Showing papers by "University of Zimbabwe published in 2012"

Tuberculosis Diagnostics and Biomarkers: Needs, Challenges, Recent Advances, and Opportunities

Abstract: Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics.

Nevirapine versus ritonavir-boosted lopinavir for HIV-infected children.

Abstract: Background Nevirapine-based antiretroviral therapy is the predominant (and often the only) regimen available for children in resource-limited settings. Nevirapine resistance after exposure to the drug for prevention of maternal-to-child human immunodeficiency virus (HIV) transmission is common, a problem that has led to the recommendation of ritonavir-boosted lopinavir in such settings. Regardless of whether there has been prior exposure to nevirapine, the performance of nevirapine versus ritonavir-boosted lopinavir in young children has not been rigorously established. Methods In a randomized trial conducted in six African countries and India, we compared the initiation of HIV treatment with zidovudine, lamivudine, and either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 2 to 36 months of age who had no prior exposure to nevirapine. The primary end point was virologic failure or discontinuation of treatment by study week 24. Results A total of 288 children were enrolled; the median p...

Role of Polyphenol Oxidase, Peroxidase, Phenylalanine Ammonia Lyase, Chlorogenic Acid, and Total Soluble Phenols in Resistance of Potatoes to Soft Rot.

Abstract: Pectobacterium atrosepticum, P. carotovorum subsp. brasiliensis, and Dickeya spp. cause soft rot of potato (Solanum tuberosum) worldwide. Plants respond to bacterial invasion by activating defense responses associated with accumulation of several enzymes and inhibitors, which prevent pathogen infection. This study focused on the role of polyphenol oxidase (PPO), peroxidase (POD), phenylalanine ammonia lyase (PAL), chlorogenic acid, and total soluble phenols in imparting resistance to soft rot pathogens. Seven and 11 varieties grown by farmers in South Africa and Zimbabwe, respectively, were used in the study. The results showed significantly higher (P < 0.001) enzyme activity of PPO and PAL as well as higher concentrations of chlorogenic acid and total soluble phenols in Vanderplank, Pentland Dell, M69/11, Romano, M59/20, and MondialZw. PAL activity increased significantly with time in all varieties, and the highest activity was recorded 8 h after cutting. The resistance of the varieties was corr...

Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial.

Abstract: BACKGROUND: Few data have described long-term outcomes for infants born to HIV-infected African women taking antiretroviral therapy (ART) in pregnancy. This is particularly true for World Health Organization (WHO)-recommended tenofovir-containing first-line regimens, which are increasingly used and known to cause renal and bone toxicities; concerns have been raised about potential toxicity in babies due to in utero tenofovir exposure. METHODS AND FINDINGS: Pregnancy outcome and maternal/infant ART were collected in Ugandan/Zimbabwean HIV-infected women initiating ART during The Development of AntiRetroviral Therapy in Africa (DART) trial, which compared routine laboratory monitoring (CD4; toxicity) versus clinically driven monitoring. Women were followed 15 January 2003 to 28 September 2009. Infant feeding, clinical status, and biochemistry/haematology results were collected in a separate infant study. Effect of in utero ART exposure on infant growth was analysed using random effects models. 382 pregnancies occurred in 302/1,867 (16%) women (4.4/100 woman-years [95% CI 4.0-4.9]). 226/390 (58%) outcomes were live-births, 27 (7%) stillbirths (≥22 wk), and 137 (35%) terminations/miscarriages ( 0.4). Of 219 surviving infants, 182 (83%) enrolled in the follow-up study; median (interquartile range [IQR]) age at last visit was 25 (12-38) months. From mothers' ART, 62/9/111 infants had no/20%-89%/≥90% in utero tenofovir exposure; most were also zidovudine/lamivudine exposed. All 172 infants tested were HIV-negative (ten untested). Only 73/182(40%) infants were breast-fed for median 94 (IQR 75-212) days. Overall, 14 infants died at median (IQR) age 9 (3-23) months, giving 5% 12-month mortality; six of 14 were HIV-uninfected; eight untested infants died of respiratory infection (three), sepsis (two), burns (one), measles (one), unknown (one). During follow-up, no bone fractures were reported to have occurred; 12/368 creatinines and seven out of 305 phosphates were grade one (16) or two (three) in 14 children with no effect of in utero tenofovir (p>0.1). There was no evidence that in utero tenofovir affected growth after 2 years (p = 0.38). Attained height- and weight for age were similar to general (HIV-uninfected) Ugandan populations. Study limitations included relatively small size and lack of randomisation to maternal ART regimens. CONCLUSIONS: Overall 1-year 5% infant mortality was similar to the 2%-4% post-neonatal mortality observed in this region. No increase in congenital, renal, or growth abnormalities was observed with in utero tenofovir exposure. Although some infants died untested, absence of recorded HIV infection with combination ART in pregnancy is encouraging. Detailed safety of tenofovir for pre-exposure prophylaxis will need confirmation from longer term follow-up of larger numbers of exposed children. TRIAL REGISTRATION: www.controlled-trials.com ISRCTN13968779

Efficacy and safety of three antiretroviral regimens for initial treatment of HIV-1: a randomized clinical trial in diverse multinational settings.

Abstract: Background Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world. Methods and Findings 1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure. An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72–1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54–0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39–0.64 for women; HR 0.79, CI 0.62–1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12–2.04; p = 0.007). Conclusion EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen. Trial Registration www.ClinicalTrials.gov NCT00084136 Please see later in the article for the Editors' Summary.

Failing to yield? Ploughs, Conservation Agriculture and the problem of agricultural intensification: An example from the Zambezi Valley, Zimbabwe

Abstract: Agricultural intensification, or increasing yield, has been a persistent theme in policy interventions in African smallholder agriculture. This article focuses on two hegemonic policy models of such intensification: (1) the ‘Alvord model’ of plough-based, integrated crop-livestock farming promoted in colonial Zimbabwe; and (2) minimum-tillage mulch-based, Conservation Agriculture, as currently preached by a wide range of international agricultural research and development agencies. An analysis of smallholder farming practices in Zimbabwe's Zambezi Valley, reveals the limited inherent understanding of farmer practices in these models. It shows why many smallholder farmers in southern Africa are predisposed towards extensification rather than intensification, and suggests that widespread Conservation Agriculture adoption is unlikely.

The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

Abstract: Background Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made. Methods and findings Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis. Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained. Conclusions Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects. To inform the implementation of effective referral interventions, improved monitoring and evaluation practices are necessary, along with studies that develop better understanding of how interventions work. Please see later in the article for the Editors' Summary

Assessment of eight HPV vaccination programs implemented in lowest income countries

Abstract: Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP) The GAP provides free HPV vaccine to organizations and institutions in lowest income countries The HPV vaccination programs were entirely developed, implemented and managed by local institutions Institutions submitted application forms with institution characteristics, target population, communication delivery strategies After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models Two indicators were calculated, the program vaccination coverage and adherence Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges A total of eight programs were implemented in seven countries The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 878%; the mean adherence between the first and third doses of vaccine was 909% Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities Models that included school-based vaccination were most effective at reaching girls aged 9-13 years Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods Increased rates of program coverage and adherence were positively correlated with the number of vaccination sites Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year limit the number of girls lost to follow-up Mixed models that incorporate both schools and health facilities appear to be the most effective at delivering HPV vaccine This study provides lessons for development of public health programs and policies as countries go forward in national decision-making for HPV vaccination

Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection

Abstract: Background. Long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection are reaching adolescence in large numbers in Africa and are at high risk of delayed diagnosis and chronic complications of untreated HIV infection. Chronic respiratory symptoms are more common than would be anticipated based on the HIV literature. Methods. Consecutive adolescents with presumed vertically acquired HIV attending 2 HIV care clinics in Harare, Zimbabwe, were recruited and assessed with clinical history and examination, CD4 count, pulmonary function tests, Doppler echocardiography, and chest radiography (CXR). Those with suspected nontuberculous chronic lung disease (CLD) were scanned using high-resolution computed tomography (HRCT). Results. Of 116 participants (43% male; mean age, 14 ± 2.6 years, mean age at HIV diagnosis, 12 years), 69% were receiving antiretroviral therapy. Chronic cough and reduced exercise tolerance were reported by 66% and 21% of participants, respectively; 41% reported multiple respiratory tract infections in the previous year, and 10% were clubbed. More than 40% had hypoxemia at rest (13%) or on exercise (29%), with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) in 7%. Forced expiratory volume in 1 second (FEV1) was <80% predicted in 45%, and 47% had subtle CXR abnormalities. The predominant HRCT pattern was decreased attenuation as part of a mosaic attenuation pattern (31 of 56 [55%]), consistent with small airway disease and associated with bronchiectasis (Spearman correlation coefficient (r 2 = 0.8) and reduced FEV1 (r 2 = −0.26).

Livelihoods after Land Reform in Zimbabwe: Understanding Processes of Rural Differentiation

Abstract: This paper explores the consequences of Zimbabwe's land reform for the dynamics of differentiation in Zimbabwe's countryside, reporting on the results from a 10-year study from Masvingo province. Based on a detailed analysis of livelihoods across 400 households at 16 sites, the paper offers a detailed typology of livelihood strategies, linked to a class-based analysis of emerging agrarian dynamics. The paper identifies a significant and successful ‘middle farmer’ group, reliant on ‘accumulation from below’ through petty commodity production, existing alongside other worker-peasants and the semi-peasantry, whose livelihoods remain vulnerable, with prospects for accumulation currently limited. In addition, there are others who are ‘accumulating from above’, through patronage and corruption. While small in number, this group has significant political and economic influence, and is embedded in powerful alliances that have fundamental impacts on the wider political–economic dynamics. To conclude, the economic, social and political implications of the emerging patterns of differentiation in Zimbabwe's countryside are discussed.

Current status and future prospects of epidemiology and public health training and research in the WHO African region

Abstract: Background To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. Methods A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend 90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes’ [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90–6.11; P = 0.03] and ‘number of HIV/AIDS patients’ (IRR = 1.30; 95% CI 1.02–1.66; P < 0.001). Conclusions Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continent.

Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe

Abstract: Background. Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries. Methods. We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus–infected adults (aged 18–73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda. Results. One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0–49, 50–99 or ≥100 CD4 cells/μL was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4–15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%–4%: 9.1%; 5%–9%: 4.5%; ≥10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days). Conclusions. Children ≥4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits.

Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief

Abstract: In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide.

Measuring forest floor and canopy interception in a savannah ecosystem

Abstract: Interception is one of the most underestimated processes of the hydrological cycle. However, it amounts to a substantial part of the terrestrial evaporation and forms a direct feedback of moisture to the atmosphere which is important to sustain continental rainfall. Most investigations on interception focus on canopy interception only, whereas the interception by the surface and forest floor may be of same order of magnitude. Moreover there is a regional bias. Most research has been carried out in Europe and America and little is known about interception in Africa. This paper presents a study on forest floor and canopy interception in a savannah ecosystem. The study deals with both interception storage capacity of different vegetation types and the related moisture fluxes. The interception storage capacity of Msasa leaf litter and of Thatching grass is 1.8 mm and 1.5 mm respectively. This water storage capacity is dependent on storm intensity, with high intensity storms resulting in smaller storage capacity than less intensive storms. Canopy interception for the study period averaged 25% of the total rainfall, which is comparable with other studies. More importantly, the study revealed that combining canopy and forest floor interception yields a total interception flux amounting to 37% of the rainfall, or close to 50% of the total evaporation. This is a significant amount which implies that interception of both canopy and forest floor should be included in hydrological modelling and that interception is relevant for water management.

Survey of brucellosis at the wildlife–livestock interface on the Zimbabwean side of the Great Limpopo Transfrontier Conservation Area

Abstract: A cross-sectional study was conducted to determine the seroprevalence of bovine brucellosis in communal cattle and wildlife at a wildlife–livestock interface in the southeast lowveld of Zimbabwe, part of the Great Limpopo Transfrontier Conservation Area. RBT and c-Elisa were used in serial for detection of antibodies against Brucella spp. Between July 2007 and October 2009, a total of 1,158 cattle were tested and the overall seroprevalence of brucellosis was 9.9%. A total of 97 wild animals (African buffaloes (n = 47), impala (n = 33), kudu (n = 16), and giraffe (n = 1)) were tested and only one animal (giraffe) was seropositive for brucellosis (1.03%). Brucella seroprevalence showed an increasing trend with age, with adult cattle (>6 years) recording the highest seroprevalence (11.1%), but the differences were not statistically significant. Similarly, female cattle recorded a relatively higher seroprevalence (10.8%) compared to males (7.9%), but the difference was not significant. However, a significant (P < 0.001) association between Brucella seropositivity and abortion history was recorded in female cattle. Similarly, Brucella seropositivity was significantly (P < 0.01) associated with a history of grazing in the park for female cattle. Overall, from the interface area, cattle with a history of grazing in the park recorded a significantly (P < 0.01) higher Brucella seroprevalence (13.5%) compared to those with no history of grazing in the park (4.9%). The significant association between abortion history and seropositivity observed in this study illustrates the potential economic significance of Brucella in cattle in this area. Hence, public awareness and further epidemiological studies of the disease in wildlife, livestock, and humans in the study area are of great importance.

Soil fertility management effects on maize productivity and grain zinc content in smallholder farming systems of Zimbabwe

Abstract: Low soil zinc (Zn) threatens crop production and food nutrition in most cereal-based cropping systems in Africa. Agronomic management options that include farmers’ locally available organic nutrient resources need to be evaluated in the context of Zn nutrition in staple cereals. A three-year study (2008–11) was conducted in two smallholder farming areas of eastern Zimbabwe to evaluate the influence of farmers’ diverse soil fertility management practices on soil Zn status and effect on uptake patterns and nutritional value in maize (Zea mays L.). Participatory research approaches and formal surveys enabled identification of farmers’ diverse soil fertility management practices, which were then classified into five main domains: manure or woodland litter + mineral fertilizer; sole mineral fertilizer; legume – maize rotation; and a non-fertilized control. Over 60 randomly selected farms in each study area were then surveyed for influence of identified practices on soil Zn status across the domains. Maize growth, yield and Zn uptake patterns were monitored on a sub-sample of 20 farms covering the five management domains in each study area. Ethylenediaminetetraacetic acid (EDTA) extractable soil Zn ranged from 0.50 to 2.43 mg kg−1. Different farmer management practices significantly influenced Zn uptake (p 2.1 t ha−1 maize grain, against <0.8 t ha−1 in the non-fertilized control. Maize grain Zn concentrations increased by 46–64 % over the control. Regardless of management practice, resultant phytic acid to Zn (PA: Zn) ratios were above the critical value of 15 suggesting inadequacies in current farmer management options. We conclude that the current farmer soil fertility management regimes are insufficient to influence Zn nutrition in maize grown without external Zn fertilization on Zimbabwean sandy soils.

Effects of cattle manure on selected soil physical properties of smallholder farms on two soils of Murewa, Zimbabwe

Abstract: The effects of cattle manure and inorganic N-fertilizer application on soil organic carbon (SOC), bulk density, macro-aggregate stability and aggregate protected carbon were determined on clay and sandy soils of the Murewa smallholder farming area, Zimbabwe. Maize was grown in four fields termed homefields (HFs) and outfields (OFs) because of spatial variability induced by management practices and with the following fertility treatments: control (no fertility amelioration), 5, 15 and 25 t ⁄ ha cattle manure + 100 kg ⁄ ha N applied annually for seven consecutive years. The addition of cattle manure resulted in significant (P 0.05) different on the clay soils. A significant and positive linear relationship (r 2 = 0.85) was found between SOC and macro-aggregate stability, while an r 2 value of 0.82 was obtained between SOC and aggregate protected carbon on the clay soils. However, no regressions were performed on data from the sandy soils because of the lack of significant changes in soil physical properties. Application of cattle manure and inorganic N-fertilizer significantly increased (P < 0.05) maize grain yield on both soil types. Results show that inorganic N-fertilizer combined with cattle manure at 5–15 t ⁄ ha per yr is necessary to increase maize yields and SOC on sandy soils in Murewa, while at least 15 t ⁄ ha per yr cattle manure is required on the clay soils to improve physical properties in addition to maize yields and SOC.

Patterns of uptake of HIV testing in sub-Saharan Africa in the pre-treatment era.

Abstract: Objectives To compare nationally representative trends in self-reported uptake of HIV testing and receipt of results in selected countries prior to treatment scale-up. Methods Demographic and Health Survey (DHS) data from 13 countries in sub-Saharan Africa were used to describe the pattern of uptake of testing for HIV among sexually active participants. Univariate and multivariate logistic regression were used to analyse the associations between socio-demographic and behavioural characteristics and the uptake of testing. Results Knowledge of serostatus ranged from 2.2% among women in Guinea (2005) to 27.4% among women in Rwanda (2005). Despite varied levels of testing, univariate analysis showed the profile of testers to be remarkably similar across countries, with respect to socio-demographic characteristics such as area of residence and socio-economic status. HIV-positive participants were more likely to have tested and received their results than HIV-negative participants, with the exception of women in Senegal and men in Guinea. Adjusted analyses indicate that a secondary or higher level of education was a key determinant of testing, and awareness that treatment exists was independently positively associated with testing, once other characteristics were taken into account. Conclusion This work provides a baseline for monitoring trends in testing and exploring changes in the profile of those who get tested after the introduction and scale-up of treatment.

Climate change and variability: smallholder farming communities in Zimbabwe portray a varied understanding.

Abstract: Increasing awareness of risks associated with climate change and variability among smallholder farmers is critical in building their capacity to develop the necessary adaptive measures. Using farmer participatory research approaches and formal questionnaire surveys, interaction has been made with >800 farmers in two distinct smallholder farming systems of Makoni and Wedza Districts in eastern Zimbabwe to determine the current level of understanding of climate change and variability, current responses to perceived changes, as well as identify sources of agro-meteorological information. The results indicated that farmers portrayed a varied understanding both within and across the study sites. While poor rainfall distribution was seen as the major indicator for climate change by over two-thirds of the respondents in both sites, more farmers in Makoni attributed delay in onset of rains, high incidences of flush floods and unpredictable ‘wind movements’ yielding cyclones to climate change. In Wedza, it was recurrent droughts, winter and summer temperature extremes, and increased pest and disease incidences for both crops and livestock that indicated climate change. Perceived changes were linked more to natural and human forces (Makoni), unknown forces as well as breakdown in cultural norms and beliefs and rise of Christianity (Wedza). Disparities between the two sites could be attributed to the inherent differences of the communities in terms to their social settings. The national extension, Agritex, was ranked first by 50-60% of the farmers as major source of weather information. Electronic media (radio and television) ranked second with 47% of farmers in Makoni and 35% in Wedza. Concerns were raised over inadequacies of such information, apparent lack of reliability, timing and frequency of dissemination that directly influenced the utilisation of the information. Common coping strategies included early planting which was the more prevalent in Makoni, while combinations of cereals and legumes were a preferred solution in Wedza. We concluded that farmers’ interaction with various information sources and knowledge sharing platforms needs to be enhanced in order to deepen their understanding as well as increase their capacity to respond to pressures of climate variability and change.

Improved Neuropsychological and Neurological Functioning Across Three Antiretroviral Regimens in Diverse Resource-Limited Settings: AIDS Clinical Trials Group Study A5199, the International Neurological Study

Abstract: Background. AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. Methods. Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. Results. The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). Conclusions. The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization –recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. Clinical trials registration. NCT00096824.

Pectinolytic bacteria associated with potato soft rot and blackleg in South Africa and Zimbabwe

Abstract: Soft rot and blackleg can cause severe economic losses in potato production in South Africa and Zimbabwe depending on climatic conditions. The aim of the study was to identify the predominant bacteria causing potato soft rot and blackleg in these countries. Samples, comprising of stems and tubers from potato plants with blackleg and soft rot symptoms were collected from 2006–2009 from potato production areas where disease outbreaks occurred. The isolates from these plants and tubers yielded Gram negative, pectinolytic bacteria on crystal violet pectate and inoculated tubers. Identification was based on biochemical and phenotypic characteristics, rep-PCR, Amplified Fragment Length Polymorphisms and sequences of gyrB and recA genes. Isolates from Zimbabwe were identified as Pectobacterium carotovorum subsp. brasiliensis (Pcb) (21 isolates), Dickeya dadantii subsp. dadantii (Dd) (20 isolates), P. c. subsp. carotovorum (Pcc) (16 isolates) and P. atrosepticum (Pa) (4 isolates). Pcb, Pcc and Dd subsp. dadantii were isolated from samples collected from all the regions, while Pa was isolated from Nyanga the coolest region in Zimbabwe. In South Africa, however, Pcb was the most common causal agent of soft rot and blackleg. P. atrosepticum was the only pathogen isolated from samples collected in Nyanga, Zimbabwe, and was not isolated from any South African samples. AFLP analysis separated the Pcb strains into 12 clusters, reflecting subdivision in terms of geographic origin, and Pcc isolates were clearly differentiated from Pcb isolates. A large degree of DNA polymorphism was evident among these 12 clusters. The study identified all the pathogens associated with the blackleg/soft rot disease complex.

Acceptability of early infant male circumcision as an HIV prevention intervention in Zimbabwe: a qualitative perspective.

Abstract: Background Early infant male circumcision (EIMC) is simpler, safer and more cost-effective than adult circumcision. In sub-Saharan Africa, there are concerns about acceptability of EIMC which could affect uptake. In 2009 a quantitative survey of 2,746 rural Zimbabweans (aged 18–44) indicated that 60% of women and 58% of men would be willing to have their newborn son circumcised. Willingness was associated with knowledge of HIV and male circumcision. This qualitative study was conducted to better understand this issue. Methods In 2010, 24 group discussions were held across Zimbabwe with participants from seven ethnic groups. Additionally, key informant interviews were held with private paediatricians who offer EIMC (n = 2) plus one traditional leader. Discussions were audio-recorded, transcribed, translated into English (where necessary), coded using NVivo 8 and analysed using grounded theory principles. Results Knowledge of the procedure was poor. Despite this, acceptability of EIMC was high among parents from most ethnic groups. Discussions suggested that fathers would make the ultimate decision regarding EIMC although mothers and extended family can have (often covert) influence. Participants' concerns centred on: safety, motive behind free service provision plus handling and disposal of the discarded foreskin. Older men from the dominant traditionally circumcising population strongly opposed EIMC, arguing that it separates circumcision from adolescent initiation, as well as allowing women (mothers) to nurse the wound, considered taboo. Conclusions EIMC is likely to be an acceptable HIV prevention intervention for most populations in Zimbabwe, if barriers to uptake are appropriately addressed and fathers are specifically targeted by the programme.

Creating food self reliance among the smallholder farmers of eastern Zimbabwe: exploring the role of integrated agricultural research for development

Abstract: The failure of the linear and non-participatory Agricultural Research and Development (ARD) approaches to increase food security among smallholder farmers in sub-Saharan Africa has prompted researchers to introduce an Integrated Agricultural Research for Development (IAR4D) concept. The IAR4D concept uses Innovation Platforms (IPs) to embed agricultural research and development organizations in a network to undertake multidisciplinary and participatory research. This paper uses Zimbabwe as a case study to analyze the relevance of the technologies and innovations that are being promoted by IPs in Zimbabwe to improve food security. Using data collected through the Sub-Saharan Africa Challenge Programme, the paper shows that access to inputs, social capital, productivity enhancing technologies and market information are critical in addressing food security issues among smallholder farmers. The multi-stakeholder partnership forged through IPs should adopt a coordinated approach to provide smallholders with access to these prerequisites for food security. The paper argues that more emphasis should be put on these issues rather than on farm research initiatives whose contribution to food security appears to be less significant.

Antiretroviral therapy uptake and coverage in four HIV community cohort studies in sub-Saharan Africa.

Abstract: objective To compare socio-demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa. methods Data on voluntary counselling and testing and ART use among HIV-infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio-demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates. results Among adults known to be HIV-infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV-diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites. conclusions Higher HIV testing rates among HIV-infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need.

The State and the Bloody Diamond Rush in Chiadzwa: Unpacking the Contesting Interests in the Development of Illicit Mining and Trading, c.2006–2009

Abstract: This article examines the development of diamond mining and trading in Chiadzwa, a communal area in Marange, Zimbabwe. It also examines the nature of the state and its role in the early dynamics of diamond exploitation. Mining development in Chiadzwa had far-reaching political, economic, cultural and moral, as well as epidemiological, demographic and environmental, implications for the Marange landscape. This article unravels the activities surrounding illicit diamond activities in Marange, revealing the different interests involved, their interaction with the state and their impact on the landscape of the diamondiferous area. From March 2006, Chiadzwa – located some 80 kilometres from the eastern town of Mutare – literally and metaphorically became a terrain of contestation following the ‘discovery’ of diamonds. Numerous interests converged on the area seeking to exploit the diamonds, systematically displacing the interests and hegemony of the original, mostly apostolic, inhabitants of Marange. The disco...

Developing an informal settlement upgrading protocol in Zimbabwe – the Epworth story

Abstract: This paper describes how a settlement profile, mapping and enumeration of Magada, an informal settlement in the town of Epworth just outside Harare, provided the basis for an upgrading programme. This was both in terms of the needed information and in terms of agreement between the residents and their community organizations and local and national government. The local government’s agreement to support in situ upgrading was the first of its kind in Zimbabwe and it is the first settlement plan to include meaningful participation by residents in articulating their own development priorities and in influencing the design. The work to map and number each plot was undertaken by teams that included residents, supported by members of the Zimbabwe Homeless People’s Federation and its support NGO Dialogue on Shelter Trust, along with planning students. This was supported by high resolution satellite images and a GIS process was developed drawing in data from enumerations covering each household. A concept plan was...