Simbarashe Rusakaniko
University of Zimbabwe, Community Medicine, Faculty Member
Research Interests:
Globally, late presentation with advanced disease among people diagnosed with cancer is a major concern to oncology, to government health ministries and to cancer service organisations. The phenomenon is thought to be more pronounced in... more
Globally, late presentation with advanced disease among people diagnosed with cancer is a major concern to oncology, to government health ministries and to cancer service organisations. The phenomenon is thought to be more pronounced in Sub Saharan Africa. This paper draws from a wider phenomenological study on the lived experience of selected people diagnosed with cancer in rural and urban Zimbabwe. It sought to identify and examine the interplay of factors which results in late presentation for a cancer diagnosis and for treatment. A total of 30 adult participants diagnosed with cancer and 5 key informants took part in the study. Semi structured interviews, focus group discussions and key informant interviews were used as tools for data collection. Key results indicated pronounced late presentation due to low levels of basic knowledge of cancer symptoms by both clients and health care professionals, widespread consultation of traditional health practitioners before and after a diagnosis, financial handicaps and varying symptom interpretation. These results are crucial for nursing and clinical practice, for educational programming and for people who provide care and support to people with cancer. Keywords: Advanced Disease; Cancer Diagnosis; Late Presentation; Lived Experience Phenomenological Study
Research Interests:
Research Interests:
Objective: To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to... more
Objective: To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to reach parts of the country where the conventional visual acuity charts are not available. Design: Aperformance evaluation of counting fingers (LLTT) in screening for blindness against the standard test (Snellen chart). Setting: Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Zimbabwe. Subjects: Patients presenting to the Eye Outpatient Department at Sekuru Kaguvi Eye Unit with various eye problems. Main outcome measure: Sensitivity of low level technology tool (LLTT) in identifying blind people. Results: Sensitivity and specificity of LLTT in detecting blindness in all age groups combined was 100% and 88.5% respectively. Although sensitivity was not affected by patient age, specificity decreased with increasing age. The overall positive predictive value for the test was 53.3% and the prevalence of blindness among outpatient attendees was 11.6%. Conclusion: Finger counting is an effective tool that can be employed in screening for blindness in communities which are hard to reach, have low literacy rate and when conventional methods of testing visual acuity are not available.
Research Interests:
Objectives: This survey was carried out to determine: 1. The ability of caregivers to recognise signs of pneumonia in children aged below five years who are coughing. 2. The proportion of caregivers who possess a watch and are able to use... more
Objectives: This survey was carried out to determine: 1. The ability of caregivers to recognise signs of pneumonia in children aged below five years who are coughing. 2. The proportion of caregivers who possess a watch and are able to use that watch to count respiratory rates in children. 3. The home remedies used for cough. Design: A cross sectional study. Setting: Three Primary Health Care Clinics and a tertiary level hospital in Harare. Materials and methods: 413 children aged less than five years attending a health care centre for cough were studied. Socio-demographic and personal characteristics of both mother and child were documented. An inventory of home remedies that were being used since onset of cough was taken. The child was also examined for signs of pneumonia by both caregiver and research nurse. The sensitivity and specificity of the caregiver's ability to recognise signs of pneumonia compared to the research nurse was calculated. Results: The ability of caregivers to recognise signs of pneumonia was high (sensitivity 95pc for hospitalized cases and 85pc for the clinic cases). Sensitivity tended to drop with increase in child's age. The caregiver's ability to recognise signs of pneumonia was not significantly related to the number of children she had or her level of education. Only 19.5pc of caregivers owned a watch and could use a watch to count respiratory rates correctly. Those who owned a watch were more likely to count respiratory rates correctly. Those who claimed ability to use a watch actually counted respiratory rates correctly. Sixty six pc had used some remedy to treat the cough at home. Conclusions: Caregivers were able to recognise signs of pneumonia without a watch. Only a small proportion of caregivers own watches and are able to use them correctly to count respiratory rates. National ARI control programmes should emphasize caregivers observing breathing when a child has a cough and encourage seeking early and appropriate health care when pneumonia is detected. Watches or timers should be made available and be recommended for use by trained health workers in health centres only. Use of potentially harmful remedies should be discouraged.
Research Interests:
Objective: To determine perinatal mortality rates and associated socio-demographic factors in two rural districts in Zimbabwe. Design: Cross sectional community based survey. Setting: Murewa and Madziwa rural districts. Subjects: Women... more
Objective: To determine perinatal mortality rates and associated socio-demographic factors in two rural districts in Zimbabwe. Design: Cross sectional community based survey. Setting: Murewa and Madziwa rural districts. Subjects: Women aged 15 to 50 years who had been pregnant over the preceding two years before the study. Materials and methods: A questionnaire was administered to eligible women by trained interviewers. Information pertaining to the women's socio-demographic characteristics, reproductive health profile and pregnancy outcome was documented. A post hoc case control analysis was undertaken to determine the risk factors associated with poor perinatal outcome. Women who had a poor perinatal outcome were designated cases and those with a good outcome were designated controls. Results: The average perinatal mortality rate for both districts was 111 per 1,000 live births (Murewa 182 per 1,000 and Madziwa 48 per 1,000). Factors significantly associated with perinatal mortality were ethnicity, marital status, subjective standard of living and the women's level of formal education. Being Zezuru or being married was associated with poor perinatal outcome. Living well and having high levels of education were also associated with poor perinatal outcome. Perinatal mortality was not significantly associated with maternal age or spouse level of education. Conclusion: This study showed unacceptability high perinatal mortality rates in these rural districts. The true socio-demographic factors associated with perinatal mortality could not be ascertained in this study because of confounding factors. There is need to study quality of antenatal, intrapartum and neonatal care offered by health centres in these districts. In addition there is need to strongly advocate a perinatal programme to address these high mortality rates.
Research Interests: Demography, Adolescent, Medicine, Rural Health, Pregnancy, and 15 moreHumans, Female, Pubmed, Risk factors, Middle Aged, Questionnaires, Adult, Infant Mortality, Risk Factors, Cross Sectional Studies, Pregnancy Outcome, Case Control Studies, Marital Status, Socioeconomic Factors, and Population surveillance
Research Interests:
Sexuality in the teenager is often complicated by unplanned/unwanted pregnancy, abortion and the risks of STDs including AIDS. There is therefore a need for improved understanding of factors affecting adolescent sexuality and the... more
Sexuality in the teenager is often complicated by unplanned/unwanted pregnancy, abortion and the risks of STDs including AIDS. There is therefore a need for improved understanding of factors affecting adolescent sexuality and the implementation of programmes designed to improve their knowledge, risk awareness and subsequent behavioural outcomes. A multicentre study of reproductive health knowledge and behaviour followed by a health education intervention was undertaken amongst teenagers in selected countries of East, Central and Southern Africa. Reported here are findings at baseline derived from the Zimbabwe component on reproductive biology knowledge and behavior. A self-administered questionnaire was used among 1 689 adolescent pupils drawn from rural, urban, co-education, single sex, boarding and day secondary schools in Zimbabwe. Correct knowledge on reproductive biology as measured by the meaning and interpretation of menstruation and wet dreams varied by school from 68 pc to 86 pc, with a significant trend (p < 0,01) based on level of education at baseline. The reported mean age at which menarche took place was 13,5 years +/- 1,3 (mean +/- SD). First coitus was reported to have taken place at the mean age of 12 years for boys and 13,6 years for girls. Seventeen pc of the adolescent pupils reported that they were sexually experienced and 33,2 had relationships. There were misconceptions reported on menstruation with 23 pc reporting that it was an illness. Peers, followed by magazines were the first sources of information on various aspects of reproductive biology, both of which might not provide the correct first information. Among pupils reporting that they were sexually experienced, the largest proportion (56 pc) had unprotected sex. The findings point to the need for targeting the adolescent pupils for information on reproductive biology and increased awareness on the risks of pregnancy, STDs and HIV.
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
To examine the level of reported quality of condom use by young adult Zimbabwean males at higher learning institutions. A cross sectional descriptive survey. Two technical colleges in Harare, Zimbabwe. A sample of 400 subjects (200 from... more
To examine the level of reported quality of condom use by young adult Zimbabwean males at higher learning institutions. A cross sectional descriptive survey. Two technical colleges in Harare, Zimbabwe. A sample of 400 subjects (200 from each of the higher learning centres). Reported quality of condom use. All participants were males who had at least completed &#39;O&#39; levels, or the equivalent of high school. The majority of the participants were single (78.2%), while a fifth (20.2%) were married and the remaining few were separated or living with a partner. Among those who were married about one fifth had children. The majority 136 (36.8%) were Roman Catholic. The mean age of students surveyed was 24 (SD 3.5) years. The reported quality of condom use in the last 12 months in this sample was measured by four items: 24.6% reported using condoms every time; 27.7% put the condom on every time before the penis entered the vagina for the first time; 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. In this study the results indicated that behaviour specific influences i.e. attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the reported quality of condom use. Using the health promotion model the results indicated that marital status, having been shown how to use condoms, attitudes towards condom use and use of marijuana were all independently predictive of the reported quality of condom use.
Research Interests: Demography, Medicine, Zimbabwe, Humans, Male, and 5 moreQuestionnaires, Adult, Condom, Condoms, and Cross Sectional Studies
Research Interests:
Research Interests:
Research Interests:
ABSTRACTWith COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centers for Diseases Prevention and Control proposed the... more
ABSTRACTWith COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centers for Diseases Prevention and Control proposed the ‘100-100-70%’ strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets. In this mixed-methods study, between June 2021 and July 2022 a quantitative survey was conducted with healthcare workers accessing a comprehensive health check in Zimbabwe to determine whether and, if so, when they had received a COVID-19 vaccine. Healthcare workers were categorized as those who had received the vaccine ‘early’ (before 30.06.2021) and those who had rec...
Research Interests:
This study explores the influence of personal and institutional factors towards adherence to tuberculosis treatment among patients receiving treatment at Wilkins hospital and its catchment area. A qualitative research design was employed... more
This study explores the influence of personal and institutional factors towards adherence to tuberculosis treatment among patients receiving treatment at Wilkins hospital and its catchment area. A qualitative research design was employed and information was elicited from respondents using focus group discussions, in-depth interviews and key informant interviews. Results from the study show that adherence to tuberculosis treatment is a function of institutional support and personal economic security. Fear of stigmatisation and the possibility of losing employment among employed patients negatively affects their adherence to treatment. In addition, availability of drugs, affordability of treatment, professional work commitment, acceptance and empathy promotes treatment adherence. The study concluded that medical institutions must address the software side of treatment developing professionals within the curing industry to professionally and confidentially handle those presenting them...
Research Interests:
The objective of this study is to examine racial/ethnic differences in prevalence of chronic conditions and multimorbidities in the geriatric population of a state with diverse races/ethnicities. Fifteen chronic conditions and their dyads... more
The objective of this study is to examine racial/ethnic differences in prevalence of chronic conditions and multimorbidities in the geriatric population of a state with diverse races/ethnicities. Fifteen chronic conditions and their dyads and triads were investigated using Hawaii Medicare 2012 data. For each condition, a multivariable logistic regression model was used to investigate differences in race/ethnicity, adjusting for subject characteristics. Of the 84,212 beneficiaries, 27.8% were Whites, 54.6% Asians, and 5.2% Hispanics. Racial/ethnic disparities were prevalent for most conditions. Compared with Whites, Asians, Hispanics, and Others showed significantly higher prevalence rates in hypertension, hyperlipidemia, diabetes, and most dyads or triads of the chronic conditions. However, Whites had higher prevalence rates in arthritis and dementia. Race/ethnicity may need to be considered when making clinical decisions and developing health care programs to reduce health disparit...
Research Interests:
Research Interests: Physiology, Behavior, Biology, Evaluation, Health, and 15 moreMedicine, HIV, Biological Sciences, Antiretroviral Therapy, Population, Humans, AIDS, Clinical Sciences, Developed Countries, Immune system, Highly Active Antiretroviral Therapy, Disease Progression, Acquired immunodeficiency syndrome, Medical and Health Sciences, and HIV infections
Research Interests:
OBJECTIVE We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and... more
OBJECTIVE We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being. DESIGN We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status. MAIN OUTCOME MEASURES We used three waves of data to compare caregivers' pre-disclosure worries to post-disclosure reports and to characterise associations between disclosure and well-being of the child (Strengths and Difficulties Questionnaire), caregiver (Patient Health Questionnaire-9), and family (Family Relationship Quality) over time. RESULTS Caregivers' pre-disclosure worries and fears about how their child would react to disclosure of their HIV status largely went unrealised. Furthermore, we did not find strong evidence of clinically-important increases in problems on average following disclosure. CONCLUSION Findings support the call to identify supportive intervention strategies that address caregiver fears at the beginning of the disclosure process.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the... more
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person’s knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9 to 15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.
Research Interests:
Objective: To determine the extent of association and relative risk of developing ocular surface squamous neoplasia (OSSN) among HIV positive patients seen in July 2004 at Sekuru Kaguvi Eye Unit, in Harare, Zimbabwe. Design: Prospective... more
Objective: To determine the extent of association and relative risk of developing ocular surface squamous neoplasia (OSSN) among HIV positive patients seen in July 2004 at Sekuru Kaguvi Eye Unit, in Harare, Zimbabwe. Design: Prospective study. Setting: Sekuru Kaguvi Eye Unit. Subjects: All patients who presented with conjunctival growths in July 2004. Main outcome measure: Relative risk. Results: The relative risk of being HIV positive among patients with ocular surface squamous neoplasia was 3.6 with 95% CI 1.5 to 8.6. The mean CD4 cell count level was significantly lower among OSSN patients when compared to patients with non-ocular surface squamous neoplasia. Recommendations: 1. HIV related malignancies can be used as an indicator of when to commence patients on anti-retroviral (ARVs) when CD4 counts are not accessible; 2. Medical practitioners in resource-poor settings should conduct meaningful operational research as part and parcel of their routine clinical work using available resources, since funding is not readily available.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Introduction Peptides (B-cell epitopes) have broad applications in disease diagnosis and surveillance of pathogen exposure. In this framework, we present a pilot study to design and produce a peptide microarray for the integrated... more
Introduction Peptides (B-cell epitopes) have broad applications in disease diagnosis and surveillance of pathogen exposure. In this framework, we present a pilot study to design and produce a peptide microarray for the integrated surveillance of neglected tropical diseases. The peptide microarray was evaluated against peptides derived from Ascaris lumbricoides, Necator americanus, Schistosoma haematobium, Schistosoma mansoni, Trichuris trichiura, Bacillus anthracis, Mycobacterium leprae, Wuchereria bancrofti, Rabies lyssavirus, Chlamydia trachomatis and Trypanosoma brucei. Methods S. haematobium was diagnosed using the urine filtration technique. S. mansoni, A. lumbricoides, N. americanus and T. trichiura were diagnosed using the Kato Katz and formal ether concentration techniques. Immunogenic peptides were retrieved from the Tackling Infection to Benefit Africa infectious diseases epitope microarray. Further peptides were predicted using ABCpred. IgG and IgM reactivity against the ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
ABSTRACT The National Disability Policy was launched in Zimbabwe in June 2021 and includes a range of commitments for the provision of disability-inclusive health services and rehabilitation. Fulfilment of these pledges is important, as... more
ABSTRACT The National Disability Policy was launched in Zimbabwe in June 2021 and includes a range of commitments for the provision of disability-inclusive health services and rehabilitation. Fulfilment of these pledges is important, as at least 7% of the population have disabilities, and people with disabilities face greater challenges accessing healthcare services and experience worse health outcomes. However, it will require financial investment which is challenging as the needs of people with disabilities are set against a background of widespread health systems failures in Zimbabwe, exacerbated by the COVID-19 pandemic. Zimbabwe currently faces an epidemic of TB and HIV and a growing burden of non-communicable diseases (NCDs) with a lack of investment, healthcare staff or infrastructure to provide the necessary care. Urgent action is therefore needed to strengthen the health system and ‘build back better’ after both the pandemic and the regime change. The Zimbabwean government may face the dilemma, common in many low-resource settings, of whether to focus on disability or to wait until the health system has been strengthened for the majority. This paper proposed four complementary arguments why it is important to focus on people with disabilities. First, this focus respects the rights of people with disabilities, including those specified in the new National Disability Policy. Second, it will be challenging to reach the Sustainable Development Goals, including those on health and other global health targets, without including people with disabilities. Third, there is a growing rationale that disability-inclusive health systems will work better for all, and fourth, that they will create cost savings. Everyone will therefore benefit when the health systems are designed for inclusion. In conclusion, a focus on disability may help to strengthen health systems for all as well as helping to achieve human rights and global development goals.
Research Interests:
Research Interests:
Background Healthcare workers are disproportionately affected by COVID-19. In low- and middle- income countries, they may be particularly impacted by underfunded health systems, lack of personal protective equipment, challenging working... more
Background Healthcare workers are disproportionately affected by COVID-19. In low- and middle- income countries, they may be particularly impacted by underfunded health systems, lack of personal protective equipment, challenging working conditions and barriers in accessing personal healthcare. Methods In this cross-sectional study, occupational health screening was implemented at the largest public sector medical centre in Harare, Zimbabwe, during the “first wave” of the country’s COVID-19 epidemic. Clients were voluntarily screened for symptoms of COVID-19, and if present, offered a SARS-CoV-2 nucleic acid detection assay. In addition, measurement of height, weight, blood pressure and HbA1c, HIV and TB testing, and mental health screening using the Shona Symptom Questionnaire (SSQ-14) were offered. An interviewer-administered questionnaire ascertained client knowledge and experiences related to COVID-19. Results Between 27th July and 30th October 2020, 951 healthcare workers access...
Research Interests:
Research Interests:
Background: Individuals living in S. haematobium endemic areas are often at risk of having other communicable diseases, simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking schistosomiasis... more
Background: Individuals living in S. haematobium endemic areas are often at risk of having other communicable diseases, simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking schistosomiasis infection. In this study we investigated the prevalence and effects of coinfections in pre-school age children.Methodology : About 465 Preschool age children were clinically examined for the following top morbidity conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. S. haematobium infection was diagnosed by urine filtration and the children were screened for other communicable infections common in rural areas.Results : Prevalence of S. haematobium was 35% (145). A positive relationship between S. haematobium prevalence and under-5 mortality rate in Zimbabwean provinces was demonstrated. The odds of co-infections observed for S. haematobium were: upper respiratory tract infection AOR = 1.98 (95% CI 1.657 to ...
Research Interests:
Research Interests:
Background Adolescents experience higher levels of non-adherence to HIV treatment. Drug concentration in hair promises to be reliable for assessing exposure to antiretroviral (ARV) drugs. Pharmacokinetic modelling can explore utility of... more
Background Adolescents experience higher levels of non-adherence to HIV treatment. Drug concentration in hair promises to be reliable for assessing exposure to antiretroviral (ARV) drugs. Pharmacokinetic modelling can explore utility of drug in hair. We aimed at developing and validating a pharmacokinetic model based on atazanavir/ritonavir (ATV/r) in hair and identify factors associated with variabilities in hair accumulation. Methods We based the study on secondary data analysis whereby data from a previous study on Zimbabwean adolescents which collected hair samples at enrolment and 3 months follow-up was used in model development. We performed model development in NONMEM (version 7.3) ADVAN 13. Results There is 16% / 18% of the respective ATV/r in hair as a ratio of steady-state trough plasma concentrations. At follow-up, we estimated an increase of 30% /42% of respective ATV/r in hair. We associated a unit increase in adherence score with 2% increase in hair concentration both ...
Research Interests:
Research Interests:
Research Interests:
OBJECTIVE To describe perinatal practices from a community perspective and identify factors associated with perinatal death. DESIGN Cross sectional community based survey. SETTING Murewa and Madziwa rural areas, Zimbabwe. SUBJECTS Women... more
OBJECTIVE To describe perinatal practices from a community perspective and identify factors associated with perinatal death. DESIGN Cross sectional community based survey. SETTING Murewa and Madziwa rural areas, Zimbabwe. SUBJECTS Women aged 15 to 50 years who had been pregnant within the 24 months preceding the survey. MAIN OUTCOME MEASURES Where delivered, where preferred to deliver, model of delivery, use of herbs in labour, duration of labour, assistant at delivery, time of delivery, condition of baby at birth, resuscitation methods, birth weight, initiation of breast feeding, illness in the first week and outcome of pregnancy. RESULTS 644 women were interviewed; 581/644 stated where they would have liked to deliver and 505/644 stated where they actually delivered their last baby. The majority 369/581 (62.4%) preferred to delivery at a government hospital and 240/505 (47.5%) actually delivered at a government hospital. Of the home deliveries only 27/581 (4.6%) preferred to deliver at home and yet 123/505 (24.4%) actually delivered at home. Primary care clinics were less preferred 151/581 (25.5%) as a place for delivery and 89/505 (17.6%) actually delivered there. Labour lasting more than 12 hours occurred in 20.4% of deliveries. Nurses were the commonest attendants at delivery 309/508 (60.4%) and morbidity following delivery was noted in 72/495 (14.5%). Resuscitation was carried out in 61/72 infants. Beating/shaking 36/61 (58.0%) and pouring cold water over the baby 11/61 (18.0%) were the commonest methods of resuscitation. Being delivered by a doctor compared to a nurse and being in Murewa district were statistically significant risk factors for mortality with Odds Ratio (OR) 5.21 (95% CI 2.86 to 9.51) and 3.90 (95% CI 1.51 to 10.09) respectively. The odds of dying when delivered by breech extraction were high, but not statistically significant OR 3.73 (95% CI 0.92 to 13.97) when compared to being delivered by vertex delivery. Labour more than 12 hours, use of herbs in pregnancy and time of delivery were not significantly associated with mortality with OR (95% CI) of 1.02 (0.40 to 2.19), 0.92 (0.00 to 4.38), 1.05 (0.56 to 1.97) respectively. On logistic regression analysis only being delivered in Murewa district remained significant. CONCLUSION The utilisation of primary health care centres for delivery was unexpectedly low and home deliveries were unacceptably high. Increased mortality when delivered by a doctor and high early neonatal morbidity suggest poor monitoring and delayed intervention in labour. Infant morbidity following delivery was high and methods for neonatal resuscitation inappropriate. There is a need for more studies looking into health worker skills particularly in the areas of partogram use and neonatal resuscitation in these districts.