https://hdl.handle.net/10646/2760 2026-04-09T21:40:18Z 2026-04-09T21:40:18Z Mhembe, Chamunorwa https://hdl.handle.net/10646/4043 2023-05-29T01:08:12Z 2019-08-01T00:00:00Z

Determinants of Non-Adherence to Antiretroviral Treatment Among HIV Positive Adolescents in the Mining District of Sanyati, Mashonaland West Province, Zimbabwe, 2019 Mhembe, Chamunorwa Adherence to ART in Mashonaland West province was 84% in 2018, lower than the 95% target recommended by the World Health Organisation. Among the seven districts in the province, Sanyati district had the lowest adherence rate of 85% in 2017 and 76% in 2018 across all age groups. This was particularly the case among adolescents where adherence was 90% in 2017 and droped to 84% in 2018. This study therefore assessed factors associated with non-adherence to antiretroviral therapy among adolescents living in the mining District of Sanyati. Method: An analytical cross-sectional study was conducted in Sanyati District amongst 256 randomly selected HIV positive adolescents. Interviewer-administered questionnaires were used to collect data. Univariate, bivariate, stratified and stepwise backward logistic regression analysis were perfomed. Results: Independent factors associated with non-adherence to antiretroviral therapy were participating in artisanal mining for >50 hours per week with (aOR=6.24 CI=1.87-11.25), having good perceived ART benefits (aOR=0.11 CI=0.03-0.46) and failure to disclose HIV status (aOR=8.30 CI=1.86-37.09). In this study, adolescents who were participating in artisanal mining for >50 hours per week, who were using alternative HIV treatment methods and those who failed to disclose taking of ART medicines to friends or family members were more likely to be non-adherent to ART. Sanyati District has to come up with Adolescents community ART refill groups (ACARG) and to produce and procure IEC material on HIV management and ART specifically for adolescents.

2019-08-01T00:00:00Z Chipendo, Tendai https://hdl.handle.net/10646/4042 2023-05-29T01:08:12Z 2019-08-01T00:00:00Z

Determinants of post exposure prophylaxis uptake following occupational exposure to HIV in Matabeleland South Province, 2018. Chipendo, Tendai Occupational exposures to blood borne infections such as HIV represent a major risk factor for health care workers. Post-exposure prophylaxis reduces the likelihood of HIV infection after potential exposure and can reduce the risk of HIV infection by over 80%. In Matabeleland South Province, a preliminary review showed a low uptake of PEP among health care workers. A study to determine the factors associated with uptake of PEP among HIV exposed health workers was carried out in Matabeleland South Province. An unmatched 1:1 case-control study was conducted. A case was defined as a health care worker in Matabeleland South Province who was occupationally exposed to HIV in 2018 and did not commence on HIV PEP.A control was a health care worker in Matabeleland South Province, occupationally exposed to HIV in 2018, and commenced on HIV PEP. An interviewer-administered questionnaire was used to collect data from 186study participants. Epi. InfoTM7.2.2.6 was used to generate frequencies, medians and proportions and to explore associations between exposures and PEP uptake. A total of 93 cases and 93 controls were recruited into the study. Females constituted 51% of the study participants. Forty-seven (51%) of the 93health workers who took PEP had good knowledge on PEP compared to 23% who did not take PEP. Having a history of previously occupational exposures (aOR=2.62, 95% CI 1.29-5.33), having a perceived risk of HIV infection at the workplace (aOR=0.28, 95% CI 0.14-0.54) and having been trained on PEP (aOR=0.42, 95% CI 0.22-0.81) were independent factors associated with uptake of PEP. Twenty-one(36%) of the 58 health workers who did not complete the PEP course highlighted side effects of the medication as the major reason for non-completion of PEP. The study revealed significant knowledge gaps regarding PEP among those who did not take PEP. Health workers’ perception of the risk of HIV acquisition at the workplace and training of health care workers on PEP play an important role in uptake of PEP services. Side effects of PEP contribute to non-adherence to the medication. Having a health system that offers a comprehensive package of counselling, follow up and accessible PEP services may increase uptake of PEP services.

2019-08-01T00:00:00Z Kashiri, Athur https://hdl.handle.net/10646/4041 2023-05-29T01:08:11Z 2019-08-01T00:00:00Z

Risk factors for obstetric fistula in Manicaland Province, 2019. Kashiri, Athur Obstetric fistula is a tragic childbirth injury caused by prolonged obstructed labour that leaves women with urinary or faecal incontinence. A repair camp was set up in 2015 at Chinhoyi Provincial hospital for all obstetric fistula repair surgeries. From August 2015 to December 2018, a total of 600 fistula have been repaired and 276 (46%) of them were from Manicaland Province, the highest in the country. We therefore conducted the study to identify the risk factors for obstetric fistula in Manicaland Province. Methods: We conducteda 1:1 unmatched case-control study. A case was a woman who gave birth and developed obstetric fistula in Manicaland Province from 01 January 2015 to 31 December 2018.We used an interview guide to collect data from key informants and interviewer administered questionnaires to collect data from cases and controls. Epi Info 7 was used for analysis. Univariate, bivariate and multivariate analysis was done to determine risk factors for obstetric fistula. Results: A total of 52 cases and 52 controls were recruited in the study. A total of 37 (71.2%) cases and 46 (88.5%)controls were married. Marriage at age less than 18 years [OR=2.38, 95% (1.03 –5.47)], first pregnancy at age less than 18years, being apostolic [OR=4.9, 95% (2.03 –11.80)]and use of herbs during pregnancy [OR=3.40, 95% (1.21 –9.50)] were significant risk factors for obstetric fistula. Duration of labour less than 20 hours [OR = 0.18, 95% (0.06 –0.47)]and delivery at a health facility[OR=0.19, 95% (0.07 –0.47)] were protective. Age at first delivery of less than 18 years[AOR = 2.72, 95% CI (1.12 –6.60)] was an independent predictor for obstetric fistula. Independent protective factors were: duration of labour less than 20 hours[AOR = 0.24, 95% (0.08 –0.68] and delivery at a health facility [AOR = 0.28, 95%(0.10 –0.73)]. The socio-demographic and cultural factors which are low level of education, use of herbs during pregnancy, early marriage and pregnancy, belonging to the apostolic sect increased the risk for obstetric fistula development among the women while health services factors such as delivery in a health facility with the help of skilled birth attendants and ANC booking were protective factors for obstetric fistula. Addressing these socio-demographic and cultural factors will help to reduce the magnitude of obstetric fistula among the women.

2019-08-01T00:00:00Z Mhondoro, Marvellous Elizabeth https://hdl.handle.net/10646/4040 2023-05-29T01:08:10Z 2019-09-01T00:00:00Z

1risk factors for community acquired urinary tract infections by extended spectrum beta-lactamase producing bacteria, Harare 2019. Mhondoro, Marvellous Elizabeth Drug resistance is a major public health concern responsible for morbidity and mortality globally. In Harare 3rd generation cephalosporin resistant E. coli in urines increased from 28% to 38% from 2012-2017. These organisms known as extended spectrum beta-lactamases(ESBL)are multi-drug resistant and resist the 1stand 2ndline treatment for UTI. The associated risk factors for ESBL and the treatment outcomes in Harare remain undefined. The study was conducted to determine the factors associated with community acquired UTI by ESBL positive bacteria. Methods: A 1:1 unmatched case control study was conducted among patients being attended at two major hospitals in Harare between April and August 2019. A case was a patient with community acquired UTI and a urine culture positive for ESBL-producing bacteria while a control was a patient with same diagnosis but a urine culture negative for ESBL-producing bacteria. Participants were randomly selected from laboratory registers and were interviewed using structured questionnaires to collect data on demographic characteristics, co-morbidity factors, behaviour factors, health related factors and knowledge on UTI. Data were analysed using Epi-Info 7TM (CDC, USA)to generate frequencies, means and proportions. Bivariate, stratified analysis and logistic regression were done. Results: Eighty-one cases-control pairs were recruited. UTI within past 6months (OR 4.13 CI 1.28-13.35), antibiotic use within the previous 12 months (OR 2.93 CI 1.14-7.49) and in males, having prostate enlargement(OR 8.93 CI 1.88-42.47)were the independent risk factors for community acquired UTI by ESBL producing organisms. Sixty-two percent of cases(50/81)compared to17%(14/81)controls had ciprofloxacin resistant urinary tract infections. Thirty-two percent(26/81)cases compared to11%(9/81)controls had gentamicin resistant UTI. Two percent(4/162)of participants had carbapenem resistant infections. The cases were70% less likely to fully recover within 7 days than the controls. Conclusion: Patients with recurrent UTI, previous antibiotic use and men with prostate diseases are at high risk of ESBL infection. The empirical use of beta-lactam and ciprofloxacin in high risk patients is inappropriate and should be discouraged. We recommend the use of laboratory results to guide treatment to arrest antibiotic resistance that is driven by empirical drug use. We also recommend revision of treatment guidelines for UTI in patients with risk factors for ESBL infections

2019-09-01T00:00:00Z