BACKGROUND:As genomics and biobanking expanded rapidly across Africa, ethical governance frameworks for genomic research and biobanking often failed to keep pace, particularly in countries like Zimbabwe, where research increasingly involved international collaboration, but regulatory oversight remained limited. This study analysed how Zimbabwean researchers addressed the ethical, legal, and sociocultural issues (ELSIs) central to human biospecimen and genomic research. METHODS:We conducted a comprehensive review of research protocols submitted to the Medical Research Council of Zimbabwe between 2009 and 2016, specifically those involving human biospecimen collection, biobanking, and genomic research. A structured abstraction form was employed to evaluate how these protocols addressed key ELSIs, including informed consent, biospecimen and data sharing, benefit sharing, and intellectual property considerations. RESULTS:Of the 200 eligible protocols, 92(46%) were submitted by independent research institutions and 67(33.5%) by universities. Consent practices varied: 99(49.5%) protocols utilized specific consent, 37(18.5%) employed broad consent, and 37(18.5%) used blanket consent. Notably, 2(1%) protocols did not use consent forms, opting instead for broad or specific notifications. Only 44(22%) protocols included plans for the destruction of collected samples. While 44(22%) protocols involved exporting biospecimens, nearly two-thirds of these lacked a material transfer agreement (MTA). Critically, benefit sharing was absent across all protocols, and only 26(13%) addressed intellectual property rights. CONCLUSIONS:This review exposes systemic gaps in the ethical planning of genomics and biobanking research in Zimbabwe. Although researchers are increasingly engaging in cutting-edge science, the regulatory and ethical frameworks require transformation. The limited attention to benefit sharing, consent for future use, and intellectual property reflects deeper governance and equity challenges. To protect research participants and ensure ethical integrity, Zimbabwe urgently needs updated national guidelines that define minimum standards for addressing a full range of ELSIs, moving beyond consent and privacy to embrace justice, accountability, and long-term stewardship. Strengthening these frameworks is crucial to ensuring ethical integrity in Zimbabwe's growing biobanking and genomic research landscape.

Background Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe. Methods This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom’s cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05. Results This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender ( p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50–56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1–2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1–0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk ( p > 0.05). Conclusion This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.

Post-partum haemorrhage (PPH) is a significant cause of maternal mortality in Zimbabwe and Africa. Despite easy access and availability of oxytocin to treat PPH, incidence cases of maternal mortality from PPH still occur, thus additional interventions are needed to prevent PPH. This parallel, double-blind, closed label randomized clinical trial was carried out to determine the efficacy of prophylactic administration of tranexamic acid (TXA) before caesarean section to prevent PPH. In a blinded, 2-centre, randomized control trial with 2 parallel groups that enrolled 1,224 participants who had an elective or emergency caesarean delivery at term, we randomly assigned them to receive 1 g (10 mL) of TXA or 10 mL normal saline at the onset of skin incision. All participants in the study and control group received the standard care of 5 IU intravenous oxytocin on delivery of the baby. The primary outcome was occurrence of PPH, defined by an estimated blood loss exceeding 1,000 mL using laboratory haematocrit values taken before and after the procedure. Six-hundred and thirteen (613) participants were randomized to receive placebo and 611 received TXA. Adjusted analysis from a generalized linear model showed that there was no statistically significant association between the risk of PPH and TXA administration (adjusted relative risk = 1.07; 95% confidence interval = 0.87–1.31). There was no effect modification by type of caesarean section, whether a participant had an emergency or elective caesarean section. TXA did not cause significant adverse events during the clinical trial. Prophylactic administration of TXA before a caesarean section did not significantly reduce the risk of PPH compared to standard methods alone.

INTRODUCTION:Due to the increasing incidence of diabetes in Zimbabwe, complications such as diabetic foot (DF) are anticipated. Establishing local gaps and needs in DF healthcare is paramount for tailoring management strategies.AIMS:To determine the status of DF services in the healthcare system and explore awareness of DF management and practices among registered general nurses (RGNs) in Zimbabwe.METHODS:A mixed-methods approach was applied. Thirty-one RGNs from 16 public health facilities in Harare, Zimbabwe attending a DF workshop were administered with a cross-sectional survey instrument and a semi-structured questionnaire. Data collected included presence/absence of DF services and podiatrists in healthcare facilities, healthcare system approaches in DF care and availability of DF training/education programs for RGNs. Analysis was performed using Stata and Nvivo software.RESULTS:No respondents reported availability of podiatrists. Only 1 (3%) of RGNs reported DF screening in primary care. Sixty percent (18) did not know or had never screened for DF. The RGNs reported inadequate DF educational programs/modules in primary care settings.CONCLUSION:This data highlights a need to improve DF education for RGNs at the frontline of managing PLWD. Understanding the needs for DF services may guide interventions to improve education and awareness programs that are appropriately tailored to local constraints in the health system. The non-communicable diseases director is encouraged to develop DF educational programmes for frontline health care workers.

Background: Spinal Cord Injury (SCI) is one of the most common disabling neurological conditions managed by Occupational therapists in Zimbabwe. The coping strategies adopted by these SCI survivors and the factors associated with the adjustment have not been fully explored. Materials and Methods: A descriptive cross sectional study was done to determine the coping strategies used by SCI patients adjust to their condition. The Brief Cope Inventory and Spinal Cord Lesions Coping Strategies Questionnaire were used to gather data from SCI patients in three institutions that rehabilitate people with SCI in Zimbabwe. Ethical procedures were followed. Results: Forty three patients with SCI participated in the study. Seventy-seven percent were male and median age was 35 years (IQR 27-43). The most common cause of injury was road traffic accident (63%) followed by mining related falls. The most used coping strategies were religion (91%), acceptance (79%), positive reframing (70%) and use of emotional support (67%) which are all positive in nature. Least used coping strategies were substance abuse (2%), denial (7%) and behavioural disengagement (16%) which are all negative in nature. Male gender (p=0.034) and receiving rehabilitation at a rehabilitation centre (p=0.041) were associated with use of a positive coping strategy. Conclusion: SCI generally affect a young male population. There is a need to capitalize on the commonly used positive coping strategies and to support women and those in hospitals. There is also need to further explore factors associated with the coping strategies adopted so SCI survivors are assisted to cope positively with their injury.

The global societal impact of the COVID-19 pandemic is incalculable with profound social suffering, deep economic hardships and enforced closure of schools, businesses, and higher learning institutions through the imposition of lockdown and social distancing in mitigation of the spread of the SARS-Cov-2 infection. Institutions have had to hastily migrate teaching, learning and assessment to online domains, at times with ill-prepared academics, students and institutions and with unwelcome and disorienting consequences. Our study surveyed perspectives of faculty at the University of Zimbabwe Faculty of Medicine and Health Sciences (UZFMHS) towards the hastily adopted online teaching, learning and assessment implemented in response to the mitigation of the COVID-19 pandemic. Twenty nine (29) faculty in all the major disciplines and career hierarchy. There were mixed responses regarding the use of this modality for teaching, learning and assessment: training before online teaching, learning and assessment, advantages and disadvantages, cost effectiveness, effectiveness for teaching, learning and assessment, effect on student feedback, disruptions from internet connectivity issues, interaction with students, suitability for practical training, and barriers to online teaching, learning and assessment. These results would enable the UZFMHS develop institutional and personalised approaches that would enable execution of online teaching, learning and assessment under the current and post COVID-19 pandemic.

BACKGROUND: We conducted the first national TB prevalence survey to provide accurate estimates of bacteriologically confirmed pulmonary TB disease among adults aged ≥15 years in 2014.METHODS: A TB symptoms screen and chest X-ray (CXR) were used to identify presumptive TB cases who submitted two sputum samples for smear microscopy, liquid and solid culture. Bacteriological confirmation included acid-fast bacilli smear positivity confirmed using Xpert® MTB/RIF and/or culture. Prevalence estimates were calculated using random effects logistic regression with multiple imputations and inverse probability weighting.RESULTS: Of 43,478 eligible participants, 33,736 (78%) were screened; of these 5,820 (17%) presumptive cases were identified. There were 107 (1.9%) bacteriologically confirmed TB cases, of which 23 (21%) were smear-positive. The adjusted prevalences of smear-positive and bacteriologically confirmed TB disease were respectively 82/100,000 population (95% CI 47-118/100,000) and 344/100,000 (95% CI 268-420/100,000), with an overall all-ages, all-forms TB prevalence of 275/100,000 population (95% CI 217-334/100,000). TB prevalence was higher in males, and age groups 35-44 and ≥65 years. CXR identified 93/107 (87%) cases vs. 39/107 (36%) using the symptom screen.CONCLUSION: Zimbabwe TB disease prevalence has decreased relative to prior estimates, possibly due to increased antiretroviral therapy coverage and successful national TB control strategies. Continued investments in TB diagnostics for improved case detection are required.

background. Traumatic brain injury (TBI) imposes an enormous burden on health systems and it is the most frequent cause of hospitalization in children. This study aimed at describing the causes, presentation, management, and outcome of children with TBI admitted at a tertiary referral hospital in Harare, Zimbabwe. Methods. This prospective cohort study was conducted with a convenience sample of children aged ≤ 12 years and admitted with TBI at the study site from June 2018 to May 2019. The children were followed from their admission to one-month post-discharge. Sociodemographic, clinical, and neuroimaging data were collected. The median length of stay was calculated and the Chi-square, Fisher’s exact, and Kruskal Wallis tests were used. results. 84 children with TBI were recruited. Most were males (66.7%) and (56.0%) had sustained TBI following a motor vehicle accident. An initial period of loss of consciousness that lasted a median of 6.5 (IQR = 4.8) hours was noted in 60.7% of patients. The most common symptom at presentation was headache (61.9%), and mild TBI was the most common type of TBI. Skeletal injuries were the most encountered associated injuries (13.1%) and the majority of patients were managed non-operatively – 79 (94.0%). Most patients (56.0%) experienced upper good recovery at one-month follow-up. conclusions. Motor vehicle accidents are the main cause of pediatric TBI in Zimbabwe. Most patients do not require surgical treatment and have a good recovery.

Background Women of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015. Methods DHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia. Results Prevalence (95% confidence interval (CI)) of anemia was 37.8(35.9–39.7), 28.2(26.9–29.5), 27.8(26.5–29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7–9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03–2.74), 2010: 2.35(1.99–2.77), and 2015: 2.48(2.18–2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08–1.65), 2010: 1.26(1.03–1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16–1.47), 2010: 1.23(1.09–1.34)]; not taking iron supplementation [2005: 1.17(1.03–1.33), 2010: 1.23(1.09–1.40), and2015: 1.24(1.08–1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden. Conclusion The prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women’s health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.

INTRODUCTION:clinical infertility is failure to conceive within a year of regular sexual intercourse by a non contracepting couple. Infertility care is costly and result in investigations being incomplete and inconclusive. It is therefore important to streamline investigations offered to infertile couples such that only the most cost effective tests are done. This paper explores the adequacy of investigations and treatments offered to women presenting for infertility care. METHODS:the data used in this analysis was obtained from a cross sectional sample of 216 women who presented with infertility in public and private gynaecological clinics in Harare, Zimbabwe. Information on investigations and treatment offered to women presenting for care was extracted from hospital cards, case notes, laboratory and radiological reports. Data was analysed using STATA SE/15. RESULTS:of the 178 (82.4%) who had ultrasound scan evaluation (USS) 50 (28.1%) had fibroids and 22 (12.4%) had polycystic ovaries. Tubal patency tests were done in 118 participants using (hystero-salpingogram) HSG alone in 62.7%, laparoscope and dye alone in 21.2% and both in 16.1% of them. Of the 97 (44.9%) men who had semen analysis 61 (62.9%) had abnormal parameters. CONCLUSION:this study reveals that evaluation for tubal patency and USS to rule out reproductive organ pathology are not being offered to all women with a diagnosis of infertility. Likewise, male partner semen evaluation is not being done in all male partners. There is a high prevalence of abnormal semen parameters. Studies should be done to understand why some male partners are not forthcoming in providing semen for analysis. It is important for protocols to be produced by professional bodies which prescribe the minimum basic investigations in couples with infertility.

Background and Objectives: Red blood cell antigens have been reported to be involved in the epidemiology of various diseases. Other studies have suggested that the Rhesus C antigen has a protective effect against HIV infection. However, there is limited information to support these findings. Therefore, this study sought to investigate whether there was an association between Rhesus C antigen and HIV infection.Materials and Method: A clinical and laboratory based analytical cross-sectional study was carried out on 165 HIV positive samples from the Centre of Excellency at the Parirenyatwa Group of Hospitals and 165 HIV negative samples from National Blood Service Zimbabwe. Rhesus blood grouping for the 5 principal Rhesus antigens (D, C, E, c and e) was done using reagents supplied by Lorne Laboratories.Results: A total of 330 HIV positive and negative samples were used for the study. One hundred and sixty-five (50%) of them were from HIV negative regular blood donors at the National Blood Service Zimbabwe and the other 165 (50%) were from HIV positive patients enrolled at the Centre of Excellency Clinic of the Parirenyatwa Group of Hospitals. Ninety-four (57%) and 71(43%) of the patients were males and females respectively. Forty-four (27%) and 46 (28%) of the HIV positive patients were in the 31-40- and 41-50-year age ranges respectively. Only 2 (1%) of the patients were over the age of 70 years. The study showed no association between Rhesus C antigen and HIV infection (p>0.05). E and C antigens were the least frequent Rhesus phenotypes in both HIV negative and HIV positive samples. The total number of probable genotypes containing the C gene was also very low at 57(17%). There were 33 (20%) of HIV negative donor samples with Rhesus C antigen, compared to 21 (13%) of HIV positive patient samples.Conclusions: The study was unable to establish the link between the Rhesus C antigens with protection against HIV infection. Since Rhesus C antigen is of low frequency in the Black population, very few patients with this antigen were identified with HIV infection. French title: L'antigene Rhesus C assure-t-il une fonction protectrice contre l'infection par le VIH ? Contexte et objectifs : Il a ete rapporte que les antigenes des globules rouges sont impliques dans l'epidemiologie de diverses maladies. D'autres etudes ont suggere que l'antigene Rhesus C a un effet protecteur contre l'infection par le VIH. Cependant, il existe peu d'informations pour etayer ces conclusions. Par consequent, cette etude a cherche a determiner s'il y avait une association entre l'antigene Rhesus C et l'infection par le VIH.Materiels et methode : Une etude transversale analytique clinique et en laboratoire a ete realisee sur 165 echantillons positifs pour le VIH du Centre of Excellency at the Parirenyatwa Group of Hospitals et 165 echantillons negatifs pour le VIH du National Blood Service Zimbabwe. Le groupage sanguin Rhesus pour les 5 principaux antigenes Rhesus (D, C, E, c et e) a ete effectue a l'aide de reactifs fournis par Lorne Laboratories.Resultats : Un total de 330 echantillons positifs et negatifs pour le VIH ont ete utilises pour l'etude. Cent soixante-cinq (50 %) d'entre eux provenaient de donneurs de sang reguliers seronegatifs du National Blood Service du Zimbabwe et les 165 autres (50 %) provenaient de patients seropositifs inscrits a la Centre of Excellency at the Parirenyatwa Group of Hospitals. Quatre-vingt quatorze (57%) et 71 (43%) des patients etaient respectivement des hommes et des femmes. Quarante-quatre (27 %) et 46 (28 %) des patients seropositifs avaient respective-ment 31-40 ans et 41-50 ans. Seuls 2 (1%) des patients avaient plus de 70 ans. L'etude n'a montre aucune association entre l'antigene Rhesus C et l'infection par le VIH (p>0,05). Les antigenes E et C etaient les phenotypes rhesus les moins frequents dans les echantillons VIH negatifs et VIH positifs. Le nombre total de genotypes probables contenant le gene C etait egalement tres faible a 57 (17 %). Il y avait 33 (20 %) echantil-lons de donneurs VIH negatifs avec l'antigene Rhesus C, contre 21 (13 %) echantillons de patients VIH positifs.Conclusions : L'etude n'a pas pu etablir de lien entre les antigenes Rhesus C et la protection contre l'infection par le VIH. L'antigene Rhesus C etant peu frequent dans la population noire, tres peu de patients porteurs de cet antigene ont ete identifies comme infectes par le VIH.

Background Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. Methods A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. Results Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2–4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was ‘unexplained’ in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. Conclusion Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.

Background: Poor management of diabetes mellitus gives rise to complications such as diabetic foot (DF), which pose a host of medical and socioeconomic problems, especially in low-income countries where resources, capacity and awareness are limited. Aim: This study purposed to identify local factors influencing poor management of diabetes and, therefore, increasing risk of DF in Zimbabwe. Method: This study utilised a descriptive qualitative design with a purposive sample of 30 nurses from 14 polyclinics and 2 major referral hospitals in Harare, Zimbabwe. Four focus-group discussions were conducted following a semi-structured interview guide with sections addressing commonly encountered socio-economic, cultural and behavioural factors, which potentially increase the risk of DF complications among diagnosed and undiagnosed diabetic individuals. Thematic analysis was used to analyse the data. Results: Four major themes were identified including poor socioeconomic status, poor self-care, religious and cultural factors, and health-system-related factors. Lack of awareness results in poor health-seeking behaviour, and use of unconventional treatment methods, which may increase DF risk among people living with diabetes, both diagnosed and undiagnosed. Conclusion: Appropriately tailored education and awareness interventions taking into account local socio-economic and cultural factors are key to the prevention of DF and promotion of self-management activities.

RÉSUMÉ Original Research 2020, Volume 22, Number 1

Background and objectives: Massive blood transfusion is defined as transfusion approximating or exceeding a patient's total blood volume (5-6 litres in adults) within 24-hours. This procedure is used to manage severely anaemic and bleeding patients. Negative outcomes associatedwith acidosis, hypothermia and coagulopathy may result. The study was carried out to review the management of massive transfusion in Zimbabwe.Materials and methods: A 4-year retrospective clinical laboratory-based study was carried out on patients who had massive blood transfusionat a Zimbabwean hospital, from January 2014 to December 2017. Data was collected from patients’ hospital records after permission from thehospital director.Results: Of the 180 patient records, 145 (80.6%) were from female and 35 (19.4%) from male patients. Massive blood transfusion was done mostly on obstetric patients. Full blood count was the most commonly requested laboratory test, with 155 (86%) requests. Some of the patients had severe anaemia. Routine coagulation tests were significantly abnormal. All patients received packed red cells during the first 24 hours, followed by fresh frozen plasma (57.8%). Platelets, cryoprecipitate and whole blood were infrequently transfused (22%, 3% and 2% respectively). The mortality rate was 25.6% within 24 hours after transfusion. Transfusion of packed red cells alone was significantly associated with mortality (p<0.001) which increased significantly with the use of high numbers of packed red cell units.Conclusion: Massive blood transfusion is associated with a high mortality rate in Zimbabwe. Transfusion of packed red blood cells alone resulted in highest mortality. There was an insufficient use of laboratory tests to monitor massive blood transfusion. This potentially can be addressed by establishing a national massive transfusion protocol for Zimbabwe. French Title: Une revue de la transfusion sanguine massive et de ses syndromes associés au Zimbabwe Contexte et objectifs: La transfusion sanguine massive est définie comme une transfusion se rapprochant ou dépassant le volume sanguin total d'un patient (5-6 litres chez l'adulte) dans les 24 heures. Cette procédure est utilisée pour gérer les patients gravement anémiques et hémorragiques. Des résultats négatifs associés à l'acidose, l'hypothermie et la coagulopathie peuvent en résulter. L'étude a été réalisée pourexaminer la gestion de la transfusion massive au Zimbabwe.Matériel et méthodes: Une étude rétrospective clinique en laboratoire de 4 ans a été menée sur des patients ayant subi une transfusion sanguine massive dans un hôpital du Zimbabwe, de Janvier 2014 à Décembre 2017. Les données ont été collectées à partir des dossiers des patients de l'hôpital après autorisation du Directeur de l'hôpital.Résultats: Sur les 180 dossiers de patients, 145 (80,6%) provenaient de femmes et 35 (19,4%) de patients de sexe masculin. Une transfusion sanguine massive a été effectuée principalement sur des patientes obstétricales. L'hémogramme complet était le test de laboratoire le plus demandé, avec 155 (86%) demandes. Certains patients souffraient d'anémie sévère. Les tests de coagulation de routine étaient significativement anormaux. Tous les patients ont reçu des concentrés de globules rouges au cours des 24 premières heures, suivis de plasma frais congelé (57,8%). Les plaquettes, le cryoprécipité et le sang total ont été rarement transfusés (22%, 3% et 2% respectivement). Le taux de mortalité était de 25,6% dans les 24 heures suivant la transfusion. La transfusion de concentrés de globules rouges seule était significativement associée à la mortalité (p<0,001) qui augmentait significativement avec l'utilisation d'un nombre élevé d'unités.Conclusion: La transfusion sanguine massive est associée à un taux de mortalité élevé au Zimbabwe. La transfusion de concentrés de globules rouges seule a entraîné la mortalité la plus élevée. Les tests de laboratoire étaient insuffisants pour surveiller les transfusions sanguines massives. Cela peut potentiellement être résolu en établissant un protocole national de transfusion massive pour le Zimbabwe

Background More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals. Methods The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007–2010 (1st Period), and 2013–2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage. Results Crude ORS coverage increased from 21.0% (95% CI: 17.4–24.9) in 1st Period to 40.5% (36.5–44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1–65.3) to 64.7% (61.8–67.5) in Zambia; and decreased from 72.3% (68.4–75.9) to 64.6% (60.9–68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from − 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from − 16.5% in the Northern Province to − 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66–5.86) for Zimbabwe, 2.83 (2.35–3.40) for Zambia, and, 0.71(0.59–0.87) for Malawi. Conclusion ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Controversy regarding use of genetically modified (GM) foods still persists in both developing and developed worlds.Proponents of genetically engineered foods argue this is a sustainable solution to resource-limited settings where food insecurity continues to increase.However, in this pertinent debate, there is deficiency of knowledge on the opinion of the general public from resource-limited African communities.The aim of this paper is to describe the general public's level of knowledge and perceptions towards use of GM foods in Zimbabwe.A descriptive cross sectional survey was conducted among 301 participants attending a country-wide Traditional and Organic Foods Festival in Harare.A self-administered questionnaire was used to collect data.Poor level of knowledge on GM foods was demonstrated among most respondents (60%) and associated with level of education (p<0.05).More than a third of respondents (36%) believed that GM chicken was being sold on Zimbabwean local markets.Lack of understanding on the genetic engineering process in food production was common among respondents.Attitude towards GM foods was negative and intention to consume GM foods was low (38%).Genetic engineering on food production was viewed as driven by a few companies for profit maximization (72%) with consequences for GM foods complex and too risky for humans (70%).Consumers believed a total of 44 GM foods were available on the Zimbabwean market with chicken, maize and fruits being common foods reported as GM foods.More than half (54%) of respondents reported to have consumed GM foods in the past even though GM foods are not permitted in the country.People with increased knowledge on genetic engineering and GM foods were more receptive of GM foods in their diets.Although intention to consume GM foods was high among individuals with increased knowledge and positive perceptions towards GMOs, knowledge and understanding on GM foods among study participants was limited.Positive perceptions, increased knowledge on genetic engineering and GM foods makes people more receptive of GM foods in their diets.There is need to improve consumer awareness on genetic engineering in food production to empower consumers to make informed choices regarding GM food.Consumers in resource-limited settings are sceptical of genetic modification in food and should be consulted during policy formulations on GM foods.Mandatory labelling of GM foods could also improve confidence among consumers on the foods they consume.

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. The project was conducted over a countrywide geographical region and established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa. This paper outlines the strategy undertaken during the implementation of the GILES initiative and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa.

Health facility data are a critical source of local and continuous health statistics. Countries have introduced web-based information systems that facilitate data management, analysis, use and visualisation of health facility data. Working with teams of Ministry of Health and country public health institutions analysts from 14 countries in Eastern and Southern Africa, we explored data quality using national-level and subnational-level (mostly district) data for the period 2013–2017. The focus was on endline analysis where reported health facility and other data are compiled, assessed and adjusted for data quality, primarily to inform planning and assessments of progress and performance. The analyses showed that although completeness of reporting was generally high, there were persistent data quality issues that were common across the 14 countries, especially at the subnational level. These included the presence of extreme outliers, lack of consistency of the reported data over time and between indicators (such as vaccination and antenatal care), and challenges related to projected target populations, which are used as denominators in the computation of coverage statistics. Continuous efforts to improve recording and reporting of events by health facilities, systematic examination and reporting of data quality issues, feedback and communication mechanisms between programme managers, care providers and data officers, and transparent corrections and adjustments will be critical to improve the quality of health statistics generated from health facility data.