Showing papers by "University of Zimbabwe published in 2010"

Antiretroviral Treatment for Children with Peripartum Nevirapine Exposure

Abstract: Background Single-dose nevirapine is the cornerstone of the regimen for prevention of mother-to-child transmission of human immunodeficiency virus (HIV) in resource-limited settings, but nevirapine frequently selects for resistant virus in mothers and children who become infected despite prophylaxis. The optimal antiretroviral treatment strategy for children who have had prior exposure to single-dose nevirapine is unknown. Methods We conducted a randomized trial of initial therapy with zidovudine and lamivudine plus either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 6 to 36 months of age, in six African countries, who qualified for treatment according to World Health Organization (WHO) criteria. Results are reported for the cohort that included children exposed to single-dose nevirapine prophylaxis. The primary end point was virologic failure or discontinuation of treatment by study week 24. Enrollment in this cohort was terminated early on the recommendation of the data and safety ...

How to Improve the Validity of Sexual Behaviour Reporting: Systematic Review of Questionnaire Delivery Modes in Developing Countries

Abstract: OBJECTIVES To systematically review comparative research from developing countries on the effects of questionnaire delivery mode. METHODS We searched Medline, EMbase and PsychINFO and ISSTDR conference proceedings. Randomized control trials and quasi-experimental studies were included if they compared two or more questionnaire delivery modes, were conducted in a developing country, reported on sexual behaviours and occurred after 1980. RESULTS A total of 28 articles reporting on 26 studies met the inclusion criteria. Heterogeneity of reported trial outcomes between studies made it inappropriate to combine trial outcomes. Eighteen studies compared audio computer-assisted survey instruments (ACASI) or its derivatives [personal digital assistant (PDA) or computer-assisted personal interview (CAPI)] against another self-administered questionnaires, face-to-face interviews or random response technique. Despite wide variation in geography and populations sampled, there was strong evidence that computer-assisted interviews lowered item-response rates and raised rates of reporting sensitive behaviours. ACASI also improved data entry quality. A wide range of sexual behaviours were reported including vaginal, oral, anal and/or forced sex, age of sexual debut, condom use at first and/or last sex. Validation of self-reports using biomarkers was rare. CONCLUSIONS These data reaffirm that questionnaire delivery modes do affect self-reported sexual behaviours and that use of ACASI can significantly reduce reporting bias. Its acceptability and feasibility in developing country settings should encourage researchers to consider its use when conducting sexual health research. Triangulation of self-reported data using biomarkers is recommended. Standardizing sexual behaviour measures would allow for meta-analysis.

Early versus Delayed Initiation of Antiretroviral Therapy for Concurrent HIV Infection and Cryptococcal Meningitis in Sub-Saharan Africa

Abstract: BACKGROUND. Cryptococcal meningitis (CM) remains a leading cause of acquired immunodeficiency syndrome-related death in sub-Saharan Africa. The timing of the initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-associated CM remains uncertain. The study aimed to determine the optimal timing for initiation of ART in HIV-positive individuals with CM. METHODS. A prospective, open-label, randomized clinical trial was conducted at a tertiary teaching hospital in Zimbabwe. Participants were aged > or = 18 years, were ART naive, had received a first CM diagnosis, and were randomized to receive early ART (within 72 h after CM diagnosis) or delayed ART (after 10 weeks of treatment with fluconazole alone). Participants received 800 mg of fluconazole per day. The ART regimen used was stavudine, lamivudine, and nevirapine given twice daily. The duration of follow-up was up to 3 years. The primary end point was all-cause mortality. RESULTS. Fifty-four participants were enrolled in the study (28 in the early ART arm and 26 in the delayed ART arm). The median CD4 cell count at enrollment was 37 cells/mm(3) (interquartile range, 17-69 cells/mm(3)). The 3-year mortality rate differed significantly between the early and delayed ART groups (88% vs 54%; P < .006); the overall 3-year mortality rate was 73%. The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively (P = .031, by log-rank test). The risk of mortality was almost 3 times as great in the early ART group versus the delayed ART group (adjusted hazard ratio, 2.85; 95% confidence interval, 1.1-7.23). The study was terminated early by the data safety monitoring committee. CONCLUSIONS. In resource-limited settings where CM management may be suboptimal, when compared with a delay of 10 weeks after a CM diagnosis, early initiation of ART results in increased mortality. Trial registration. ClinicalTrials.gov identifier: NCT00830856.

Unfulfilled promises? Heritage management and community participation at some of Africa's cultural heritage sites

Abstract: The application of participatory management has had varied success in the field of heritage management depending on the context in which it has been applied, and the evidence from some heritage sites in sub‐Saharan Africa reveals mixed results; some far from satisfactory. Most of the goals – particularly those aimed at involving local communities in decision making in heritage resources – still remain unfulfilled and at best experimental. This contribution deals with these issues within the context of case studies drawn from different areas of the sub‐continent. The case studies demonstrate that the discourse of community participation is sometimes overly ambitious in its intents and, from a practical point of view, is not easy to apply. This is because communities are neither universal nor homogenous. Furthermore, many professionals pay lip‐service to the whole concept of participation because the interests of local communities and those of professionals do not always coincide. Also, in some situations, ...

Hormonal contraception and HIV acquisition: reanalysis using marginal structural modeling.

Abstract: During the HC-HIV Study more than 30% of participants switched their contraceptive method. The decision to switch contraceptive use was found to be associated with participants’ use of condoms, their sexual behavioral risk, and their partners’ behavioral risks – all risk factors for HIV acquisition in the HC-HIV Study dataset. Furthermore, these HIV risk factors changed over time and may both predict subsequent hormonal contraceptive use and be predicted by past hormonal contraceptive exposure and thus were found to be time-dependent confounders. Use of conventional Cox proportional hazard regression modeling as applied in the original analysis [1] cannot satisfactorily adjust for

Micro-dosing as a pathway to Africa’s Green Revolution: evidence from broad-scale on-farm trials

Abstract: Next to drought, poor soil fertility is the single biggest cause of hunger in Africa. ICRISAT-Zimbabwe has been working for the past 10 years to encourage small-scale farmers to increase inorganic fertiliser use as the first step towards Africa’s own Green Revolution. The program of work is founded on promoting small quantities of inorganic nitrogen (N) fertiliser (micro-dosing) in drought-prone cropping regions. Results from initial on-farm trials showed that smallholder farmers could increase their yields by 30–100% through application of micro doses, as little as 10 kg Nitrogen ha−1. The question remained whether these results could be replicated across much larger numbers of farmers. Wide scale testing of the micro-dosing (17 kg Nitrogen ha−1) concept was initiated in 2003/2004, across multiple locations in southern Zimbabwe through relief and recovery programs. Each year more than 160,000 low resourced households received at least 25 kg of nitrogen fertiliser and a simple flyer in the vernacular explaining how to apply the fertiliser to a cereal crop. This distribution was accompanied by a series of simple paired plot demonstration with or without fertiliser, hosted by farmers selected by the community, where trainings were carried out and detailed labour and crop records were kept. Over a 3 year period more than 2,000 paired-plot trials were established and quality data collected from more than 1,200. In addition, experimentation to derive N response curves of maize (Zea mays L.), sorghum (Sorghum bicolor (L.) Moench) and pearl millet (Pennisetum glaucum (L.) R.Br.) in these environments under farmer management was conducted. The results consistently showed that micro-dosing (17 kg Nitrogen ha−1) with nitrogen fertiliser can increase grain yields by 30–50% across a broad spectrum of soil, farmer management and seasonal climate conditions. In order for a household to make a profit, farmers needed to obtain between 4 and 7 kg of grain for every kg of N applied depending on season. In fact farmers commonly obtained 15–45 kg of grain per kg of N input. The result provides strong evidence that lack of N, rather than lack of rainfall, is the primary constraint to cereal crop yields and that micro-dosing has the potential for broad-scale impact on improving food security in these drought prone regions.

Causes of acute hospitalization in adolescence: burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: a prospective survey.

Abstract: BACKGROUND: Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV seroprevalence has not previously been investigated. METHODS AND FINDINGS: Adolescents (aged 10-18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. 139 (46%) of 301 participants were HIV-positive (median age of diagnosis 12 y: interquartile range [IQR] 11-14 y), median CD4 count = 151; IQR 57-328 cells/microl), but only four (1.3%) were herpes simplex virus-2 (HSV-2) positive. Age (median 13 y: IQR 11-16 y) and sex (57% male) did not differ by HIV status, but HIV-infected participants were significantly more likely to be stunted (z-score<-2: 52% versus 23%, p<0.001), have pubertal delay (15% versus 2%, p<0.001), and be maternal orphans or have an HIV-infected mother (73% versus 17%, p<0.001). 69% of HIV-positive and 19% of HIV-negative admissions were for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions. CONCLUSION: HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV/AIDS. Low HSV-2 prevalence and high maternal orphanhood rates provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care.

Antiretroviral Therapies in Women after Single-Dose Nevirapine Exposure

Abstract: Background Peripartum administration of single-dose nevirapine reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) but selects for nevirapine-resistant virus. Methods In seven African countries, women infected with HIV-1 whose CD4+ T-cell counts were below 200 per cubic millimeter and who either had or had not taken single-dose nevirapine at least 6 months before enrollment were randomly assigned to receive antiretroviral therapy with tenofovir–emtricitabine plus nevirapine or tenofovir-emtricitabine plus lopinavir boosted by a low dose of ritonavir. The primary end point was the time to confirmed virologic failure or death. Results A total of 241 women who had been exposed to single-dose nevirapine began the study treatments (121 received nevirapine and 120 received ritonavir-boosted lopinavir). Significantly more women in the nevirapine group reached the primary end point than in the ritonavir-boosted lopinavir group (26% vs. 8%) (adjusted P=0.001). Virologic failure occu...

Causes and consequences of psychological distress among orphans in eastern Zimbabwe

Abstract: Substantial resources are invested in psychological support for children orphaned or otherwise made vulnerable in the context of HIV/AIDS (OVC). However, there is still only limited scientific evidence for greater psychological distress amongst orphans and even less evidence for the effectiveness of current support strategies. Furthermore, programmes that address established mechanisms through which orphanhood can lead to greater psychological distress should be more effective. We use quantitative and qualitative data from Eastern Zimbabwe to measure the effects of orphanhood on psychological distress and to test mechanisms for greater distress amongst orphans suggested in a recently published theoretical framework. Orphans were found to suffer greater psychological distress than non-orphans (sex- and age-adjusted co-efficient: 0.15; 95% CI 0.030.26; P0.013). Effects of orphanhood contributing to their increased levels of distress included trauma, being out-of-school, being cared for by a non-parent, inadequate care, child labour, physical abuse, and stigma and discrimination. Increased mobility and separation from siblings did not contribute to greater psychological distress in this study. Over 40% of orphaned children in the sample lived in households receiving external assistance. However, receipt of assistance was not associated with reduced psychological distress. These findings and the ideas put forward by children and caregivers in the focus group discussions suggest that community-based programmes that aim to improve caregiver selection, increase support for caregivers, and provide training in parenting responsibilities and skills might help to reduce psychological distress. These programmes should be under-pinned by further efforts to reduce poverty, increase school attendance and support out-of-school youth.

The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth.

Abstract: Background: HIV prevention among young people in southern Africa is a public health priority. There is little rigorous evidence of the effectiveness of different intervention approaches. We describe findings of a cluster randomized trial of a community-based, multicomponent HIV, and reproductive health intervention aimed at changing social norms for adolescents in rural Zimbabwe.Methods: Thirty rural communities were randomized to early or deferred implementation of the intervention in 2003. Impact was assessed in a representative survey of 18-22-year-olds after 4 years. Participants self-completed a questionnaire and gave a dried blood spot sample for HIV and herpes simplex virus-2 (HSV-2) antibody testing. Young women had a urinary pregnancy test. Analyses were by intention-to-treat and were adjusted for clustering.Findings: Four thousand six hundred and eighty-four, 18-22-year-olds participated in the survey (97.1% of eligible candidates, 55.5% women). Just over 40% had been exposed to at least 10 intervention sessions. There were modest improvements in knowledge and attitudes among young men and women in intervention communities, but no impact on self-reported sexual behavior. There was no impact of the intervention on prevalence of HIV or HSV-2 or current pregnancy. Women in intervention communities were less likely to report ever having been pregnant.Interpretation: Despite an impact on knowledge, some attitudes, and reported pregnancy, there was no impact of this intervention on HIV or HSV-2 prevalence, further evidence that behavioral interventions alone are unlikely to be sufficient to reverse the HIV epidemic. The challenge remains to find effective HIV prevention approaches for young people in the face of continued and unacceptably high HIV incidence, particularly among young women. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Undiagnosed HIV Infection among Adolescents Seeking Primary Health Care in Zimbabwe

Abstract: Background. Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. We therefore investigated the epidemiology of HIV infection at the primary care level.Methods. Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counseling and testing. Patients attending for acute primary care (APC) who were HIV infected were asked about their risk factors.Results. Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among APC attendees than among antenatal care attendees (17% vs 6%; P < .007), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%; P < .002). Seventy (81%) of 86 HIV-positive APC attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/mu L (interquartile range, 176-485 cells/mu L) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs 12%; P < .001). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive APC attendees, only one of whom was HSV-2 positive.Conclusions. Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counseling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications.

Farmers' insect pest management practices and pesticidal plant use in the protection of stored maize and beans in Southern Africa

Abstract: Storage losses due to pests threaten livelihoods of farmers across Africa. Synthetic pesticides provide effective control when used correctly but resource-poor farmers cannot afford them. A survey of farmer ethno-ecological knowledge of pests of stored maize and bean, and their pest management practices including pesticidal plant use, was conducted in eastern Zambia and northern Malawi. Almost all respondents reported serious pest damage, with bruchids (Callosobruchus maculatus) and grain weevils (Sitophilus spp.) being major pests in beans and maize, respectively. The larger grain borer (Prostephanus truncatus) was reported more widely in Malawi. In Zambia, 50% of farmers used synthetic pesticides during storage, while nearly all did so in Malawi. Despite differences in storage methods between Malawi and Zambia, farmers in both countries were familiar with pesticidal plants, where Tephrosia vogelii was the most frequently reported. Surprisingly few farmers actually used pesticidal plants, highlighting a promotion opportunity. Our results provide a foundation for optimizing the use of pesticidal plants and enhancing their value to resource-poor farmers, across Africa.

Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe.

Abstract: This study tested the feasibility of a combined microcredit and life-skills HIV prevention intervention among 50 adolescent female orphans in urban/peri-urban Zimbabwe. Quantitative and qualitative data were collected on intervention delivery, HIV knowledge and behavior, and economic indicators. The study also tested for HIV, HSV-2, and pregnancy. At 6 months, results indicated improvements in knowledge and relationship power. Because of the economic context and lack of adequate support, however, loan repayment and business success was poor. The results suggest that microcredit is not the best livelihood option to reduce risk among adolescent girls in this context.

Type-specific cervico-vaginal human papillomavirus infection increases risk of HIV acquisition independent of other sexually transmitted infections.

Abstract: Background Sexually transmitted infections (STIs) such as herpes simplex virus (HSV)-2 are associated with an increased risk of HIV infection. Human papillomavirus (HPV) is a common STI, but little is know about its role in HIV transmission. The objective of this study was to determine whether cervico-vaginal HPV infection increases the risk of HIV acquisition in women independent of other common STIs.

Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe

Abstract: Despite the significant burden of common mental disorders (CMD) among women in sub Saharan Africa, data on postnatal depression (PND) is very limited, especially in settings with a high HIV prevalence. The Edinburgh Postnatal Depression Scale (EPDS), a widely used screening test for PND has been validated in many countries, but not in Zimbabwe. We assessed the validity of the EPDS scale among postpartum women compared with Diagnostic Manual of Mental Disorders (DSM-IV) criteria for major depression. Six trained community counselors administered the Shona version of the EPDS to a random sample of 210 postpartum HIV-infected and uninfected women attending two primary care clinics in Chitungwiza. All women were subsequently subjected to mental status examination using DSM IV criteria for major depression by 2 psychiatrists, who were blinded to the subject’s EPDS scores. Data were analyzed using receiver operating characteristic (ROC) curve analysis. Of the 210 postpartum mothers enrolled, 64 (33%) met DSM IV criteria for depression. Using a cut-off score of 11/12 on the Shona version of the EPDS for depression, the sensitivity was 88%, and specificity was 87%, with a positive predictive value of 74%, a negative predictive value of 94%, and an area under the curve of 0.82. Cronbach's alpha coefficient for the whole scale was 0.87. Conclusion: The Shona version of the EPDS is a reliable and valid tool to screen for PND among HIV-infected and un-infected women in Zimbabwe. Screening for PND should be integrated into routine antenatal and postnatal care in areas with high HIV prevalence.

Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study.

Abstract: Objectives To estimate the rates and timing of mother to infant transmission of HIV associated with breast feeding in mothers who seroconvert postnatally, and their breast milk and plasma HIV loads during and following seroconversion, compared with women who tested HIV positive at delivery. Design Prospective cohort study. Setting Urban Zimbabwe. Participants 14 110 women and infants enrolled in the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial (1997-2001). Main outcome measures Mother to child transmission of HIV, and breast milk and maternal plasma HIV load during the postpartum period. Results Among mothers who tested HIV positive at baseline and whose infant tested HIV negative with polymerase chain reaction (PCR) at six weeks (n=2870), breastfeeding associated transmission was responsible for an average of 8.96 infant infections per 100 child years of breast feeding (95% CI 7.92 to 10.14) and varied little over the breastfeeding period. Breastfeeding associated transmission for mothers who seroconverted postnatally (n=334) averaged 34.56 infant infections per 100 child years (95% CI 26.60 to 44.91) during the first nine months after maternal infection, declined to 9.50 (95% CI 3.07 to 29.47) during the next three months, and was zero thereafter. Among women who seroconverted postnatally and in whom the precise timing of infection was known (≤90 days between last negative and first positive test; n=51), 62% (8/13) of transmissions occurred in the first three months after maternal infection and breastfeeding associated transmission was 4.6 times higher than in mothers who tested HIV positive at baseline and whose infant tested HIV negative with PCR at six weeks. Median plasma HIV concentration in all mothers who seroconverted postnatally declined from 5.0 log10 copies/mL at the last negative enzyme linked immunosorbent assay (ELISA) to 4.1 log10 copies/mL at 9-12 months after infection. Breast milk HIV load in this group was 4.3 log10 copies/mL 0-30 days after infection, but rapidly declined to 2.0 log10 copies/mL and Conclusions Breastfeeding associated transmission is high during primary maternal HIV infection and is mirrored by a high but transient peak in breast milk HIV load. Around two thirds of breastfeeding associated transmission by women who seroconvert postnatally may occur while the mother is still in the “window period” of an antibody based test, when she would test HIV negative using one of these tests. Trial registration Clinical trials.gov NCT00198718.

Plasma and Cervical Viral Loads among Ugandan and Zimbabwean Women during Acute and Early HIV-1 Infection

Abstract: Early HIV infection represents a dynamic period during which infection disseminates from local lymph nodes and HIV viremia initially climbs to very high levels followed by a decline to an equilibrium (viral setpoint). The high viremia levels in peripheral blood during early infection appear associated with high levels of HIV transmission [1]. In addition, the level of viral setpoint is an important predictor of subsequent HIV disease progression [2-4]. While this dynamic period has been well-documented in the peripheral blood, little is known about the dynamic of genital viral loads during early infection (first 6 months). Genital viral loads, the biologic mediator between plasma viral loads and HIV transmission, are important to understand particularly during the early infection period. Two recent studies conducted in men [5] and women [6] have documented high genital viral loads during this period. However, it is unclear if and when a setpoint is attained in the genital compartment. It is also unclear whether there are modifiable risk factors that influence genital viral loads during the early infection period. Few studies have examined factors associated with plasma viral setpoint. A study conducted among Kenyan sex workers [7] found that use of the injectable-progestin contraceptive depot-medroxyprogesterone acetate (DMPA) at the time of HIV infection was associated with a higher plasma viral load setpoint while the presence of genital ulcer disease (GUD) during early HIV infection was associated with higher subsequent plasma viral loads. However, these findings have not been corroborated. HIV-1 genital shedding among women can be affected by both systemic (pregnancy, hormonal contraceptive use, CD4 lymphocyte levels, plasma viral loads, HAART, HIV-1 subtype) [8-15] and local factors (menstruation, genital inflammation, cervical and vaginal infections, abnormal vaginal flora) [6;8-9;13;16-20]. However, factors associated with HIV-1 genital shedding during early HIV-1 infection have not been reported. We studied the relationship between plasma and genital HIV viral loads among Ugandan and Zimbabwean women during acute and early (first 6 months) HIV infection and examine factors, including hormonal contraceptive use, that may be associated with plasma and genital viral loads during this period and could impact subsequent HIV-1 disease progression or transmission. Data was drawn from a prospective cohort study of contraception and HIV acquisition – the Hormonal Contraception and the Risk of HIV Acquisition (HC-HIV) Study [21] and a subsequent study conducted among the women who became HIV-infected – the Hormonal Contraception and HIV-1 Genital Shedding and Disease Progression among Women with Primary HIV Infection (GS) Study.

Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe

Abstract: Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT.

Fruits of Their Labors: Gender, Property Rights, and Tree Planting in Two Zimbabwe Villages

Abstract: An analysis of tree planting by women and men in two Zimbabwe villages demonstrates that women are significantly less likely than men to plant trees on homestead land where the security of their duration of tenure is uncertain due to the likelihood of change in marital status However, men and women are equally likely to plant trees in community woodlots where the duration of their tenure is secure if they remain village residents These findings demonstrate the importance of attention to gendered security of tenure at the sub-household level

Postnatal depression by HIV status among women in Zimbabwe.

Abstract: Background: Postnatal depression (PND) is a serious public health problem in resource-limited countries. Research is limited on PND affecting HIV-infected women in sub-Saharan Africa. Zimbabwe has one of the highest antenatal HIV infection rates in the world. We determined the prevalence and risk factors of PND among women attending urban primary care clinics in Zimbabwe. Methods: Using trained peer counselors, a simple random sample of postpartum women (n = 210) attending the 6-week postnatal visit at two urban primary care clinics were screened for PND using the Shona version of the Edinburgh Postnatal Depression Scale (EPDS). All women were subsequently subjected to mental status examination using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression by two psychiatrists who had no knowledge of the EPDS test results. Results: Of the 210 mothers (31 HIV positive, 148 HIV negative, 31 unknown status) enrolled during the postpartum period, 64 (33%) met D...

Chronic cough and its association with TB-HIV co-infection: factors affecting help-seeking behaviour in Harare, Zimbabwe

Abstract: OBJECTIVE To qualitatively investigate reasons why individuals who reported chronic cough of 2 weeks or more in a cross-sectional prevalence survey had not accessed community-based outreach or other diagnostic services. METHODS This study was nested into a cluster randomised trial comparing two methods of providing community-level diagnosis for tuberculosis (TB). Twenty individuals (12 males) with previously unreported chronic cough, because of undiagnosed pulmonary TB in five cases, were interviewed. An additional 20 individuals who had attended clinical services participated in two focus group discussions. Data were coded and analysed using grounded theory principles. RESULTS Participants described cough, and specifically their own symptoms, as having many possible causes other than TB. People avoided care-seeking for cough to avoid a possible diagnosis of 'TB2' (HIV-related TB). Waiting in the hope of spontaneous resolution was common. Delaying treatment-seeking was also a strategy for deferring costs. Another common theme was negative perceptions of health facilities, as places where people anticipated discourteous treatment and being put at risk of contracting TB and HIV. Expectations that they should be in control of their own health further contributed to delayed health-seeking in men. CONCLUSIONS Some individuals remain reluctant to be investigated for chronic cough even when provided with community-level services, with fear of the connotations of being diagnosed with TB and an aversion to contact with health providers among the dominant themes. In men, deferred acceptance that a chronic cough should be investigated may be related to concepts of masculinity, especially when symptoms are mild.

The burden and risk factors of Sexually Transmitted Infections and Reproductive Tract Infections among pregnant women in Zimbabwe

Abstract: Sexually transmitted infections (STIs) and Reproductive tract infections (RTIs) are responsible for high morbidity among women. We aim to quantify the magnitude of the burden and risk factors of STI/RTI s among pregnant women in Zimbabwe. A cross sectional study of pregnant women enrolled at 36 weeks of gestation from the national PMTCT program. Study was conducted from three peri-urban clinics around Harare Zimbabwe offering maternal and child health services. A total of 691 pregnant women were enrolled. Prevalence of HSV was (51.1%), HIV (25.6%) syphilis (1.2%), Trichomonas vaginalis (11.8%), bacterial vaginosis (32.6%) and Candidiasis (39.9%). Seven percent of the women had genital warts, 3% had genital ulcers and 28% had an abnormal vaginal discharge. Prevalence of serological STIs and vaginal infections were 51% and 64% respectively. Risk factors for a positive serologic STI were increasing age above 30 years, polygamy and multigravid; adjusted OR (95% CI) 2.61(1.49-4.59), 2.16(1.06-4.39), 3.89(1.27-11.98) respectively, partner taking alcohol and number of lifetime sexual partners. For vaginal infections it was age at sexual debut; OR (95% CI) 1.60(1.06-2.42). More than 25% of the women reported previous STI treatment. Fifty two percent reported ever use of condoms and 65% were on oral contraceptives. Mean age gap for sexual partners was 6.3 years older. There is a high morbidity of STI/RTIs in this cohort. There is need to continuously screen, counsel, treat and monitor trends of STI/RTIs to assess if behaviour changes lead to reduction in infections and their sustainability.

Implementing integrated disease surveillance and response: four African countries' experience, 1998-2005.

Abstract: The Integrated Disease Surveillance and Response (IDSR) strategy was developed by the Africa Regional Office (AFRO) of the World Health Organisation (WHO) and proposed for adoption by member states in 1998. The goal was to build WHO/AFRO countries' capacity to detect, report and effectively respond to priority infectious diseases. This evaluation focuses on the outcomes in four countries that implemented this strategy. Major successes included: integration of the surveillance function of most of the categorical disease control programmes; implementation of standard surveillance, laboratory and response guidelines; improved timeliness and completeness of surveillance data and increased national-level review and use of surveillance data for response. The most challenging aspects were: strengthening laboratory networks; providing regular feedback and supervision on surveillance and response activities; routine monitoring of IDSR activities and extending the strategy to sub-national levels.

Tenures in Transition, Tenures in Conflict: Examples from the Zimbabwe Social Forest1

Abstract: The landscapes of rural communities are commonly divided into areas in which distinctive resource uses are practiced and for which there exist particular types of property rights. Such tenure niches for different resources may overlap where those resources themselves occupy the same space (e.g., land and trees). Further, competing legal and utilization systems (e.g., national and local) may place the same resource in different incompatible tenure niches. Conflict may involve overlapping tenure niches. Co-management by conflicting right-holders may offer a solution.

Parks-people conflicts: the case of Gonarezhou National Park and the Chitsa community in south-east Zimbabwe

Abstract: National parks have been the centre piece of international conservation strategies in developing countries. The expansion in the network of national parks has enabled the conservation of biodiversity and habitats but the acquisition of vast areas into the park system has often been achieved through the displacement of resident local communities. Displaced people are exposed to a variety of impoverishment risks and this stokes up animosity towards parks. The research reported here seeks to understand the key issues involved in the occupation of a section of Gonarezhou National Park by Headman Chitsa's people. The paper examines how the interplay between the history of displacement and dispossession, demographic pressures, limited economic opportunities, the 'fast track' land reform programme and dynastic politics are fomenting the land conflict between Gonarezhou and Chitsa community. Secondary actors with diverse interests have also come into the fold. Official efforts to resolve the conflict using a top-down approach have yielded little success. This culminated in a shift towards the use of traditional mechanisms of resolving a chieftaincy dispute as a step towards addressing the broader parks-people land conflict. Lessons from the case study are, inter alia, that interventions aimed at resolving parks-people conflicts should be alive to local culture, livelihood needs and power dynamics and, to the extent possible, eschew forcible relocations. Finally, we draw attention to the need to address the wider contradiction between policies promoting wildlife conservation and those promoting agriculture. The article is written to share lessons with readers interested in parks-people conflicts. (Resume d'auteur)