Walter Mangezi

Blood group antigens are inherited characteristics which are grouped into 15 systems based on genetic, structural, biochemical and serological or immunological characteristics. The exact role of the blood group antigens is not yet fully understood, but recent studies have indicated some relationships between some blood group antigens and certain diseases or successes in transplantations. Some haemolytic anaemia due to membrane disorders are directly associated with abnormal or absence of certain blood groups. Other blood groups have been implicated in mental health and bleeding challenges. ABO blood group antigens are ubiquitous and are found in all body tissues. A cross sectional study was carried out at the Annex Hospital to determine the distributions of the ABO blood groups in mental health patients for a period of six months. AB and B blood group frequencies increased to 11.1% and 27% compared to 3.7% and 19.2% in the general population respectively. A and O blood group frequen...

Background There are substantial gaps in our knowledge regarding the aetiology of mental, neurological and substance use disorders in sub-Saharan Africa, and the cost-effectiveness and scalability of interventions to reduce the burden of these conditions on the continent. To address these gaps, international investment has focussed on building research capacity, including funding doctoral students in African countries, to support development of high quality, contextually relevant interventions. Absent, however, is an understanding of how capacity building feeds into research careers.Methods Within a broader mental health research capacity-building initiative (African Mental Health Research Initiative), we conducted 52 qualitative interviews with early-career researchers, policymakers, academics, and service users from four African countries (Ethiopia, Malawi, South Africa, and Zimbabwe) and with international funders of mental health research. The interview guide focused on the rese...

Title: Depression among HIV positive pregnant women in Zimbabwe: a primary health care based cross-sectional study Authors: Eugenia Nyamukoho (eugenianyamukoho@yahoo.com) Walter Mangezi (wmangezi@yahoo.co.uk) Bazondlile Dube (bazoedube@gmail.com) Ruth Verhey (ruth.verhey@zol.co.zw) Dixon Chibanda (dichi@zol.co.zw) Version: 1 Date: 15 Dec 2018 Author’s response to reviews: The Editor BMC Pregnancy and childbirth RE: Revision-Depression among HIV positive pregnant women in Zimbabwe

In the practice of forensic psychiatry in Zimbabwe, there have been problems in bringing psychiatric offenders to justice due to delays in assessment. This has been caused by a shortage of psychiatrists with the relevant skills. Practitioners need to be equipped with the required competencies to deal with both the civil and criminal domains of forensic psychiatry. They also need neuropsychological tools for the evaluation of offenders and victims, and knowledge of the appropriate tests to be used in each case. To date, the Department of Psychiatry at the University of Zimbabwe has had no formal curriculum in forensic psychiatry. To meet these needs, a forensic psychiatry curriculum was developed. The goals for the curriculum were for the students to: 1) acquire knowledge in the assessment and management of psychiatric conditions and their relation to criminal and civil legal issues; 2) attain attitudes that foster a focus on assessment of the patients’ mental health, not their innoc...

Zimbabwe is a landlocked country which has recently emerged from some marked political and socioeconomic challenges. Against this background, mental health has fallen down the priority list, as matters such as food shortages and the AIDS scourge have taken precedence. Zimbabwe is in southern Africa; Zambia and Botswana lie to the north, Namibia to the west, South Africa to the south and Mozambique to the east. Its population is 11.4 million. The capital city is Harare, which has a population of 1.6 million.

Background: Mental health is slowly gaining global significance as a key health issue, yet the stigma attached to psychosis is still a major problem. There has been little in-depth exploration of sustainable, cost-effective, and replicable community engagement strategies that address mental health myths and stigma, which are major barriers to early health-seeking behaviours. In low-income countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models, perpetuating an environment where mental health conversations are a cultural taboo. Mental health interventions should be accompanied by creative, evidence-based community engagement, ensuring that interventions are suitable for local settings and giving communities a voice in directing their health initiatives.  Methods: Z Factor aimed to engage young adults and their support networks across a variety of socioeconomic groups in a rural district of Zimbabwe through their participat...

Background: Tardive dyskinesia is a debilitating, intractable, hyperkinetic movement disorder which contributes to an increase in psychiatric morbidity. Reduced function CYP2D6 alleles have been associated with tardive dyskinesia pathogenesis amongst Caucasians and Asians, with CYP2D*4 and *6 and CYP2D6*10 being implicated in these races respectively. No similar study has been successfully conducted in black Africans. Objective: To determine the relationship between tardive dyskinesia and CYP2D6*17 (the major reduced function CYP2D6 allele in Africans). Methodology: Abnormal Involuntary Movements Scale (AIMS) scoring and CYP2D6 genotyping were carried out on psychiatric patients exposed to typical antipsychotic medications in an unmatched case control study. A case of tardive dyskinesia was defined as a patient with an AIMS score ≥ 2 in two body areas OR ≥ 3 in one body area Results: A total of 18 cases and 32 controls made up the study sample.The sample’s mean age was 36.9±12.0 yea...

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was[80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, h...

This report describes a pilot project which involved undergraduate medical students’ clinical competence in psychiatry assessed through objective structured clinical examinations for the first time in Zimbabwe. The pilot describes how gaps in medical education can be addressed by collaborative partnerships that allow sharing of knowledge by local institutions and international experts.

Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through ...

Determination of HIV prevalence among people with mental illness is necessary for developing integrated services for HIV and mental illness. This study determined HIV prevalence and uptake of HIV care among outpatients of psychiatric hospitals in Harare, Zimbabwe. HIV status was determined using open testing of 270 randomly selected consenting adult outpatients. HIV prevalence was 14.4% and the risk of acquiring HIV was similar to the general population of adults in Zimbabwe. Females were six times more likely to have HIV infection than males. Although a relatively high proportion of patients had been tested for HIV in the past (77.2%), fewer were recently tested (27.8%). Access to HIV care was high (94%) amongst patients previously diagnosed to be HIV positive. Tertiary mental health services should offer similar HIV care packages as other points of care and there is need for interventions that reduce the risk of HIV in women with mental disorders.

Zimbabwe is a landlocked country which has recently emerged from some marked political and socio-economic challenges. Against this background, mental health has fallen down the priority list, as matters such as food shortages and the AIDS scourge have taken prece dence. Zimbabwe is in southern Africa; Zambia and Botswana lie to the north, Namibia to the west, South Africa to the south and Mozambique to the east. Its population is 11.4 million. The capital city is Harare, which has a population of 1.6 million.

Background. Capacity building is essential in low- and middle-income countries (LMICs) to address the gap in skills to conduct and implement research. Capacity building must not only include scientific and technical knowledge, but also broader competencies, such as writing, disseminating research and achieving work–life balance. These skills are thought to promote long-term career success for researchers in high-income countries (HICs) but the availability of such training is limited in LMICs. Methods. This paper presents the contextualisation and implementation of the Academic Competencies Series (ACES). ACES is an early-career researcher development programme adapted from a UK university. Through consultation between HIC and LMIC partners, an innovative series of 10 workshops was designed covering themes of self-development, engagement and writing skills. ACES formed part of the African Mental Health Research Initiative (AMARI), a multi-national LMIC-led consortium to recruit, tra...

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprisi...

World Health Organization (WHO) adolescent HIV-testing and treatment guidelines recommend community-based interventions to support antiretroviral therapy (ART) adherence and retention in care, while acknowledging that the evidence to support this recommendation is weak. This cluster randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of a psychosocial, community-based intervention on HIV-related and psychosocial outcomes. We are conducting the trial in two districts. Sixteen clinics were randomized to either enhanced ART-adherence support or standard of care. Eligible individuals (HIV-positive adolescents aged 13-19 years and eligible for ART) in both arms receive ART and adherence support provided by adult counselors and nursing staff. Adolescents in the intervention arm additionally attend a monthly support group, are allocated to a designated community adolescent treatment supporter, and followed up through a short message service (SMS) and calls...

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical difference...

Commitment to building mental health treatment capacity in Africa is increasing but little agreement exists on strategies to train health workers on mental health or evaluation of training efforts. We systematically reviewed published literature on interventions to train health-care workers in Africa on mental health. 37 studies met our inclusion criteria. Training outcomes focused on changes in knowledge and attitude, with few studies evaluating skill and practice and only two studies measuring clinical outcomes. Quality of study methodology was generally not high, with scarce follow-up data and use of control cohorts. Existing studies provide examples of many training and evaluation strategies, but evidence to draw conclusions about the efficacy of different training techniques is inadequate. Key knowledge gaps include development and testing of innovative educational strategies; development of standardised, competency-based learning objectives and outcome measures; and training t...

What problem was addressed? In 2009, following a decade of national economic turmoil, only 25% of faculty posts in the once-vibrant Department of Psychiatry at the University of Zimbabwe College of Health Sciences were filled. The university needed to attract and retain academic mental health faculty staff, make teaching and assessment more efficient and effective, improve access to resources for teachers and learners, and integrate mental health into general health care. What was tried? In 2010, our international consortium, led by the University of Zimbabwe College of Health Sciences, won three 5-year Medical Education Partnership Initiative (MEPI) grants to build capacity in medical education. One award, IMHERZ, was for improving mental health education and research capacity in Zimbabwe. The other two, NECTAR (Novel Education Clinical Trainees and Researchers) and CHRIS (Cerebrovascular Heart Failure, Rheumatic Heart Disease Intervention Strategy), focused on communicable and cardiovascular disease, respectively. Initiatives across all three programmes included the provision of Internet access, library and intranet upgrading, teaching support and research support centres, an academic skills programme for postgraduate trainees, and incountry skill building in pedagogy and educational leadership, all evaluated independently by the Evaluation Center, University of Colorado, Denver (CO, USA). Guiding principles were to build a sustainable programme, strengthen existing approaches and foster local leadership. For IMHERZ we introduced nine competitive scholarships to attract promising academic psychiatrists, a programme of 12 master classes led by visiting professors to increase knowledge and skills, research courses and research mentorship and the modernisation of teaching and assessment methods for undergraduates. What lessons were learned? A needs assessment showed that training experiences and recruitment into psychiatry were adversely affected by demoralising service gaps. We thus introduced skills building for service development, with multi-professional consultation and training in community, human immunodeficiency virus (HIV), and child and forensic mental health, areas the needs assessment had identified as particularly problematic. We learned that in-country teaching and mentoring, combined with carefully selected short placements of 1 month to observe services in the region made learning and service development more relevant than if we sent trainees for long periods to centres in high-income countries. We found that pedagogies were required to be resource-feasible; for example, structured role-play using peers was more feasible than the use of standardised patients. We learned that mentoring relationships between visiting experts and local faculty members that spanned the periods pre-, during and post-visit, using e-mail and Skype, and using co-teaching during the visit, all fostered local leadership in education. Visiting experts were appreciated most when they transferred skills. It is encouraging that the number of faculty consultant psychiatrists has increased by 300% since 2010 (from one to four) and recruitment into postgraduate programmes has also increased. Although it will take longer than 5 years to see changes in national mental health systems, fledgling services are running in child, community, HIV and forensic psychiatry. Local faculty staff are teaching modernised undergraduate and postgraduate psychiatric curricula. Three PhDs and two MPhils in mental health are registered. A research platform emerging alongside MEPI is providing opportunities for trainees to gain research experience as part of a team. Four years into the programme, MEPI is revitalising psychiatry in Zimbabwe.

Background: World Health Organization (WHO) adolescent HIV-testing and treatment guidelines recommend community-based interventions to support antiretroviral therapy (ART) adherence and retention in care, while acknowledging that the evidence to support this recommendation is weak. This cluster randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of a psychosocial, community-based intervention on HIV-related and psychosocial outcomes.

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Con-trol). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was [80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences , however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire-4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future ran-domised controlled trial of task-shifted PST-AD.