Background/Purpose Stage at diagnosis is an important metric in treatment and prognosis of cancer... more Background/Purpose Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. In sub-Saharan Africa (SSA), for the latter, the only data source is the population-based cancer registry (PBCR). For childhood cancers, the “Toronto Staging Guidelines” have been developed to facilitate abstraction of stage by cancer registry personnel. Although the feasibility of staging using this system has been shown, there is limited information on the accuracy of staging. Methods A panel of case records of 6 common childhood cancers was established. 51 cancer registrars from 20 SSA countries staged these records, using Tier 1 of the Toronto guidelines. The stage that they assigned was compared with that decided by two expert clinicians. Results The registrars assigned the correct stage for 53-83% of cases (71% overall), with the lowest values for acute lymphocytic leukaemia (ALL), retinoblastoma and non Hodgkin lymphoma (NHL...
BackgroundViral load (VL) monitoring of pregnant women living with HIV (PWLHIV) and antiretrovira... more BackgroundViral load (VL) monitoring of pregnant women living with HIV (PWLHIV) and antiretroviral therapy (ART) may contribute to lowering the risk of vertical transmission of HIV. The aims of this study were to assess the uptake of HIV VL testing among PWLHIV at entry to the prevention-of-mother-to-child transmission (PMTCT) services and identify facilitatory factors and barriers to HIV VL access.MethodsA retrospective, cross-sectional study was conducted at 15 health facilities in Mutare district, Manicaland Province, Zimbabwe from January to December 2018. This analysis was complemented by prospective interviews with PWLHIV and health care providers between October 2019 and March 2020. Quantitative data were analysed using descriptive and inferential statistical methods. Risk factors were evaluated using multivariate logistic regression. Open-ended questions were analysed and recurring and shared experiences and perceptions of PWLHIV and health care providers identified.ResultsA...
OBJECTIVE To document the pattern of cancer in children (0-14 years) registered in the Zimbabwe N... more OBJECTIVE To document the pattern of cancer in children (0-14 years) registered in the Zimbabwe National Cancer Registry from 2000-2009. DESIGN Retrospective descriptive analysis. METHODS Analysis of data from the Zimbabwe National Cancer Registry for the period 2000-2009. SETTING The Zimbabwe National Cancer Registry. RESULTS Childhood Cancer constituted 3.8% of all malignancies recorded at the cancer registry during the study period. The common cancers were: Wilm's Tumour 286 (16.2%), Kaposi Sarcoma 277 (15.7%), Retinoblastoma 231 (13.1%), Non- Hodgkins lymphoma 182 (10.3%), leukemia 158 (8.9%), brain and nervous tissue 107 (6.1%), connective tissue 105 (5.9%), bone 97 (5.5%), Hodgkins lymphoma 57 (3.2%), Non-melanoma skin 33 (1.9%). All the other remaining cancers were 233 (13.2%). Burkits lymphoma constituted only 2% of all cancers. The noted pattern of cancers in this study were compared to patterns from other countries and similarities and differences are discussed. CONCLU...
Introduction Control of the HIV & AIDS pandemic, which has lasted for more than 34 years, has bee... more Introduction Control of the HIV & AIDS pandemic, which has lasted for more than 34 years, has been underpinned on antiretroviral therapy (ART) which is offered in five steps called the HIV treatment cascade. The steps are: HIV diagnosis, linkage to care, retention in care, receipt of antiretroviral therapy and plasma viral suppression [1]. The elimination of mother-tochild transmission of HIV (eMTCT) program is instrumental in the elimination of HIV by year 2030 [2]. EMTCT interventions are offered in another series of steps called the PMTCT cascade. The steps involve access to antenatal care, HIV testing and enrolment into care, initiating ART, follow up, access to postnatal care, testing the child and their enrolment into care, initiating the child on ART and follow up. Under the PMTCT option B+ the step of determining eligibility for ART is eliminated since all ART-naïve HIV-positive pregnant women receive ART while those already on ART continue ART [3]. The success of all the st...
The lack of accurate population‐based information on childhood cancer stage and survival in low‐i... more The lack of accurate population‐based information on childhood cancer stage and survival in low‐income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population‐based registries in sub‐Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non‐Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed‐up, allowing calculation of 3‐year relative survival by cancer type and registry. Stage‐specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three‐year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%‐33%] for BL in Harare to 57% (95% CI = 31%‐76%...
Objectives African potato (hypoxis hemerocallidea) is used against HIV to enhance immune-function... more Objectives African potato (hypoxis hemerocallidea) is used against HIV to enhance immune-function, although no studies have evaluated its use in HIV infected individuals on combination antiretroviral therapy. The study aimed to evaluate the acute effects of orally administered hypoxoside, a constituent of African potato, on the hepatic and renal function in HIV infected individuals on tenofovir disoproxil fumarate/ lamivudine/ efavirenz regimen. Methods This was an open-label, two-period, fixed-sequence, pre-post test study, pilot design. Ethical approval was obtained from Medical Research Council of Zimbabwe (MRCZ A/2045) and Medicines Control Authority of Zimbabwe (MCAZ CT134/2016). Blood samples were collected before and after administration of African potato tablets. Tablets were administered orally once daily at 15mg/ kg hypoxoside for 10 days. Hepatic function tests (ALT, AST, ALP, GGT, albumin, total/ direct bilirubin); renal function tests (eGFR, blood urea nitrogen, creatinine), serum electrolytes (sodium, potassium, chloride) were assayed. STATA was used for statistical analysis. Results Twenty-six participants were enrolled (85% female). Median age (range) was 43 (28-52) years. Most had overweight Body Mass Index (46%) and were married (54%). No statistical difference was noted during hypoxoside for AST/ ALT/ ALP/ GGT/ albumin/ bilirubin. There were no changes in creatinine/ eGFR/ electrolytes. A mean significant increase in total protein (p=0.04) and decrease in blood urea nitrogen (p=0.04) were noted. Conclusion Short-term exposure to hypoxoside from African potato appeared safe and was not associated with clinically significant changes in hepatic, renal function tests/electrolytes. There is further need to evaluate extent of systemic exposure during long-term use in a larger population.
IntroductionThe Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatmen... more IntroductionThe Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub‐Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event‐free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation.MethodsThe Collaborative WT Africa Project is a multi‐centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described.ResultsIn total, 201 WT patients were included. Two‐year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. P...
BackgroundThe treatment of childhood cancer often is assumed to be costly in African settings, th... more BackgroundThe treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost‐effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub‐Saharan Africa.MethodsWithin hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost‐effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy.ResultsCost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical perso...
Annals of Tropical Medicine and Public Health, 2018
Context: In 2013, the world Health Organization endorsed Option B plus as a strategy towards elim... more Context: In 2013, the world Health Organization endorsed Option B plus as a strategy towards elimination of vertical transmission of HIV (human immunodeficiency virus). The purpose of the study was to examine the Option B+ trends and outcome predictors in Zimbabwe. Aims: to examine the PMTCT trends in Mashonaland East Province in Zimbabwe to determine the programmatic correlates of reduced MTCT in the first three years of introduction of PMTCT option B+. Settings and Design: Ecological study in Mashonaland East Province, Zimbabwe. Methods and Materials: The study was based on Option B plus data from the Provincial Health information system. Spatial mapping of MTCT rates was done using ArcMap 10.1. Statistical Analysis Used: Descriptive statistics and multiple linear regression of the correlates of MTCT rates using R software based on step-wise Akaike information criterion. Results: The MTCT rate for Mashonaland East was 5.3% in 2014, 5.2% in 2015 and 4.0% in 2016. The predictors for reduced PMTCT included: booking the pregnancy with a known HIV positive status (β= -0.011, SEB=0.0035), arriving in labour and delivery with unknown HIV status (β= -0.029, SEB=0.0078), testing HIV positive at retesting in labour and delivery (β= - 0.04; SEB=0.03), women with unknown HIV status within 24 months post-delivery (β= - 0.0044; SEB=0.0032) and identification of HIV exposed infants within 72 hours of birth (β= - 0.01; SEB=0.0026). Conclusions: PMTCT Option B+ was associated with a decline in MTCT rate. Intensive psychosocial support of pregnant or nursing women may facilitate reduction of MTCT rates.
Introduction: Cancer and sepsis comorbidity is a major public health problem in most parts of the... more Introduction: Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices. Methods: This was a descriptive cross sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively. Results: A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures with 56.0% gram positive, 42.0% gram negative bacteria and 2.0% yeast isolates. Most common isolates were Coagulase Negative Staphyl...
The objective of this study was to explore cultural practices that could expose babies to HIV inf... more The objective of this study was to explore cultural practices that could expose babies to HIV infection during the postnatal period in Chiota community in Zimbabwe. Purposively selected and gender disaggregated members of the community (n = 231) were informants to 23 focus group discussions and 8 semi-structured key-informant interviews. Data were analysed thematically. Emerging themes relating to risky practices were rituals surrounding open fontanelle, toning of child's sexual libido, initiation of sex after childbirth, treatment of eye and ear infections, tongue-tie and pre-mastication. These practices exposed babies to bodily fluids such as saliva, breast milk, vaginal fluids, pre-cum and semen which in turn put the babies at low to high risk of contracting HIV. This paper discusses implications for these risky practices in prevention of mother-to-child transmission of HIV. There is, therefore, need for studies to establish the prevalence of these practices.
A culture of silence surrounding HIV is a major contributor to continued HIV transmission and poo... more A culture of silence surrounding HIV is a major contributor to continued HIV transmission and poor care for people living with HIV/AIDS. To encourage medical leadership in addressing stigma and fear related to HIV at individual and community levels To pilot a mini-course for final year medical students in Zimbabwe that demonstrates stigma-reduction knowledge and skills needed to communicate information about HIV to patients, to address ethical implications of testing versus not testing for HIV, to increase awareness of the medical and preventive benefits of knowing one's HIV status and showing people how to cope with the emotional burden of dealing with HIV everyday. Methods of proven effectiveness for training medical students in ethics and communication skills were used such as presentations by well respected role models and opinion leaders, role-playing, small group discussions, accompanied by materials indicating local resources, in three afternoon teaching sessions. Univers...
To assess the practicality and effectiveness of an Ultra-Short zidovudine regimen for prevention ... more To assess the practicality and effectiveness of an Ultra-Short zidovudine regimen for prevention of perinatal HIV transmission in rural Zimbabwe. Double-blinded placebo-controlled randomized clinical trial. The Salvation Army Howard Hospital, a district hospital in rural Zimbabwe. 222 HIV positive pregnant women presenting for antenatal care prior to 36 weeks were randomized. Twenty nine women were lost to follow up. In the Thai regimen, mothers received zidovudine (300 mg po bid) from 36 weeks gestation until labour, and zidovudine (300 mg po q3h) during labour, and the neonates received a placebo. In the Ultra-Short regimen, the mothers received a placebo from 36 weeks to labour, then zidovudine (300 mg po q3h) in labour. The neonates received zidovudine (2 mg/kg po qid) for the first three days of life. Infant HIV RNA status at six weeks of life. Results were available for 90 infants from the Thai group and 89 infants from the Ultra-Short group. Infant HIV seroconversion rates at...
To determine the association between malignancy and the Human Immunodeficiency Virus type 1 (HIV-... more To determine the association between malignancy and the Human Immunodeficiency Virus type 1 (HIV-1) infection in children. Case series. The Paediatric Oncology Unit at Parirenyatwa Teaching Hospital. 76 consecutive newly diagnosed cases of malignancy between May 15 and November 15 1997. HIV serostatus. 27 out of 64 children were HIV seropositive, giving a seroprevalance rate of 42.2% (95% CI 30.1 to 54.3%). The four commonest diagnosed malignancies were non-Hodgkin's lymphoma (22.4%), acute lymphoblastic leukemia (19.7%), Wilm's tumour (19.7%) and Kaposi's sarcoma (15.8%). These tumours accounted for 77.6% of all malignancies. Nine of a total of 17 patients with non-Hodgkin's lymphoma were HIV positive and all 12 patients with Kaposi's were also HIV positive. No cases of Burkitt's lymphoma were seen. Although there was increased incidence of non-Hodgkin's lymphoma (NHL) compared to previous years, there was no significant association with the HIV serostat...
Background/Purpose Stage at diagnosis is an important metric in treatment and prognosis of cancer... more Background/Purpose Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. In sub-Saharan Africa (SSA), for the latter, the only data source is the population-based cancer registry (PBCR). For childhood cancers, the “Toronto Staging Guidelines” have been developed to facilitate abstraction of stage by cancer registry personnel. Although the feasibility of staging using this system has been shown, there is limited information on the accuracy of staging. Methods A panel of case records of 6 common childhood cancers was established. 51 cancer registrars from 20 SSA countries staged these records, using Tier 1 of the Toronto guidelines. The stage that they assigned was compared with that decided by two expert clinicians. Results The registrars assigned the correct stage for 53-83% of cases (71% overall), with the lowest values for acute lymphocytic leukaemia (ALL), retinoblastoma and non Hodgkin lymphoma (NHL...
BackgroundViral load (VL) monitoring of pregnant women living with HIV (PWLHIV) and antiretrovira... more BackgroundViral load (VL) monitoring of pregnant women living with HIV (PWLHIV) and antiretroviral therapy (ART) may contribute to lowering the risk of vertical transmission of HIV. The aims of this study were to assess the uptake of HIV VL testing among PWLHIV at entry to the prevention-of-mother-to-child transmission (PMTCT) services and identify facilitatory factors and barriers to HIV VL access.MethodsA retrospective, cross-sectional study was conducted at 15 health facilities in Mutare district, Manicaland Province, Zimbabwe from January to December 2018. This analysis was complemented by prospective interviews with PWLHIV and health care providers between October 2019 and March 2020. Quantitative data were analysed using descriptive and inferential statistical methods. Risk factors were evaluated using multivariate logistic regression. Open-ended questions were analysed and recurring and shared experiences and perceptions of PWLHIV and health care providers identified.ResultsA...
OBJECTIVE To document the pattern of cancer in children (0-14 years) registered in the Zimbabwe N... more OBJECTIVE To document the pattern of cancer in children (0-14 years) registered in the Zimbabwe National Cancer Registry from 2000-2009. DESIGN Retrospective descriptive analysis. METHODS Analysis of data from the Zimbabwe National Cancer Registry for the period 2000-2009. SETTING The Zimbabwe National Cancer Registry. RESULTS Childhood Cancer constituted 3.8% of all malignancies recorded at the cancer registry during the study period. The common cancers were: Wilm's Tumour 286 (16.2%), Kaposi Sarcoma 277 (15.7%), Retinoblastoma 231 (13.1%), Non- Hodgkins lymphoma 182 (10.3%), leukemia 158 (8.9%), brain and nervous tissue 107 (6.1%), connective tissue 105 (5.9%), bone 97 (5.5%), Hodgkins lymphoma 57 (3.2%), Non-melanoma skin 33 (1.9%). All the other remaining cancers were 233 (13.2%). Burkits lymphoma constituted only 2% of all cancers. The noted pattern of cancers in this study were compared to patterns from other countries and similarities and differences are discussed. CONCLU...
Introduction Control of the HIV & AIDS pandemic, which has lasted for more than 34 years, has bee... more Introduction Control of the HIV & AIDS pandemic, which has lasted for more than 34 years, has been underpinned on antiretroviral therapy (ART) which is offered in five steps called the HIV treatment cascade. The steps are: HIV diagnosis, linkage to care, retention in care, receipt of antiretroviral therapy and plasma viral suppression [1]. The elimination of mother-tochild transmission of HIV (eMTCT) program is instrumental in the elimination of HIV by year 2030 [2]. EMTCT interventions are offered in another series of steps called the PMTCT cascade. The steps involve access to antenatal care, HIV testing and enrolment into care, initiating ART, follow up, access to postnatal care, testing the child and their enrolment into care, initiating the child on ART and follow up. Under the PMTCT option B+ the step of determining eligibility for ART is eliminated since all ART-naïve HIV-positive pregnant women receive ART while those already on ART continue ART [3]. The success of all the st...
The lack of accurate population‐based information on childhood cancer stage and survival in low‐i... more The lack of accurate population‐based information on childhood cancer stage and survival in low‐income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population‐based registries in sub‐Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non‐Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed‐up, allowing calculation of 3‐year relative survival by cancer type and registry. Stage‐specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three‐year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%‐33%] for BL in Harare to 57% (95% CI = 31%‐76%...
Objectives African potato (hypoxis hemerocallidea) is used against HIV to enhance immune-function... more Objectives African potato (hypoxis hemerocallidea) is used against HIV to enhance immune-function, although no studies have evaluated its use in HIV infected individuals on combination antiretroviral therapy. The study aimed to evaluate the acute effects of orally administered hypoxoside, a constituent of African potato, on the hepatic and renal function in HIV infected individuals on tenofovir disoproxil fumarate/ lamivudine/ efavirenz regimen. Methods This was an open-label, two-period, fixed-sequence, pre-post test study, pilot design. Ethical approval was obtained from Medical Research Council of Zimbabwe (MRCZ A/2045) and Medicines Control Authority of Zimbabwe (MCAZ CT134/2016). Blood samples were collected before and after administration of African potato tablets. Tablets were administered orally once daily at 15mg/ kg hypoxoside for 10 days. Hepatic function tests (ALT, AST, ALP, GGT, albumin, total/ direct bilirubin); renal function tests (eGFR, blood urea nitrogen, creatinine), serum electrolytes (sodium, potassium, chloride) were assayed. STATA was used for statistical analysis. Results Twenty-six participants were enrolled (85% female). Median age (range) was 43 (28-52) years. Most had overweight Body Mass Index (46%) and were married (54%). No statistical difference was noted during hypoxoside for AST/ ALT/ ALP/ GGT/ albumin/ bilirubin. There were no changes in creatinine/ eGFR/ electrolytes. A mean significant increase in total protein (p=0.04) and decrease in blood urea nitrogen (p=0.04) were noted. Conclusion Short-term exposure to hypoxoside from African potato appeared safe and was not associated with clinically significant changes in hepatic, renal function tests/electrolytes. There is further need to evaluate extent of systemic exposure during long-term use in a larger population.
IntroductionThe Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatmen... more IntroductionThe Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub‐Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event‐free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation.MethodsThe Collaborative WT Africa Project is a multi‐centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described.ResultsIn total, 201 WT patients were included. Two‐year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. P...
BackgroundThe treatment of childhood cancer often is assumed to be costly in African settings, th... more BackgroundThe treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost‐effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub‐Saharan Africa.MethodsWithin hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost‐effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy.ResultsCost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical perso...
Annals of Tropical Medicine and Public Health, 2018
Context: In 2013, the world Health Organization endorsed Option B plus as a strategy towards elim... more Context: In 2013, the world Health Organization endorsed Option B plus as a strategy towards elimination of vertical transmission of HIV (human immunodeficiency virus). The purpose of the study was to examine the Option B+ trends and outcome predictors in Zimbabwe. Aims: to examine the PMTCT trends in Mashonaland East Province in Zimbabwe to determine the programmatic correlates of reduced MTCT in the first three years of introduction of PMTCT option B+. Settings and Design: Ecological study in Mashonaland East Province, Zimbabwe. Methods and Materials: The study was based on Option B plus data from the Provincial Health information system. Spatial mapping of MTCT rates was done using ArcMap 10.1. Statistical Analysis Used: Descriptive statistics and multiple linear regression of the correlates of MTCT rates using R software based on step-wise Akaike information criterion. Results: The MTCT rate for Mashonaland East was 5.3% in 2014, 5.2% in 2015 and 4.0% in 2016. The predictors for reduced PMTCT included: booking the pregnancy with a known HIV positive status (β= -0.011, SEB=0.0035), arriving in labour and delivery with unknown HIV status (β= -0.029, SEB=0.0078), testing HIV positive at retesting in labour and delivery (β= - 0.04; SEB=0.03), women with unknown HIV status within 24 months post-delivery (β= - 0.0044; SEB=0.0032) and identification of HIV exposed infants within 72 hours of birth (β= - 0.01; SEB=0.0026). Conclusions: PMTCT Option B+ was associated with a decline in MTCT rate. Intensive psychosocial support of pregnant or nursing women may facilitate reduction of MTCT rates.
Introduction: Cancer and sepsis comorbidity is a major public health problem in most parts of the... more Introduction: Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices. Methods: This was a descriptive cross sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively. Results: A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures with 56.0% gram positive, 42.0% gram negative bacteria and 2.0% yeast isolates. Most common isolates were Coagulase Negative Staphyl...
The objective of this study was to explore cultural practices that could expose babies to HIV inf... more The objective of this study was to explore cultural practices that could expose babies to HIV infection during the postnatal period in Chiota community in Zimbabwe. Purposively selected and gender disaggregated members of the community (n = 231) were informants to 23 focus group discussions and 8 semi-structured key-informant interviews. Data were analysed thematically. Emerging themes relating to risky practices were rituals surrounding open fontanelle, toning of child's sexual libido, initiation of sex after childbirth, treatment of eye and ear infections, tongue-tie and pre-mastication. These practices exposed babies to bodily fluids such as saliva, breast milk, vaginal fluids, pre-cum and semen which in turn put the babies at low to high risk of contracting HIV. This paper discusses implications for these risky practices in prevention of mother-to-child transmission of HIV. There is, therefore, need for studies to establish the prevalence of these practices.
A culture of silence surrounding HIV is a major contributor to continued HIV transmission and poo... more A culture of silence surrounding HIV is a major contributor to continued HIV transmission and poor care for people living with HIV/AIDS. To encourage medical leadership in addressing stigma and fear related to HIV at individual and community levels To pilot a mini-course for final year medical students in Zimbabwe that demonstrates stigma-reduction knowledge and skills needed to communicate information about HIV to patients, to address ethical implications of testing versus not testing for HIV, to increase awareness of the medical and preventive benefits of knowing one's HIV status and showing people how to cope with the emotional burden of dealing with HIV everyday. Methods of proven effectiveness for training medical students in ethics and communication skills were used such as presentations by well respected role models and opinion leaders, role-playing, small group discussions, accompanied by materials indicating local resources, in three afternoon teaching sessions. Univers...
To assess the practicality and effectiveness of an Ultra-Short zidovudine regimen for prevention ... more To assess the practicality and effectiveness of an Ultra-Short zidovudine regimen for prevention of perinatal HIV transmission in rural Zimbabwe. Double-blinded placebo-controlled randomized clinical trial. The Salvation Army Howard Hospital, a district hospital in rural Zimbabwe. 222 HIV positive pregnant women presenting for antenatal care prior to 36 weeks were randomized. Twenty nine women were lost to follow up. In the Thai regimen, mothers received zidovudine (300 mg po bid) from 36 weeks gestation until labour, and zidovudine (300 mg po q3h) during labour, and the neonates received a placebo. In the Ultra-Short regimen, the mothers received a placebo from 36 weeks to labour, then zidovudine (300 mg po q3h) in labour. The neonates received zidovudine (2 mg/kg po qid) for the first three days of life. Infant HIV RNA status at six weeks of life. Results were available for 90 infants from the Thai group and 89 infants from the Ultra-Short group. Infant HIV seroconversion rates at...
To determine the association between malignancy and the Human Immunodeficiency Virus type 1 (HIV-... more To determine the association between malignancy and the Human Immunodeficiency Virus type 1 (HIV-1) infection in children. Case series. The Paediatric Oncology Unit at Parirenyatwa Teaching Hospital. 76 consecutive newly diagnosed cases of malignancy between May 15 and November 15 1997. HIV serostatus. 27 out of 64 children were HIV seropositive, giving a seroprevalance rate of 42.2% (95% CI 30.1 to 54.3%). The four commonest diagnosed malignancies were non-Hodgkin's lymphoma (22.4%), acute lymphoblastic leukemia (19.7%), Wilm's tumour (19.7%) and Kaposi's sarcoma (15.8%). These tumours accounted for 77.6% of all malignancies. Nine of a total of 17 patients with non-Hodgkin's lymphoma were HIV positive and all 12 patients with Kaposi's were also HIV positive. No cases of Burkitt's lymphoma were seen. Although there was increased incidence of non-Hodgkin's lymphoma (NHL) compared to previous years, there was no significant association with the HIV serostat...
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