitted, many of the recommended activities were not implemented, the delivery modalities were different from intended, the budget available was minimal, and the number of people exposed to activities were fewer than hoped. Despite these 'on the ground' challenges and adaptations, the Wash'Em process was considered feasible by implementers and was seen to be less top-down than most programme design approaches. The populations exposed to the intervention found the activities engaging, understood the content, and reportedly took action to improve handwashing behaviour. Programmes such as Wash'Em, which facilitate community participation and are underpinned by theory and evidence, are likely to yield positive results even if processes are followed imperfectly.

Weight and Lipid Levels in People Living With HIV and Initiating a Dolutegravir-Based Regimen in a Resource Limited Setting: A Prospective Study.

Background: Following the 2018 World Health Organization's (WHO) guidelines on HIV treatment and management, the Zimbabwean government has embraced dolutegravir (DTG)-based regimens as the preferred first-line treatment for people living with HIV (PLWH). Despite this implementation, there remains a paucity of knowledge on the potential associations between DTG-based regimens, body weight and blood lipid levels among PLWH in Zimbabwe. Thus, the aim of this study was to investigate variances in body weight and blood lipid levels at two distinct timepoints-baseline and 6-month post-DTG initiation. Methods: We conducted this study between November 2021 and April 2023 among ART-naïve individuals initiating a DTG-based regimen. Participants were recruited from a tertiary clinic in Zimbabwe. Body weight, standing height and blood lipid levels were measured at baseline and 6-month post-DTG. Changes in weight, body mass index (BMI) and lipids levels were assessed using the paired Student's t-test and Wilcoxon signed rank test. Multivariable logistic and linear regression analysis was used to assess risk factors associated with changes in weight, BMI and lipid levels. Results: A cohort comprising 130 study participants, characterised by a mean (±SD) age of 40.0 (±11.0) years at baseline, was subjected to a 6-month regimen of DTG-based therapy. The outcomes revealed statistically significant alterations in various physiological parameters. Specifically, post the DTG-based intervention, there were substantial increases observed in body weight (p < 0.001), BMI (p=0.003), total cholesterol (TC) levels (p=0.002) and high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001) in comparison to their baseline values. Intriguingly, the corresponding triglyceride (TG) levels exhibited a noteworthy decrease (p < 0.001). Notably, individuals aged 40 years or older exhibited a positive association (p=0.022) with increased TC levels and concurrent weight gain. Furthermore, current employment emerged as another factor positively linked to increased TC levels and weight gain. Conclusions: Upon the initiation of DTG, discernible elevations were observed in body weight, BMI and lipid levels. This study represents the first comprehensive assessment of lipid profiles and weight gain among this population in Zimbabwe, filling a critical gap in the existing literature. These findings, while indicative of short-term effects, underscore the imperative for further investigative efforts aimed at elucidating the prolonged consequences associated with DTG-induced weight gain and increased lipid levels and its underlying mechanisms.

Preferences for oral-fluid-based or blood-based HIV self-testing and provider-delivered testing: an observational study among different populations in Zimbabwe

BackgroundThere is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations.MethodsAt clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings.ResultsMay to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34–0.93) and those previously married aOR0.56 (0.34–0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28–3.13), 2.55 (1.28–5.07), 2.76 (1.48–5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96–0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47–17.41), 3.38 (2.03–5.62) and 2.23 (1.38–3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09–0.92).ConclusionsMost testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.

LEGACY OF THE CONFLICT BETWEEN EUROPEAN AND INDIGENOUS AFRICAN LEGAL CONSTRUCTS OF LAND TENURE IN CONTEMPORARY ZIMBABWE

The study focuses on the undeniable significance of the European legal traditions, brought to former Southern Rhodesia/Rhodesia by European settlers, for the legal status of land tenure in the country, the legacy of which traditions still deeply impacts the situation in present-day Zimbabwe. There are two main aspects of this influence: the aftermath of imposed land division and the prevalence of Western legal traditions in contemporary law. Numerous laws enacted unilaterally by white Rhodesians, most notably the 1930 Land Apportionment Act and the 1951 Native Land Husbandry Act, impacted the land tenure in the region. The indigenous African population was undoubtedly discriminated against by these legal actions: numerous acres of the land were taken by European conquerors and those left were of much lesser value in terms of farming and pasture. After the end of minority rule in Rhodesia in 1980, when Robert Mugabe rose to power, new land policies were imposed and numerous land allocations were awarded to the supporters of his regime in the name of removing racial injustices. The consequence was disastrous: the policy led to the demise of once world-famous agriculture and Zimbabwe became ceaselessly endangered by famine. Furthermore, laws concerning the land tenure and husbandry were (and still are) based on European legal constructs, alien to the native population of Zimbabwe. Indigenous traditions were subsequently ousted by the European law and are significantly absent in Zimbabwe today. Nowadays, after the fall of Mugabe in 2017, the country finds itself in the defining point of its history. The question persists: Can Zimbabweans derive useful values from their past in order to shape a new land policy in their homeland that would be just for all its citizenry?

A critical analysis of the challenges faced by deaf farmers in their participation in sustainable food production for nutrition and health in Mashonaland region, Zimbabwe

The Deaf Community in Mashonaland region constitutes a part of the minority population in Zimbabwe and this minority group happens to have capable farmers who are often sidelined from agricultural activities because of their difference from the hearing population. The researcher consulted the San Code of Research Ethics for advice. The study involved Deaf farmers who are involved in animal husbandry, horticulture and crop production, their workers in Mashonaland region. In total eight (8) respondents were interviewed. The researcher recorded and transcribed the collected data. The thematic analysis method was used during data analysis. The researcher grouped the transcribed data into thematic areas based on the research objectives. The findings revealed that lack of important information on important issues such as climate change, lack of access to land ownerships, communication barriers, lack of access to tertiary education and the seclusion of Deaf Community’s representation in policy making are the challenges faced by Deaf farmers in their participation in sustainable food production for nutrition and health in Mashonaland region. The study recommended awareness campaigns on Deaf Culture and the inclusion of Deaf people and other Persons with Disabilities in sustainable food production.&#x0D; How to reference using ASWNet style:&#x0D; Tome A. R. (2023). A critical analysis of the challenges faced by deaf farmers in their participation in sustainable food production for nutrition and health in Mashonaland region, Zimbabwe. African Journal of Social Work, 13(2), 100-109. https://dx.doi.org/10.4314/ajsw.v13i2.6&#x0D; Visit journal website: https://ajsw.africasocialwork.net

The impact of COVID-19 on informal humanitarian supply chains – The case study of Zimbabwe

Background: For the last 20 years Zimbabwe has been dependent on humanitarian aid. The country is in a desperate condition, with millions of citizens leaving to reside in neighbouring countries. These Zimbabweans are providing and sending food, necessities and cash to relatives in the country using largely informal humanitarian supply chains (HSCs). The outbreak of the coronavirus disease 2019 (COVID-19) pandemic was disastrous causing more hardship.Objective: This case study explores how informal HSCs played a significant role in the Zimbabwe humanitarian aid initiative and the impact of COVID-19 on these supply chains.Method: A mixed method design was used to collect qualitative data through personal interviews with Zimbabweans in South Africa. Additional quantitative data was obtained from humanitarian reports, Zimbabwe government reports as well as other publications. These were used to present the humanitarian crisis in Zimbabwe and specifically how support was provided through informal HSCs from outside Zimbabwe.Results: Through the case study the devastating effect COVID-19 had on a large component of the food insecure and suffering population of Zimbabwe is vividly illustrated. The closing of national borders prevented any food and other necessities, sent by diaspora from South Africa, reaching relatives.Conclusion: The results of this case study show the effect COVID-19 had on the humanitarian aid from relatives in South Africa. All the aid to Zimbabweans completely stopped for an extended period as these informal HSCs were completely broken because of the COVID-19 pandemic and 2 years later they remain disrupted.

English

High maternal, neonatal and child mortality rate constituting about 70% of the population in Zimbabwe. Zimbabwean rural women have faced challenges in accessing and utilizing Maternal, Neonatal and Child Health (MNCH) services. Rural areas in Zimbabwe have had high prevalence of home deliveries and pregnancy related complications associated with lack of access to and utilization of MNCH services, resulting in high maternal, stillbirths, new-born, neonatal and infant mortality rates. Access to and utilisation of MNCH services and facilities by rural based pregnant women has been limited by several issues that have been explored and assessed in the Primary Health Care clinics. However, the 3 delays (seek, access and receive health service) effects on the factors affecting health care and outcomes remain largely unclear in rural settings. Qualitative and quantitative methods research was conducted in Mutare district, Manicaland Province, Zimbabwe. Data collection tools including interviews questionnaires and focus group discussion guides were used to show how the three delays affected health service access in the district. GraphPad InStat Software and Statistical Package for Social Science were used for data analysis. Religious and cultural beliefs contributed to patient delays in seeking healthcare. With long distances and lack of transport attributed to Delays 1 and 2 with, drug unavailability, up-to date equipment and delay causing Delay 3. The patient, the provider and health systems were critical in accessibility, utilization and linkages of MNCH with other health services being crucial for achieving 4th and 5th Millennium Development Goals the targets. Key words: Maternal, Neonatal and Child Health Services, new-born; neonatal-infant mortality, three-delay model, Mutare District, child bearing Age.

No increased HIV risk in general population near sex work sites: A nationally representative cross-sectional study in Zimbabwe.

ObjectivesSex work sites have been hypothesised to be at the root of the observed heterogeneity in HIV prevalence in sub‐Saharan Africa. We determined if proximity to sex work sites is associated with HIV prevalence among the general population in Zimbabwe, a country with one of the highest HIV prevalence in the world.MethodsIn this cross‐sectional study we use a unique combination of nationally representative geolocated individual‐level data from 16,121 adults (age 15–49 years) from 400 sample locations and the locations of 55 sex work sites throughout Zimbabwe; covering an estimated 95% of all female sex workers (FSWs). We calculated the shortest distance by road from each survey sample location to the nearest sex work site, for all sites and by type of sex work site, and conducted univariate and multivariate multilevel logistic regressions to determine the association between distance to sex work sites and HIV seropositivity, controlling for age, sex, male circumcision status, number of lifetime sex partners, being a FSW client or being a stable partner of an FSW client.ResultsWe found no significant association between HIV seroprevalence and proximity to the nearest sex work site among the general population in Zimbabwe, regardless of which type of site is closest (city site adjusted odds ratio [aOR] 1.010 [95% confidence interval {CI} 0.992–1.028]; economic growth point site aOR 0.982 [95% CI 0.962–1.002]; international site aOR 0.995 [95% CI 0.979–1.012]; seasonal site aOR 0.987 [95% CI 0.968–1.006] and transport site aOR 1.007 [95% CI 0.987–1.028]). Individual‐level indicators of sex work were significantly associated with HIV seropositivity: being an FSW client (aOR 1.445 [95% CI 1.188–1.745]); nine or more partners versus having one to three lifetime partners (aOR 2.072 [95% CI 1.654–2.596]).ConclusionsSex work sites do not seem to directly affect HIV prevalence among the general population in surrounding areas. Prevention and control interventions for HIV at these locations should primarily focus on sex workers and their clients, with special emphasis on including and retaining mobile sex workers and clients into services.

Community-led monitoring: a voice for key populations in Zimbabwe.

Community-led monitoring: a voice for key populations in Zimbabwe.

Limited syphilis testing for key populations in Zimbabwe: A silent public health threat.

In this article, the authors discuss the problem of high prevalences of active syphilis amongst key populations (KPs) in Zimbabwe, in combination with low testing rates, partly because of a difficult legal and social environment for these populations. The article highlights the need to develop strategies to address the high prevalence of syphilis amongst KPs. The authors discuss requirements for addressing deficits in existing clinical services, predominantly primary care settings, in providing primary healthcare, including sexually transmitted infection (STI) management, to Zimbabwe’s KP communities and utility of point-of-care testing and self-testing and other innovations to improve testing uptake.

COVID-19 information gaps among disadvantaged communities: The case of the deaf and limited English proficiency communities in Zimbabwe

Worldwide public health authorities are taking action to contain Covid-19. While the bulk of research on the pandemic focuses on understanding the spread and seeking a cure for the virus from a virology perspective, research of the same magnitude should also focus on the risks of the pandemic for society, particularly among disadvantaged groups. This study adopted a community-centred approach to information and health rights and utilised the case study approach to investigate the quality and access to Covid-19 information, care and treatment by the Limited English Proficiency (LEP) and the Deaf communities in Zimbabwe. More than 60% of Covid-19 messages communicated in Zimbabwe’s mainstream media do not cater for the needs of these disadvantaged groups. Brochures, videos and infographics, for instance, appear in English, yet there is a significant LEP population in Zimbabwe. As regards the Deaf community, videos, conversations and interviews with health specialists, which rarely appear in mainstream public media, include Zimbabwean Sign Language interpretation. In this case, the choice of language and medium used to communicate vital Covid-19 messages in mainstream public media may pose language barriers to effective and equitable health information for these vulnerable groups. What this reality hints at is that public communication that does not discriminate is a necessity to allow all members of the community to fight the spread of Covid-19 and hence, reduce its potential risks.

Probiotic Potential, Iron and Zinc Bioaccessibility, and Sensory Quality of Uapaca kirkiana Fruit Jam Fermented with Lactobacillus rhamnosus Yoba.

Uapaca kirkiana is an underutilised indigenous fruit tree (IFT) found in the miombo ecological zone in sub-Saharan Africa. Furthermore, sub-Saharan Africa is home to many nutritionally insecure people who suffer from micronutrient deficiency. The incorporation of probiotic strains in jams as a possible way of enhancing mineral accessibility, food quality, and health is limited in Africa. This study monitored the probiotic potential, bioaccessible iron and zinc, and organoleptic properties of U. kirkiana fruit jam fermented with L. rhamnosus yoba. U. kirkiana fruits were collected from semiarid rural areas of Zimbabwe. The L. rhamnosus yoba strain was obtained from the Yoba for Life Foundation, Netherlands. Mineral and biochemical properties of the probiotic jam were analysed using AOAC standard methods. The U. kirkiana fruit tree was ranked first as a food resource by most rural populations in Zimbabwe. The probiotic jam formulation had 55% (wt/vol) U. kirkiana fruit pulp, 43% (wt/vol) sugar, 1.25% (wt/vol) pectin, 0.5% (wt/vol) citric acid, and 0.25% (wt/vol) L. rhamnosus yoba strain. The probiotic jam had 6.2 ± 0.2 log CFU/mL viable L. rhamnosus yoba cells. Iron and zinc content (mg/100 g w.b.) was 4.13 ± 0.22 and 0.68 ± 0.02 with pH 3.45 ± 0.11, respectively. Nutrient content was g/100 g w.b., carbohydrate 66 ± 4.1, fat 0.1 ± 0.01, crude protein 0.2 ± 0.01, ash 0.7 ± 0.02, and crude fiber 0.3 ± 0.01. Bioaccessible iron and zinc were 6.55 ± 0.36% and 16.1 ± 0.50% and increased by 4% and 2% in the probiotic jam, respectively. Mineral bioaccessibility and nutrient content were significantly different (p < 0.05) in jam with 0.25% L. rhamnosus yoba. Jam acceptance rating was 83%. The probiotic jam can be used as a sustainable food containing probiotic with potential nutritional and health benefits.

Analysis of Human Insecurity Linking Human Rights and Sustainable Development within a Marginalized Minority Population of the Lesbians, Gays, Bisexual, Transgender, Intersex and Queer (LGBTIQ) population in Zimbabwe

This study aimed to assess analysis of human insecurity linking human rights and sustainable development within a marginalized minority population of the Lesbians, Gays, Bisexual, Transgender, Intersex and Queer (LGBTIQ) population.

LEVELS OF HOPELESSNESS DURING COVID19 IMPOSED LOCKDOWN

Pandemics have been experienced since the existence of the known world. Their nature of operation has robbed many people the eye to see the bright future ahead. This study focused on how the recently experienced world epidemic namely covid-19 which started in China’s Wuhan province in 2019, affected the levels of hopelessness in the general population in Zimbabwe. The study adopted a quantitative approach using the quasi-experimental design. 103 participants, above 18 years, both males and females were selected using an online Beck Hopelessness scale. Descriptive statistics, Pearson chi-square and ANOVA were computed, and analysis was aided using Microsoft excel and Statistical Package for Social Sciences (SPSS) version 16.0. Results revealed that the sample had a moderate level of hopelessness, with no significant differences in different age groups as well as no significant difference in levels of hopelessness between males and females. The study concluded that pandemics are associated with some levels of hopelessness and recommended that as the nations are disseminating Covid-19 facts, statistics and prognosis, it must be accompanied by hopeful messages to kindle hope in the general population.

Comparing the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners and the urban population in Zimbabwe using the EuroQol (EQ-5D-3L+C) questionnaire: a cross-sectional study

BackgroundThe role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Besides limited epidemiological data, no data about the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners exist. The aim of the project was to access HRQoL of ASGM workers to improve the data base and compare the data to the urban Zimbabwean population.MethodsData from 83 artisanal and small-scale gold miners in Kadoma, Zimbabwe was analysed. The HRQoL was assessed using the EuroQol dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) accompanied by the cognition add-on questionnaire (EQ-5D-3L+C) and associated visual analogue scale (VAS). We described the EQ-5D dimensions and VAS values and computed health utility (HU) values using the Zimbabwean tariff. The proportions of miners reporting no problem in each EQ-5D dimension were compared with corresponding proportions reporting any problem (moderate or severe), and mean HU and VAS values were analysed across subgroups of the sample. To test differences between subgroups, Fisher’s exact test was used and between urban and mining population, Student’s t-test was used.ResultsThe reported health states of miners were homogenous, with a large amount (42%) reporting ‘full health’. Mean (SD) VAS and HU values were 81.0 (17.5) and 0.896 (0.13), respectively. Subgroup analysis showed that miners with a lower education reported significantly more problems in the dimension of daily activities and miners with mercury contact had more problems in the dimensions of pain/discomfort and cognition. Comparison between mining and urban population showed that in the oldest age group, self-rated VAS values of miners were significantly higher than of their urban counterparts.ConclusionsThere were no significant differences in the HRQoL of mining and urban populations. However, the reason might be adverse health effects faced by the urban population that do not apply to rural mining areas. A higher education level of miners can improve the HRQoL, which is especially impaired by problems in the cognition dimension.

Surgical outcomes in HIV positive patients following major surgery at two tertiary institutions in Harare, Zimbabwe

BackgroundHuman Immunodeficiency Virus (HIV) traditionally has been associated with poorer outcomes among the critically ill. Recent evidence suggests that the outcomes of surgical patients have improved with increased use of antiretroviral regimens. We set out to find if this is true for major surgical procedures in Zimbabwe. MethodsA prospective cohort study was done on 215 patients who underwent major surgical procedures at the two main tertiary hospitals in Harare between June 2015 and April 2016. Dependent variables considered were surgical outcomes and length of hospital stay (LOS). Independent parameters which were studied included patient's demographics, HIV status, clinical features, diagnosis, investigations, and procedures carried out. The data was analysed using STATA statistical package version (STATA 13). ResultsThe mean age was 47.1years (SD = 18.1) and 43% were males. The HIV prevalence was 28%. Of the HIV positive patients, 16% had CD4 count <200 cells/mm3, 42% with CD4 counts between 200 and 400 cells/mm3 and 42% with CD4 counts >500 cells/mm. In HIV positive patients the common major operations performed were total abdominal hysterectomies (19%), amputations (16%) and perforated viscus (8%). The length of hospital stay in HIV positive patients was 14.4 days (SD = 10.8) compared to 10.9 days (SD = 6.7) in HIV negative patients. Surgical site infections and pneumonia were the most common postoperative complications seen. There was no difference in LOS in HIV positive patients on HAART (LOS = 15.2 days) and those not on HAART (LOS = 14.2 days) and the post operative complications were comparable between the two groups. Mortality was 3%. ConclusionSurgical site infections (25%) and pneumonia (32%) are the most common short term postoperative complications in HIV positive patients. Low CD4 count was associated with higher rates of surgical site infections (64%) and pneumonia (72%) in HIV positive patients. There was high prevalence (28%) of HIV positivity in patients undergoing major operations at the two tertiary hospitals compared to HIV prevalence in the general adult population in Zimbabwe.

Experimental Introgression To Evaluate the Impact of Sex Specific Traits on Drosophila melanogaster Incipient Speciation.

Sex specific traits are involved in speciation but it is difficult to determine whether their variation initiates or reinforces sexual isolation. In some insects, speciation depends of the rapid change of expression in desaturase genes coding for sex pheromones. Two closely related desaturase genes are involved in Drosophila melanogaster pheromonal communication: desat1 affects both the production and the reception of sex pheromones while desat2 is involved in their production in flies of Zimbabwe populations. There is a strong asymmetric sexual isolation between Zimbabwe populations and all other “Cosmopolitan” populations: Zimbabwe females rarely copulate with Cosmopolitan males whereas Zimbabwe males readily copulate with all females. All populations express desat1 but only Zimbabwe strains show high desat2 expression. To evaluate the impact of sex pheromones, female receptivity and desat expression on the incipient speciation process between Zimbabwe and Cosmopolitan populations, we introgressed the Zimbabwe genome into a Cosmopolitan genome labeled with the white mutation, using a multi-generation procedure. The association between these sex-specific traits was determined during the procedure. The production of pheromones was largely dissociated between the sexes. The copulation frequency (but not latency) was highly correlated with the female—but not with the male—principal pheromones. We finally obtained two stable white lines showing Zimbabwe-like sex pheromones, copulation discrimination and desat expression. Our study indicates that the variation of sex pheromones and mating discrimination depend of distinct—yet overlapping—sets of genes in each sex suggesting that their cumulated effects participate to reinforce the speciation process.

'So isolation comes in, discrimination and you find many people dying quietly without any family support': Accessing palliative care for key populations - an in-depth qualitative study.

Background:Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest.Aim:To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe.Design:Qualitative study using thematic analysis of in-depth interviews and focus groups.Setting/participants:A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge).Results:Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care.Conclusion:Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.

HIV status and mortality of surgical inpatients in rural Zimbabwe: A retrospective chart review.

BackgroundPeople living with HIV treated with antiretroviral therapy (ART) are now living longer and thus many are requiring surgical procedures. For healthcare resource planning, it would be helpful to better understand the prevalence of HIV in surgical patients, the types of surgery HIV-positive patients are undergoing and whether HIV status impacts mortality.ObjectiveThe goal of this study was to determine the prevalence of HIV in surgical inpatients and the extent of ART coverage, as well as to assess any differences between HIV-positive and HIV-negative patients in type of surgery undergone and in-hospital mortality at Karanda Mission Hospital, Mount Darwin, Zimbabwe.MethodA 1-year retrospective chart review was undertaken to collect clinical and demographic data for adult (excluding maternity cases) and paediatric surgical inpatients including age, sex, type of surgery, HIV status, CD4+ counts and, if patient was HIV-positive, whether he or she was taking ART.Results and conclusion: Charts for 1510 surgical inpatient stays were reviewed. HIV prevalence among the adults was higher than that in the general population in Zimbabwe in 2016 (23.2% vs. 14.7%). There was no significant difference in inpatient mortality between the HIV-negative group and the HIV-positive group. Within the group of patients with malignancies, people living with HIV were significantly younger than uninfected patients (mean age 50.5 vs. 64.4 years; p < 0.01). There were correlations between HIV and certain malignancies. Thus, in addition to AIDS-defining illnesses, clinicians must be alert to squamous cell carcinoma and oesophageal, anal and penile cancers in HIV-positive patients.