Browsing by Subject "Zimbabwe"

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    A case study exploring an occupational perspective of social inclusion among young adults dually afflicted with substance use disorder and HIV/AIDS in Zimbabwe
    (2021) Nhunzvi, Clement; Galvaan, Roshan; Langhaug, Lisa; Harding, Richard
    Background: Curtailing adverse social determinants of health is pivotal to achieving the 2030 Agenda for Sustainable Development`s vision for a healthy and inclusive society. In Zimbabwe, fulfilling Vision 2030 may involve adopting socially inclusive approaches, particularly for young people dually afflicted with HIV and substance use disorders. However, social inclusion remains conceptually unclear and underutilized in relation to marginalized groups in low resource settings. This study sought to explore and understand how dually afflicted young adults with substance use disorders and HIV in Zimbabwe experienced and negotiated their social inclusion. Methods: This study utilised a qualitative instrumental case study design. Primary qualitative and quantitative data were collected to develop a thorough understanding of the case of an occupational perspective of social inclusion among dually afflicted young adults in Zimbabwe. The multiple methods used in this study included: i) narrative inquiry with five dually afflicted young adults; ii) in-depth interviews with five key informants; iii) document analysis of seven policies; and, iv) exploratory cross-sectional survey of social inclusion and associated factors (n=105). These multiple methods and sources contributed to the study`s trustworthiness. Multi-level case study analysis was applied as follows; 1st level: narrative analysis of each of the five young adults` stories, descriptive analysis of key informant interviews, document analysis and descriptive statistical analysis of the cross-sectional survey data. 2nd level: thematic case analysis drawing from all four data sources. 3rd level: theorised conceptual occupational constructs. Findings: Five narratives illustrated how using agency and having occupational choices were central to the young adults` experience and negotiation of social inclusion. The overarching Case theme was “Navigating an already troubled life: Striving for belonging and well-being”. This consists of three categories: 1) Dealing with a context of mixed realities, 2) Trying to adjust to new challenges and, 3) Life on the margins. These findings show how dually afflicted young adults in Zimbabwe respond and resist the influences of dominant discourses through dynamic and interconnected actions that shape their realities. Conclusion: The study describes and explains how dually afflicted young adults experienced and negotiated their social inclusion. The data affirms the role of agency and proposes a more critical view of occupational choice, activist occupational choice, in understanding social inclusion. As an emergent concept it is categorized by occupational choices, largely defying standard norms of engagement, and aims to break away from oppressive systems and problematic situations. Recognising the diverse manifestation of agency yields an appreciation for how occupations that are indigenous, collective, and resist oppression contributes to experiences of social inclusion.
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    A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period
    (BioMed Central, 2019-02-28) Kaseke, Tanaka; January, James; Tadyanemhandu, Catherine; Chiwaridzo, Matthew; Dambi, Jermaine M
    Objective Globally, 13–20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. Results The mothers’ mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2–8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = − 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.
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    An analysis of how Zimbabwe’s international legal obligation to achieve the realisation of the right of access to adequate housing, can be enforced in domestic courts as a constitutional right, notwithstanding the absence of a specific constitutional right of every person to have access to adequate housing
    (2018) Mavedzenge, Justice Alfred; de Vos, Pierre; Corder, Hugh
    The Constitution of Zimbabwe of 2013 does not expressly guarantee every person a right to have access to adequate housing. However, the Government of Zimbabwe has an international legal obligation to achieve the progressive realisation of the right to have access to adequate housing by everyone in the country. This obligation is derived from art 11 (1) of the International Covenant on Economic, Social and Cultural Rights (ICESCR). Zimbabwe is a dualist state and therefore, this obligation is not directly or automatically enforceable as municipal law in Zimbabwe. It can be enforced in domestic courts only if it has been enacted into legislation or if it is entrenched as a constitutional obligation. The absence of a specific constitutional right, guaranteed for everyone to have access to adequate housing, thus raises the concern that the government may not be held accountable, in the domestic courts, to comply with its international legal obligation to ensure that everyone enjoys access to adequate housing. There is a national housing crisis in Zimbabwe that is characterised by an acute shortage of adequate housing, mass forced evictions and unfair discrimination in the allocation of housing facilities by government. There is therefore an existing need to compel government to comply with and fulfil its international legal obligations relating to the right of every person to have access to adequate housing. In the absence of an explicit constitutional guarantee of such a right, it is necessary to find alternative constitutional rights which citizens and individuals in Zimbabwe can rely on to compel Government to comply with and fulfil its international legal obligations that arise from art 11 (1) of the ICESCR. The Constitution of Zimbabwe expressly guarantees for everyone the following rights; the fundamental freedom from arbitrary evictions, the right to life, the right to equality and the children’s right to shelter. The scope of each of these rights can be interpreted broadly to include some of the duties that ordinarily arise from the right to have access to adequate housing. Therefore, these rights can be applied together to enforce the international legal duty of the state to ensure the progressive realisation of the right to have access to adequate housing by everyone in Zimbabwe.
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    An investigation into the progression of premarital fertility since the onset of Zimbabwe's fertility transition
    (2021) Ngwenya, Chantelle Linda; Moultrie, Thomas
    Premarital fertility, that is, childbearing before first marriage, is an important yet under researched demographic topic in sub-Saharan Africa. In Zimbabwe, the distinction by marital status in fertility research is hardly drawn. Hence, a gap exists in the knowledge of premarital fertility levels. This research aims to investigate levels of, and factors associated with, premarital fertility since the onset of Zimbabwe's fertility transition in the mid-1980s. The research employed direct fertility estimation techniques to effectively compare premarital, marital, and overall fertility trends between 1988 and 2015. Cox proportional-hazards regression and forest plot analyses were then used to explain changes in factors associated with the timing of premarital first births over the same period. Data quality assessments were carried out using the method of cohortperiod fertility rates to provide explanations for any erratic results. The results showed that premarital fertility was constant and moderate, with an average of 0.7 children per woman, between 1988 and 2015. While most premarital first births consistently occurred to younger women, from 2005 onwards, they increased among women aged above 24 years and decreased among adolescents. An increase in age, commencing sexual activity after adolescence, and improved socio-economic status including level of education decreased the relative risk of having a premarital first birth. However, delaying marriage past young womanhood, history of contraceptive use, Ndebele ethnicity, and residence in regions other than Manicaland and Masvingo, especially Ndebele dominated regions, increased the same risk by 465.0%, 45.5%, 136.0% and up to 135.0% respectively. The stagnation of premarital fertility between 1988 and 2015 while both marital and overall fertility first declined and then stalled indicates that there is insufficient evidence to suggest that premarital fertility had contributed to the stall of fertility decline in Zimbabwe from the mid-1990s. The timing of premarital first births since the start of the fertility transition in the 1980s has had a strong ethnic and cultural bias. Due to evidence of the effect of migrancy and tourism on premarital fertility in border and tourism towns, an extension into the theory of migrant premarital sexual behaviour to detail the risk of premarital fertility among border town residents who interact with but are neither migrants nor tourists is recommended.
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    Analysis of virulence factors and antibiotic resistance genes in group B streptococcus from clinical samples
    (2021-01-28) Mudzana, Raymond; Mavenyengwa, Rooyen T; Gudza-Mugabe, Muchaneta
    Background Streptococcus agalacticae (Group B Streptococcus, GBS) is one of the most important causative agents of serious infections among neonates. This study was carried out to identify antibiotic resistance and virulence genes associated with GBS isolated from pregnant women. Methods A total of 43 GBS isolates were obtained from 420 vaginal samples collected from HIV positive and negative women who were 13–35 weeks pregnant attending Antenatal Care at Chitungwiza and Harare Central Hospitals in Zimbabwe. Identification tests of GBS isolates was done using standard bacteriological methods and molecular identification testing. Antibiotic susceptibility testing was done using the modified Kirby-Bauer method and E-test strips. The boiling method was used to extract DNA and Polymerase Chain Reaction (PCR) was used to screen for 13 genes. Data was fed into SPSS 24.0. Results Nine distinct virulence gene profiles were identified and hly-scpB-bca-rib 37.2% (16/43) was common. The virulence genes identified were namely hly 97.8% (42/43), scpB 90.1% (39/43), bca 86.0% (37/43), rib 69.8% (30/43) and bac 11.6% (5/43). High resistance to tetracycline 97.7% (42/43) was reported followed by 72.1% (31/43) cefazolin, 69.8% (30/43) penicillin G, 58.1% (25/43) ampicillin, 55.8% (24/43) clindamycin, 46.5% (20/43) ceftriaxone, 34.9% (15/43) chloramphenicol, and 30.2% (13/43) for both erythromycin and vancomycin using disk diffusion. Antibiotic resistance genes among the resistant and intermediate-resistant isolates showed high frequencies for tetM 97.6% (41/42) and low frequencies for ermB 34.5% (10/29), ermTR 10.3% (3/29), mefA 3.4% (1/29), tetO 2.4% (1/42) and linB 0% (0/35). The atr housekeeping gene yielded 100% (43/43) positive results, whilst the mobile genetic element IS1548 yielded 9.3% (4/43). Conclusion The study showed high prevalence of hly, scpB, bca and rib virulence genes in S. agalactiae strains isolated from pregnant women. Tetracycline resistance was predominantly caused by the tetM gene, whilst macrolide resistance was predominantly due to the presence of erm methylase, with the ermB gene being more prevalent. Multi-drug resistance coupled with the recovery of resistant isolates to antimicrobial agents such as penicillins indicates the importance of GBS surveillance and susceptibility tests. It was also observed that in vitro phenotypic resistance is not always accurately predicted by resistance genotypes.
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    Analyzing Thabo Mbeki's policy of 'quiet diplomacy' in the Zimbabwean crisis
    (2010) Malimela, Langelihle Phakama; Akokpari, John
    This thesis discusses the approach taken by the South African government in response to the political and economic crisis that has gripped neighbouring Zimbabwe since the year 2000. Its aim is to explain why South Africa, under the leadership of Thabo Mbeki, adopted the controversial policy widely referred to as 'Quiet Diplomacy'. It uses a Structuralist approach to international relations, and in particular Immanuel Wallerstein's World Systems Theory to characterise South Africa as a prototypical semi-peripheral state, with a dual-contradictory role in international relations. It argues that post- apartheid South Africa's failure to make genuine progress in terms primarily of economic transformation at home, has significantly constrained her ability to adopt more conventional diplomatic methods in dealing with the political and economic crisis in Zimbabwe.
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    Antiretroviral therapy outcomes among adolescents and youth in rural Zimbabwe
    (Public Library of Science, 2012) Bygrave, Helen; Mtangirwa, Judith; Ncube, Kwenzakwenkosi; Ford, Nathan; Kranzer, Katharina; Munyaradzi, Dhodho
    Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10-30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10-15 (young adolescents) 15.1-19 years (adolescents), 19.1-24 years (young adults) and 24.1-29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17-4.35). Young adults and adolescents had a 2-3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62-4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults.
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    Circumstantial social entrepreneurship: Exploring inclusive, social innovation in the transition from shadow to mainstream economic spaces. A case study of informal sector recycling activities in Bulawayo, Zimbabwe
    (2018) Ndlovu, Sinqobile Sichelesile; Nilsson, Warren
    As global solid waste management systems evolve to include wider elements of sustainability, developing countries are struggling with how best to work with a growing informal sector. This research seeks to investigate how developing country mainstream solid waste management systems can harness the opportunities presented through the informal recycling sector. This research explores the dialogue around „formalisation of the informal‟ and „integration of informal recycling sector into mainstream solid waste management systems‟, approaching this from an informal sector perspective. The research endeavours to offer insights to this discourse from an inclusive, social innovation approach. The research looks at what business models the informal recycling sector use as they adopt or adapt industrialised practices and how these harness inclusion and social innovation. The research area is Bulawayo, Zimbabwe with the informal recycling sector as case study. The main research question is “How can we harness inclusion and social innovation as the informal sector transitions into mainstream economic spaces?” The research employs an inductive qualitative approach through a rapid ethnography, focus group discussions and semi-structured key informant interviews. Key concepts explored in this research include „circumstantial social entrepreneurship‟, „generational informality‟, „value chain alliances‟, „public, private, community and informal sector partnerships (PPCIPs)‟ and „inclusive development as a pre-requisite to formalisation‟. By unpacking the business models employed by the informal recycling sector and how inclusive, social innovation opportunities inherent in these can be harnessed during the transition from shadow to mainstream economy spaces, this research intends to offer progressive approaches on how to unlock shared value during the graduation of the informal recycling sector from shadow to mainstream socio-economic spaces. Additionally, the outputs of this research aim to contribute to context-specific knowledge on types of non traditional social entrepreneurial activity within informal spaces and how these push boundaries of inclusive, social innovation.
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    Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa—study protocol for a mixed-methods study including a randomised controlled trial
    (2020-10-30) Nash, S; Dietrich, J; Ssemata, A S; Herrera, C; O’Hagan, K; Else, L; Chiodi, F; Kelly, C; Shattock, R; Chirenje, M; Lebina, L; Khoo, S; Bekker, L-G; Weiss, H A; Gray, C; Stranix-Chibanda, L.; Kaleebu, P; Seeley, J; Martinson, N; Fox, J
    Background HIV remains a major public health issue, especially in Eastern and Southern Africa. Pre-exposure prophylaxis is highly effective when adhered to, but its effectiveness is limited by cost, user acceptability and uptake. The cost of a non-inferiority phase III trial is likely to be prohibitive, and thus, it is essential to select the best possible drug, dose and schedule in advance. The aim of this study, the Combined HIV Adolescent PrEP and Prevention Study (CHAPS), is to investigate the drug, dose and schedule of pre-exposure prophylaxis (PrEP) required for the protection against HIV and the acceptability of PrEP amongst young people in sub-Saharan Africa, and hence to inform the choice of intervention for future phase III PrEP studies and to improve strategies for PrEP implementation. Methods We propose a mixed-methods study amongst young people aged 13–24 years. The first component consists of qualitative research to identify the barriers and motivators towards the uptake of PrEP amongst young people in South Africa, Uganda and Zimbabwe. The second component is a randomised clinical trial (ClinicalTrials.gov NCT03986970, June 2019) using a novel ex vivo HIV challenge method to investigate the optimal PrEP treatment (FTC-TDF vs FTC-TAF), dose and schedule. We will recruit 144 amongst HIV-negative uncircumcised men aged 13–24 years from voluntary male medical circumcision clinics in two sites (South Africa and Uganda) and randomise them into one of nine arms. One group will receive no PrEP prior to surgery; the other arms will receive either FTC-TDF or FTC-TAF, over 1 or 2 days, and with the final dose given either 6 or 20 h prior to surgery. We will conduct an ex vivo HIV challenge on their resected foreskin tissue. Discussion This study will provide both qualitative and quantitative results to help decide the optimum drug, dose and schedule for a future phase III trial of PrEP. The study will also provide crucial information on successful strategies for providing PrEP to young people in sub-Saharan Africa. Trial registration ClinicalTrials.gov NCT03986970 . Registered on 14 June 2019
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    Common mental disorders and barriers to adherence to HIV medications among emerging adults living with HIV using healthcare services in Harare
    (2020) Saruchera, Emily Wendy; Schneider, Marguerite; Abas, Melanie; Madhombiro, Munyaradzi
    Background: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.
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    Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe
    (2015) Zijenah, Lynn Sodai; Kadzirange, Gerard; Bandason, Tsitsi; Chipiti, Maria Mary; Gwambiwa, Bevel; Makoga, Forget; Chungu, Pauline; Kaguru, Philip; Sabur, Natasha F
    BackgroundIn Zimbabwe, sputum smear microscopy (SSM) is the routinely used TB diagnostic tool in hospitalised HIV-infected patients. However, SSM has poor sensitivity in HIV-infected patients. We compared performance of urine lipoarabinomannan strip test (LAM) and SSM among hospitalized HIV-infected patients with suspected TB.MethodsHospitalized HIV-infected patients with suspected TB were randomized to LAM plus SSM or SSM alone groups as part of a larger multi-country parent study. Here we present a comparison of LAM versus SSM performance from the Zimbabwe study site. LAM analyses (grade 2 cut-off) were conducted using (i) a microbiological reference standard (MRS; culture positivity for M.tb and designated definite TB) and (ii) a composite reference standard (CRS; definite TB plus probable TB i.e. patients with clinical TB excluded from the culture negative group). CRS constituted the primary analysis.Results82/457 (18%) of the patients randomized to the LAM group were M.tuberculosis culture positive. Using CRS, sensitivity (%, 95 % CI) of LAM was significantly higher than SSM [49.2 (42.1-56.4) versus 29.4(23.2-36.3); p < 0.001]. Specificity and PPV were 98.1%, and 95.8%, respectively. By contrast, using MRS, LAM sensitivity was similar to SSM and specificity was significantly lower, however, the combined sensitivity of LAM and SSM was significantly higher than that of SSM alone, p = 0.009. Using CRS, LAM sensitivity (%, CI) was CD4 count dependent [60.6(50.7-69.8) at ≤50 cells/μL; 40.0(22.7-59.4) at 51-100 cells/μL, and 32.8(21.0-46.3) at >100 cells/μL. The combined sensitivity of LAM and SSM was higher than SSM alone being highest at CD4 counts <50 cells/μL [67.6(57.9-76.3); p = <0.001]. Specificity of LAM or SSM alone, or of combined LAM and SSM was >97% in all the 3 CD4 strata.ConclusionAmong hospitalized HIV-infected patients with suspected TB, the sensitivity of LAM is significantly higher than that of SSM, especially at low CD4 counts. LAM and SSM are complimentary tests for diagnosis of TB in HIV-infected patients. We recommend a combination of LAM and SSM for TB diagnosis in HIV-infected patients with low CD4 counts in HIV/TB co-endemic countries, where alternative methods are unavailable.
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    Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents
    (BioMed Central, 2017-02-28) Chiwaridzo, Matthew; Chikasha, Tafadzwa Nicole; Naidoo, Nirmala; Dambi, Jermaine Matewu; Tadyanemhandu, Cathrine; Munambah, Nyaradzai; Chizanga, Precious Trish
    Background: In Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition. Methods: The study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study. Results: Twenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89). Conclusion: Excellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.
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    Correlates of social support on report of probable common mental disorders in Zimbabwean informal caregivers of patients with stroke: a cross-sectional survey
    (2019-08-16) Marima, Phillipa; Gunduza, Ropafadzo; Machando, Debra; Dambi, Jermaine M
    Abstract Objective Stroke is a major global public health burden. Unfortunately, stroke invariably leads to functional limitations, consequently, most stroke survivors are hugely dependent on family members/informal caregivers in carrying out essential daily activities. The increased demands of caregiving negatively impact caregivers’ mental health. Nevertheless, caregivers who receive an adequate amount of social support are likely to adjust better to the caregiving role. We sought to determine the impact of social support on the mental wellbeing of 71 caregivers of patients with stroke in Zimbabwe, a low-resourced country. Results The mean caregiver age was 41.5 (SD 13.8) years. Patients had a mean age of 65.2 (SD 15.3) years with most being functionally dependent (93.2%). 45.1% of the caregivers showed excessive psychiatric morbidity. The mean Multidimensional Scale of Perceived Social Support (MSPSS) score was 44 (SD 9.4), denoting high levels of social support. Caregivers who received an adequate amount of social support were likely to report of lower psychiatric morbidity (Rho = − 0.285, p = 0.016). Furthermore, caregiver who were; poorer, were caring for more functionally-dependent patients, and did not receive additional assistance were likely to report of poor mental health functioning. There is therefore a strong need to implement context-specific caregivers wellness programs.
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    Development and validation of the School Clinical Rugby Measure (SCRuM) test battery: understanding the qualities or skills defining good male adolescent rugby union players
    (2020) Chiwaridzo, Matthew; Ferguson, Gillian D; Smits-Engelsman, Bouwien CM
    Background: Globally, the number of schoolboy adolescents playing highly competitive rugby is increasing even in countries such as Zimbabwe hardly known for dominating international rugby events. Given the increased participation rates, burgeoning talent identification and recruitment programs and the reportedly high injury risk associated with competitive youth rugby in Zimbabwe and globally, the minimal qualities or skills defining good male adolescent rugby players need further clarification. This study assembled a testing battery and compared the anthropometric variables, physiological characteristics and rugby-specific game skills of Zimbabwean schoolboys to identify qualities and/or skills discriminating elite from sub-elite male adolescent rugby players and non-rugby players within and between Under 16 (U16) and U19 age categories. Methods: This study was structured in three phases. Phase I developed the School Clinical Rugby Measure (SCRuM) test battery based on amalgamated information derived from narrative literature review, qualitative study and two systematic reviews. Using mixed methods sequential explanatory study designs, Phase II refined the test battery through the evaluation of face and logical validity using key informants (n=5) and rugby experts (n=20), respectively. Subsequently, rugby coaches (n=30) assessed the practical feasibility of implementing each SCRuM test item in the local context considering test equipment, procedural and acceptability issues. Phase III evaluated the test-retest reliability of each SCRuM test item among a sample of elite U16s (n=41) and U19s (n=41). The final study in Phase III compared cross-sectional test performances of 208 athletes from different playing standards and age category to identify SCRuM test items discriminating (i) older (U19) players from younger (U16) players regardless of playing standards, and (ii) elite from both sub-elite and nonrugby players regardless of age. Results: Phase I produced the first version of the SCRuM test battery with 23 variables. Phase II reduced the constituent components to 15 variables. The test-retest reliability study showed high intraclass correlation coefficient (ICC>0.70) for all SCRuM test items except for the 5-m, 10-m speed tests and passing-for-accuracy test. Age category had a significant main effect on all SCRuM test items except for sum of seven skinfolds (p=0.45, η2 p=0.003). Playing standard had a significant main effect ii on all variables except for height (p=0.40, η2 p=0.01) and sum of seven skinfolds (p=0.11, η2 p =0.02). Upper-and-lower body muscular strength and power, prolonged high-intensity intermittent running ability, repeated high-intensity exercise performance ability, tackling, passing and catching significantly improved with increasing playing standards. However, the Yo-Yo intermittent recovery level 1 test, vertical jump test, tackling proficiency test and running-and-catching ability skills test demonstrated greater discriminative ability across playing standards among U16s. The 40-m speed test, 2-kg medicine ball chest throw test, repeated high-intensity exercise test, one-repetition maximum bench press and back squat tests, and passing ability skills test showed better discriminative validity for differentiating U19s by playing standards. Conclusion: Irrespective of playing standard and consistent with previous studies, all SCRuM test items significantly increased with age except for skinfolds measures. These results highlight the sensitivity of component SCRuM test items in discriminating younger (U16s) from older (U19s) athletes. U16 coaches should consider these differences when designing training interventions to assist with the development of prospective U19 players. However, prolonged high-intensity intermittent running ability, lower-body muscular power, tackling proficiency and running-andcatching ability demonstrated greater discriminative ability among U16s only, indicating a possible link to higher playing standards for that age category. Upper-body muscular power, upper-and-lowerbody muscular strength, 40-m sprinting ability, repeated high-intensity exercise performance ability, and passing ability significantly improved with playing standards among U19s, highlighting the physiological characteristics and game skills capable of differentiating elite male adolescent rugby players from both sub-elite or non-rugby players at that age category. Collectively, these findings provide insight to the high school rugby coaches into the qualities and skills contextually relevant for training for the attainment of higher playing standards in schoolboy rugby at distinct age categories.
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    An economic and institutional analysis of community wildlife conservation in Zimbabwe
    (2015) Ntuli, Herbert; Muchapondwa, Edwin
    This thesis focuses on the economics and institutional aspects of community wildlife conservation in the context of local communities living adjacent to the Gonarezhou NationalPark in Zimbabwe. A significant proportion of wildlife in Zimbabwe, and in Southern Africa in general, is managed as a common pool resource by communities under community-based natural resource management. Several challenges threaten conservation efforts at both local and higher levels, thus hindering its ability to bring about development that might improve the welfare of poor rural communities participating in wildlife conservation. The most pressing issues in the wildlife sector include: inability to extract resource rents from wildlife conservation that in turn affect household welfare in terms of total household income and reduction in poverty and inequality, lack of capacity by local communities to solve collective action problems or lack of incentives to self-organise, and lack of comparable successful outcomes in CBNRM communities such as the wildlife conservancy communities. Learning from other successful communities that use community-based' models, such as wildlife conservancies, might provide important insights for policy makers and development practitioners. These issues are explored in three substantial papers included in this thesis. The thesis consists of five chapters starting with an introduction, followed by three papers and finally conclusions and policy implications. The study makes use of purpose-collected primary data from local communities living adjacent to Gonarezhou National Park in Zimbabwe. The first paper investigates the effects of wildlife resources on community welfare. Specifically, the paper examines the contribution of environmental income to) total household income,) poverty reduction, and) reduction in income inequality. Furthermore, it investigates the impact of environmental income on households in different income categories, the role of wildlife in the portfolio of environmental income and the determinants of environmental income generated by different households. To achieve the objectives above, the paper makes use of income quintile analysis, the Foster-Greer-Thorbecke poverty measure, Gini coefficient analysis, Ginidecomposition analysis, ordered logit regression model and instrumental variables estimation using heteroscedasticity-based instruments. The results show that the relative contribution of environmental income towards total household income is more pronounced in poor households, while the relative contribution of agricultural income is noticeable in wealthier households. In particular, wealthier households consumed more wildlife products in total than relatively poor households. However, poorer households derive greater benefit from the consumption of wildlife resources than wealthier households. Excluding wildlife compromised the relative contribution of environmental income and, at the same time, increased the relative contribution of farm and wage income. Environmental income has more impact in terms of poverty and inequality reduction in the lower income quintiles than in the upper quintiles. Wildlife income alone accounted for about 5.5% reduction in the proportion of households living below the poverty line. Furthermore, wildlife income had an equalizing effect, bringing about a 5.4% reduction in measured inequality.
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    Evaluating the effectiveness of a multi-component intervention on early childhood development in paediatric HIV care and treatment programmes: a randomised controlled trial
    (BioMed Central, 2018-07-09) Chingono, R; Mebrahtu, H; Mupambireyi, Z; Simms, V; Weiss, H A; Ndlovu, P; Charasika, F; Tomlinson, M; Cluver, L D; Cowan, F M; Sherr, L
    Background HIV infection in a family may affect optimum child development. Our hypothesis is that child development outcomes among HIV-exposed infants will be improved through a complex early childhood stimulation (ECS) programme, and income and loans saving programme for HIV positive parents. Methods The study was a cluster-randomized controlled trial in 30 clinic sites in two districts in Zimbabwe. Clinics were randomised in a 1:1 allocation ratio to the Child Health Intervention for Development Outcomes (CHIDO) intervention or Ministry of Health standard care. The CHIDO intervention comprises three elements: a group ECS parenting programme, an internal savings and lending scheme (ISALS) and case-management home visits by village health workers. The intervention was aimed at caregiver-child dyads (child aged 0–24 months) where the infant was HIV exposed or infected. The primary outcomes were cognitive development (assessed by the Mullen Scales of Early Learning) and retention of the child in HIV care, at 12 months after enrolment. A comprehensive process evaluation was conducted. Discussion The results of this cluster-randomised trial will provide important information regarding the effects of multi-component interventions in mitigating developmental delays in HIV-exposed infants living in resource-limited environments. Trial registration This trial is registered with the Pan African Clinical Trials Registry ( www.pactr.org ), registration number PACTR201701001387209; the trial was registered on 16th January 2017 (retrospectively registered).
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    Fighting HIV/AIDS insecurities using a human rights-based approach : a case study of Zimbabwe
    (2009) Mungwari, Patience; Akokpari, John
    [No title page] This study underscores the need to tackle the escalating HIV /AIDS pandemic in Zimbabwe through a developmental and human rights based approach. In particular it focuses on second generation rights because of their emphasis on the social welfare of individuals. Second generation rights relate to the living conditions of people in society, attempting to ensure that individuals have adequate standard of living. This is achieved through the provision of adequate food, clothing, income, housing, medical care and other essential social services. While acknowledging that behaviour change is an essential element in fighting HIV/AIDS since the virus is spread mostly through sexual contact, the study recognises that it is of limited effect if factors that constrain the ability of individuals to alter their behaviour are not addressed. The study thus recommends the upholding of second-generation rights as an effective compliment to behaviour change strategies. Without mechanisms that facilitate change and build a conducive environment for such a transformation, the HIV/AIDS pandemic will continue to rage on. The research is a qualitative study conducted with a single case study. Zimbabwe is used as a case study as it provides a unique example of a country that has managed to lower its HIV/AIDS prevalence. However, it is now faced with an overwhelming challenge of increasing or at least sustaining this downward trend of the epidemic. Unfortunately, due to an economic and political melt-down the country is suffering a serious humanitarian crisis that has impoverished the community, encouraging risky sexual coping strategies and severely undermined the countries health delivery system, all which work to threaten the success achieved so far in the battle against HIV/AIDS.
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    Financial inclusion technologies and bank performance: insights from Zimbabwe's banking sector
    (2020) Munyengeterwa, Karyn; Alhassan, Abdul Latif
    The study examined the effect of financial inclusion technologies on the financial performance of Zimbabwean banks. The study employs ATM, mobile banking (MB), internet banking (IB) and point of sale (POS) transactions on the financial performance of banks as measured by return on assets. The study adopted the explanatory design and the target population of the study consisted of all the 13 commercial banks in Zimbabwe, with the study period being six years, from 2013 to 2018. The panel data was estimated using fixed and random effects. The findings of the research indicated that all the commercial banks in Zimbabwe at the time of doing this study were using POS, ATM, Mobile banking and Internet banking as they adopted digital forms of banking. In terms of financial performance, banks have been able to increase their return on assets between the years 2013 and 2018. In terms of regression analysis, the findings indicate that for every 1% increase in Mobile banking, ATM and Internet banking there will be an accompanying 0.6%, 0.9%, and 0.5% increase in financial performance respectively while for every 1% increase in POS, there will be a 0.7% decrease in financial performance. Therefore, the research recommended banks to go a step ahead in being innovative through designing new products which will only be accessible to clients who access banking through digital banking methods. Also, the research recommends the government of Zimbabwe to put in place sound macro-economic policies for the whole economy to recover so that the commercial banks in Zimbabwe can fully utilize the benefits associated with digital banking.
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    Gender and reproductive decision making among couples with HIV/AIDS in Bulawayo, Zimbabwe
    (2006) Ndlovu, Vezumuzi
    Gender, the culturally constructed social relations between men and women, plays an important role in determining not only the role and place of both sexes in society but also impacts the distribution of power between the sexes. Men, especially in patriarchal settings, have been observed to dominate women economically, politically and even sexually. Thus men generally exercise power over women. This article explores the impact of gender on reproductive and sexual decision-making among couples with HIV/AIDS. It discusses the decision-making process itself and then examines how gender and the exercise of power influence the decisions or choices made by these couples. Based on a sample of HIV-positive couples from Bulawayo (Zimbabwe), an important observation that this paper makes concerns the lack of male dominance in decision-making among these couples. This is explained in terms of high level of HIV/AIDS awareness among the study sample, the high cost of parental investment to women as well as the behavioural change necessitated by an HIVpositive diagnosis.
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    Genetic admixture of Kruger National Park black rhino (Diceros bicornis minor): conservation implications
    (2020) Stanbridge, Deborah; O'Riain, Justin; Le Roex, Nikki
    Black rhinoceroses (Diceros bicornis) have been extirpated from most of their historic range with the remaining individuals (ca. 5200) living in geographically isolated populations. Management priorities include creating new populations whilst maintaining genetic diversity and promoting gene flow between existing isolated populations. Such objectives are however currently hindered by a lack of comparative/reference data on levels of diversity, relatedness and inbreeding in a large, free-ranging black rhinoceros population. Here I attempt to address this gap in our knowledge by investigating the genetic diversity of the black rhinoceros Diceros bicornis minor within Kruger National Park (the largest free-ranging population of this subspecies) using nuclear and mitochondrial DNA. I compared the diversity of this founded population with the two source populations (KwaZulu-Natal, South Africa and Zimbabwe) using published studies, and evaluate the relative contribution of source lineages relative to the proportion of original founders. Analysis of the mtDNA control region revealed four haplotypes, with moderate haplotype and nucleotide diversity (h=0.48 (± 0.05 SD); π= 0.29%). Data from 13 microsatellite loci revealed moderate to high levels of genetic variation (number of alleles = 4.92 ± 0.90, effective number of alleles = 2.26 ± 0.25, observed heterozygosity = 0.50 ± 0.04, expected heterozygosity = 0.51 ± 0.04), low mean pairwise relatedness (r = -0.03), a low inbreeding coefficient (Fis = 0.04) and no evidence of genetic structuring. Diversity levels within the Kruger black rhinoceros population were high compared to levels reported in black rhinoceroses originating in KwaZulu-Natal and similar to those reported in individuals originating in Zimbabwe. Results show that 40-60% of the Zimbabwean lineages are represented in the Kruger population which is a noticeable increase in the relative contribution of the Zimbabwe founder population. The data provided by this study can be used to guide management and conservation decisions regarding maximising genetic variability across the subspecies. Furthermore, given the encouraging levels of genetic diversity observed, the Kruger black rhinoceros population would be an ideal source population for supplementation of genetically depauperate populations or creating new populations. Finally, these findings demonstrate a positive outcome in mixing the KwaZulu-Natal and Zimbabwe gene pools, with evidence that the founder Kruger black rhinoceros population has been genetically rescued from the low diversity seen in the KwaZulu-Natal black rhinoceroses in South Africa.