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Biomedical subjects

J Kasule

Publications and source records attributed to J Kasule.

At least 19 recordsLinked to original sources
PubMed2001

HIV-1 seroconversion incidence following pregnancy and delivery among women seronegative at recruitment in Harare, Zimbabwe.

OBJECTIVE: To estimate the incidence of HIV seroconversion among women following pregnancy and delivery. DESIGN: A prospective cohort of women who were HIV negative at recruitment on first antenatal care visit. MATERIALS AND METHODS: Pregnant women were invited to undergo voluntary confidential HIV counselling and blood draw for HIV testing during the first antenatal care visit as part of a prospective study of mother-to-child transmission of HIV-1. Repeat tests were conducted at delivery, six weeks post partum and at three monthly intervals until 24 months or on termination due to subsequent pregnancy, death or loss to follow up. Logistic regression modelling was used to determine independent predictors of HIV seroconversion. RESULTS: Among 372 HIV negative pregnant women who were enrolled, 66 seroconverted during follow up, resulting in a sero-incidence of 4.8 per 100 person years (95% confidence interval [CI], 3.1 to 6.5). Women who did not seroconvert during the time of pregnancy or follow up were significantly more likely to have used a condom with their partners (OR = 0.68, 95% CI = 0.47 to 0.99). Women aged 17 years and below had the highest seroconversion incidence (6.25%) followed by those aged 18 to 19 years (5.42%). Women who seroconverted and those who were HIV positive at recruitment were more likely to be married. Lack of education by the partner of a pregnant woman constituted a significant risk factor for HIV seroconversion (OR = 2.8; 95% CI = 1.1 to 11.0). CONCLUSIONS: There is a high HIV seroconversion incidence among women during pregnancy and following delivery, especially those aged 19 years and below. Being married does not protect the women from the risk of HIV seroconversion. Strategies for HIV prevention should target pregnant women and their partners.

Adolescent↗
PubMed1999

Abortion: attitudes and perceptions of health professionals in Zimbabwe.

OBJECTIVE: To determine the attitudes of professional health workers (doctors, nurses, matrons, social workers and hospital administrators) to medically supervised abortion. DESIGN: Cross sectional study. SETTING: Randomly selected health institutions--urban as well as rural in the eight provinces of Zimbabwe. SUBJECTS: Males and females--age range 18 to 70 years. MAIN OUTCOME MEASURES: Perception of the problem of abortion by health professionals, their knowledge of the present abortion law and desire for change. RESULTS: The majority of doctors were supportive of medically supervised abortion (61.2%) while the nurses were divided 43.2% for and 42.0% against but 14.8% were undecided. The administrators and social workers were supportive. Of the doctors 75% felt that the present abortion law was restrictive and 55.6% supported change. All health professionals agreed that the majority of women who present for abortion treatment are single. The surprising finding was that it is knowledge of the dire complications of unsafe abortion that determines one's attitude to abortion rather than religion. CONCLUSION: By increasing single women's and adolescents' access to family planning services the incidence of unintended pregnancies which result in unsafe abortion with life threatening complications will be reduced. The present restrictive abortion laws which foster backstreet unsafe abortion need to be revised.

Abortion, Legal↗
PubMed1999

Visual inspection of the cervix as a primary means of cervical cancer screening: results of a pilot study.

OBJECTIVE: To measure the effectiveness of unaided visual inspection (UVI) of the cervix as a primary means of cervical cancer screening. DESIGN: A cross sectional study. SETTING: Five primary health care clinics in Mashonaland Province, Zimbabwe. SUBJECTS: 1,000 women aged between 25 and 55 years. MAIN OUTCOME MEASURES: Sensitivity and specificity of UVI. METHODS: 1,000 women attending primary health care clinics were screened for cervical cancer by six qualified nurses. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix and a cervical cytology specimen was obtained followed by visual inspection of the cervix stained by 4% acetic acid. All women found to have abnormal cervices by visual inspection and/or by cervical cytology report were scheduled for colposcopy examination at Harare Central Hospital. RESULTS: 236 (23.6%) women had an abnormal cervical appearance after application with 4% acetic acid, out of which 157 (15.7%) were reported abnormal by cytology. True disease as defined by positive colposcopy and positive cytology was confirmed in 38 (3.8%) women. The sensitivity of UVI using colposcopy and cytology as a reference standard was 68.4%, specificity was 3.4%. CONCLUSION: The results of this study suggest that naked eye inspection of the cervix after application of acetic acid is a practical alternative to cervical cytology in screening for cervical cancer in countries with few resources like Zimbabwe.

Acetates↗
PubMed1998

Mortality in the first 2 years among infants born to human immunodeficiency virus-infected women in Harare, Zimbabwe.

Transmission of human immunodeficiency virus (HIV) and mortality was studied among infants of infected women in Zimbabwe. Of 367 infants born to HIV-infected women, 72 (19.6%) died compared with 20 (5.4%) of 372 infants of uninfected women (P < .01). Infection by HIV DNA polymerase chain reaction among infants who survived >7 days and died within 2 years could be assessed in 87% (58/67) of infants of infected women and 83% (5/6) of infants of uninfected women; transmission occurred in 40 of 58 infants. Among 27 infected infants tested at birth, 19 (70%), 5 (19%), and 3 (11%) were apparently infected via in utero, intrapartum or early postpartum, and late postpartum transmission, respectively. The majority of HIV-infected infants who died in the first 2 years of life were likely to have acquired in utero infection.

Adult↗
PubMed1997

Effects of a randomized health education intervention on aspects of reproductive health knowledge and reported behaviour among adolescents in Zimbabwe.

Unwanted teenage pregnancy and the attendant morbidity and mortality necessitate an understanding of the factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge and reproductive behaviour. A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline followed by a health education intervention, except for control schools. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents. There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored correctly on practice relating to menstruation. Pupils from intervention schools were more likely (P < 0.001) to know that a boy experiencing wet dreams could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Knowledge of family planning was low in both groups at baseline but was high at five months follow-up in the intervention schools. The findings point to the need for early school-based reproductive health education programmes, incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health.

Adolescent↗
PubMed1997

Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe.

BACKGROUND: Unwanted teenage pregnancy, sexually transmitted infections and the attendant morbidity and mortality necessitate the need for understanding factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge, reproductive behaviour, sexual and reproductive health. OBJECTIVE: To determine the impact of an intervention package on knowledge levels of various reproductive health issues through trend analysis. DESIGN: Randomized controlled trial of a health education intervention in schools stratified for representativeness. SETTING: Rural and urban secondary schools in Zimbabwe. SUBJECTS: 1,689 students recruited from 11 secondary schools in Mashonaland Central. MAIN OUTCOME MEASURE: Knowledge level before and after intervention. RESULTS: The demographic characteristics of the pupils at baseline, five months and nine months were comparable between the two groups. There was an overall increase in knowledge on menstruation. Students from the intervention schools were more likely to have correct knowledge over time on aspects of reproductive biology. A significant linear trend (p = 0.017) was observed in the area of family planning and contraception. A linear decreasing trend (p = 0.001) was observed on pregnancy risk. Though not significantly linear, the general trend of knowledge levels in all the areas of reproductive health, pregnancy risk, STDs and HIV/AIDS showed an upward trend, from 20% to 96%. Worth noting was that in all the areas the intervention group had knowledge above that in the control group. CONCLUSION: The reproductive health education intervention had an impact on aspects of reproductive biology and contraception as measured by the increased scoring at follow up when comparing intervention and control schools. The overall findings point to the need for early school based reproductive health education programmes incooperating correct information on reproductive biology and the prevention of subsequent reproductive morbidity by imparting information on non-risk behaviour during the early developmental years.

Adolescent↗
PubMed1997

Zimbabwean teenagers' knowledge of AIDS and other sexually transmitted diseases.

A cross sectional anonymously administered questionnaire was used amongst 1689 secondary school girls and boys to determine their knowledge of AIDS and other sexually transmitted diseases (STDs). Their knowledge was found to be very low. While 80% could name an STD in an open question, only 16% could recognise the important symptoms of the common and treatable diseases such as gonorrhoea and syphilis. This finding is worrying in view of the fact that these common STDs facilitate transmission of HIV/AIDS. The awareness of AIDs was high but when it came to the mode of transmission of AIDS the large majority were not aware of the risk of intercourse with an infected person. Furthermore, despite an intensive AIDS awareness campaign programme mounted by the government of Zimbabwe a large number of students thought that one can contract HIV/AIDS by shaking hands, sharing a toilet and witchcraft. Misconceptions on transmission abound. The data show that there is a need to review strategies of disseminating information to teenagers regarding STD, including AIDS, reproductive biology, sexuality and contraception. The best strategy may be the introduction of a reproductive health education curriculum in all schools starting at an early age.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The vaginal use of herbs/substances: an HIV transmission facilitatory factor?

Heterosexual intercourse accounts for 80% of HIV transmission in sub-Saharan Africa. Factors facilitating cross-infection may include sexual practices such as the vaginal use of herbs/substances to dry, contract and heat the vagina for enhancement of sexual pleasure. The behavioural-analytic study investigated the use of different types of herbs/substances used by 75 HIV positive and 76 negative sexually active females and the perceived effects of these agents. Individual in-depth interviews were conducted. 99% of all subjects admitted using herbs/substances mainly to contract (94%), dry (58%) and heat (28%) the vagina. There was no significant difference in the pattern of use of herbs and reasons given for using the agents by HIV positive and negative women. 69% of HIV negative and 80% of positive subjects had used a mean of 4 difference types of herbs and/or substances during the last 5 years. 39% negative and 25% positive subjects had experienced intra-vaginal pain and lower abdominal pains during and after sexual intercourse, laceration of the vagina and excessive vaginal secretions after using herbs. These effects were attributed to Wankie (herb or substance) in 70% of the complaints. 14 HIV positive subjects compared with 7 in the negative group had used Wankie. The role of Wankie and similar substances in transmitting HIV cross-infection requires further investigations. From the point of view of AIDS prevention, expectations of a dry and contracted vagina in sexual intercourse may reduce acceptability and use of female and male condoms.

Administration, Intravaginal↗
PubMed1995

Reproductive biology knowledge, and behaviour of teenagers in East, Central and Southern Africa: the Zimbabwe case study.

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.

Adolescent↗
PubMed1994

Randomised controlled trial of intrapartum fetal heart rate monitoring.

OBJECTIVE: To compare effectiveness of different methods of monitoring intrapartum fetal heart rate. DESIGN: Prospective randomised controlled trial. SETTING: Referral maternity hospital, Harare, Zimbabwe. SUBJECTS: 1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into study. INTERVENTIONS: Intermittent monitoring of fetal heart rate by electronic monitoring, Doppler ultrasound, use of Pinard stethoscope by a research midwife, or routine use of Pinard stethoscope by attending midwife. MAIN OUTCOME MEASURES: Abnormal fetal heart rate patterns, need for operative delivery for fetal distress, neonatal mortality, Apgar scores, admission to neonatal unit, neonatal seizures, and hypoxic ischaemic encephalopathy. RESULTS: Abnormalities in fetal heart rate were detected in 54% (172/318) of the electronic monitoring group, 32% (100/312) of the ultrasonography group, 15% (47/310) of the Pinard stethoscope group, and 9% (28/315) of the routine monitoring group. Caesarean sections were performed for 28% (89%), 24% (76), 10% (32), and 15% (46) of the four groups respectively. Neonatal outcome was best in the ultrasonography group: hypoxic ischaemic encephalopathy occurred in two, one, seven, and 10 cases in the four groups respectively; neonatal seizures occurred only in the last two groups (six and nine cases respectively); and deaths occurred in eight, two, five, and nine cases respectively. CONCLUSIONS: Abnormalities in fetal heart rate were more reliably detected by Doppler ultrasonography than with Pinard stethoscope, and its use resulted in good perinatal outcome. The use of relatively cheap ultrasound monitors should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Female↗
PubMed1992

Intrapartum foetal heart rate monitoring--continuous electronic versus intermittent Doppler--a randomised controlled trial.

OBJECTIVE: To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and neonatal mortality and short term neonatal morbidity. DESIGN: A prospective randomised controlled trial. SETTING: Women in labour at a referral maternity hospital. PATIENTS: Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study. INTERVENTION: Women were randomly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand held doppler foetal heart rate detector. OUTCOME MEASURES: These include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, neonatal seizures, and hypoxic encephalopathy. RESULTS: Randomisation achieved good comparability between the two groups. Abnormal FHR patterns were more frequent in the electronic group (54 pc versus 32 pc). Caesarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two groups. CONCLUSIONS: Asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Adult↗
PubMed1992

Norplant in Zimbabwe: preliminary report.

During an ongoing study of a pre-introduction trial of Norplant in Zimbabwe, 197 women had the subdermal implant of six capsules containing levonorgestrel inserted between June and December 1991, at Parirenyatwa, Harare Hospital and Spilhaus. Acceptability and efficacy were high and no significant side effects had been observed. Three implants were removed due to local infection. Our initial experience indicates that the Norplant continuation rate is much higher than for any other reversible method of contraception and it is highly acceptable as a long term contraceptive.

Adolescent↗
PubMed1991

Evaluation of a combined oral contraceptive pill in black Zimbabwean women.

A prospective exploratory study was carried out on lipid metabolism (41 women); as well as efficacy, acceptability and safety on another 190 women who all were using a combined oral contraceptive pill (OC) containing 30 micrograms Ethinyl oestradiol and 150mg Desogestrel (Marvelon) over a period of twelve months. The 41 women had blood analysis of triglycerides, cholesterol and high density lipoproteins (HDL) before treatment and at each of follow-up visits scheduled at 3, 6, 9 and 12 months following admission. Triglycerides, cholesterol and HDL levels were computed and there were no significant changes in any of the measured levels except HDL which was increased. No pregnancy was reported in one year of use in both groups. Cycle control was good, with a very low incidence of breakthrough bleeding and spotting being reported. The pill did not affect body weight and blood pressure significantly. It was concluded that the Marvelon formulation does not have adverse effect on lipid metabolism and is an efficacious and well tolerated contraceptive amongst Zimbabwean women.

Adolescent↗
PubMed1991

Seroprevalence of HIV infection amongst antenatal women in greater Harare, Zimbabwe.

Prevalence of HIV infection appears to be rising in many African countries. HIV infection in the pregnant woman poses a dilemma for the mother as well as for her unborn child. There are no data on HIV prevalence in Zimbabwe. This prospective study designed to determine HIV prevalence, enrolled pregnant women booking for antenatal care at Harare hospital and two of its peripheral municipal clinic. Two Elisa and a confirmatory Western Blot test on 1008 blood samples provided an HIV sero-prevalence rate in the studied population of 18 pc. High groups included unskilled labourers who were unbooked, single, divorced or cohabiting and below 30 years of age. Regarding education and income, women with over 11 years of education or earning over $600 per month constituted a lower risk category. Implications of this high prevalence rate are discussed and the urgency to examine feto maternal transmission and the effect of pregnancy on HIV status is expressed. Further more, intensification of preventive information and education programmes is recommended.

Adult↗
PubMed1991

Laparoscopic evaluation of chronic pelvic pain in Zimbabwean women.

A prospective study in which 360 women complaining of lower abdominal pain, were subjected to laparoscopic evaluation to confirm a diagnosis of chronic pelvic inflammatory disease (PID) was carried out. Out of 360 women 234 (65%) had visually normal pelvis and on hydrotubation both tubes were patent; 54 (15%) had one tube patent while 72 (20%) had bilaterally occluded tubes. There were no complications. It is concluded that if women complain of chronic lower abdominal pain laparoscopic evaluation should be carried out to confirm the diagnosis of PID to avoid unnecessary prescription of antibiotics.

Abdominal Pain↗
PubMed1989

Ectopic tubal pregnancy in Zimbabwe.

A study of 441 ectopic tubal pregnancies treated at Harare Central Hospital between 1981-84 was carried out. During that time, there were 162,964 deliveries in the unit. The incidence of tubal pregnancy in this study was only 0.27%. Patients ranged in age from 13-46 years with the majority (67%) between ages 20-29. 88% of the patients were parous, the mean parity being 2.6 96% of the patients complained of abdominal pain, 78% of amenorrhea, and 64% of abnormal uterine bleeding. Abdominal tenderness (96%) and cervical excitation (91%) were the most significant signs. Paracentesis was positive in 78% of the cases. It was a little value in the diagnosis of chronic or unruptured tubal pregnancy. There was 1 maternal death.

Africa↗
PubMed1989

The pattern of gynaecological malignancy in Zimbabwe.

This study was based on clinical and histological diagnosis of 1251 consecutive cases, referred to Harare Central Hospital for Specialist attention between January 1981 and December 1983. The frequency of each gynaecological malignancy was as follows: cervix - 78%, choriocarcinoma - 8%, endometrial carcinoma - 6%, ovarian carcinoma - 5%, vulva and vagina - 3%. The study showed that cancer of the cervix was the commonest type in African women who were 99% semiliterate rural women of low socio-economic status and who presented in 76% of the cases with advanced malignancy. It was concluded that the most practicable way of preventing cervical cancer in African women is intensive health education in rural areas to make women aware of the early symptoms of the disease.

Adolescent↗