African
Journals Online
The Central African Journal of
Medicine
ABSTRACTS (Vol.45.
No.4.)
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 80-85
Adolescent drug use in Zimbabwe assessed by their
teachers
AH EIDE, T BUTAU, SW ACUDA
Objectives: To obtain secondary school
teachers' assessment of adolescent drug use in Zimbabwe.
Secondly, to compare this assessment with some of the
results from student drug use surveys undertaken in 1990
and 1994.
Design: Cross sectional.
Setting: 17 secondary schools in Harare,
Mashonaland East and West and Matabeleland North
Provinces (including Bulawayo).
Subjects: 442 secondary school teachers,
of whom half were males.
Main Outcome Measures: Teachers'
assessment of how serious a problem adolescent drug use
is in Zimbabwe in general and at the teachers' own
school. Secondly, whether adolescent drug use is
currently on the increase or decrease.
Results: The teachers assessed alcohol
use as the most serious drug problem among secondary
school students in Zimbabwe, followed in descending order
by cannabis, tobacco, inhalants and other drugs.
Drug use was considered less serious at the teachers'
own school as compared to the assessment of the general
situation.
Student drug use is largely stable or increasing
moderately. Alcohol appears to be increasing the most.
Although partly corresponding with previous studies, the
situation was assessed as more serious than what appeared
from the student drug use surveys in 1990 and 1994. The
largest gap between teachers' assessment and students'
self-reported drug use was found for cannabis and
inhalants.
Conclusions: The study among teachers
concur to some extent with results from previous studies
among students. There are, however, variations in the
assessment of drug use among secondary school students
that do not correspond completely with the picture drawn
by previous student surveys. It is argued that some of
the variation in the assessment may in part be explained
by sociocultural and normative differences between
different sociocultural segments of Zimbabwean society.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 86-93
Analysis of the user fee for health care policy in
Eritrea
EZ ASBU
Objectives: To assess the macro-context
of the user fee policy design and implementation; to
critically evaluate the content of the user free policy
with respect to its implications for efficiency, equity,
quality and utilisation of health care and to scrutinise
the implementation of the scheme and identify the
successes and problems encountered since the introduction
of the user fee policy in 1996.
Design: Cross sectional.
Setting: Mekane Hiwot Central Referral
Hospital and Semenawi Asmore Health Centre.
Subjects: 50 health professionals and
support staff; 150 outpatients of which 100 patients were
from the hospital and 50 from the health centre and 50
inpatients from the hospital.
Main Outcome Measures: Service
utilisation.
Results: The policy was launched against
a conducive macro-economic, political and health sector
background. Fees reduced attendance at the tertiary
referral hospital and reversed the previous trend of
sharply declining use of primary level facilities.
However, the fee levels could not give an adequate signal
to patients to use the appropriate cost effective levels
of care and the referral system.
The cost recovery ratio for the system as a whole was
found to be one of the highest in sub-Saharan Africa. At
some of the lowest levels of the health care system,
however, the scheme does not seem viable. Fee waivers
were infrequent, and the process of means testing was
lengthy, thus adversely affecting equity.
Conclusions: The new policy resulted in
a cost recovery ratio. There was some indication of
allocative efficiency achievement as a result of the
price signals. The policy required some refinement in
terms of expanding the exemption categories and revenue
retention at the facility level.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 94-97
The impact of health education on the knowledge,
attitudes and practices of a rural community with regards
to schistosomiasis control using a plant molluscicide, Phytolacca
dodecandra
PR GWATIRISA, J NDAMBA, NZ NYAZEMA
Objective: To determine the impact of
health education on knowledge, attitudes and practices
(KAP) with regards to use of a plant molluscicide in
snail control.
Design: Repeat cross sectional survey.
Setting: Chiweshe communal lands.
Subjects: Males and females - age range
13 to 87 years.
Main Outcome Measures: Changes in: KAP
after health education, water usage pattern, water
contact behaviour, willingness to participate in use of P.
dodecandra.
Results: A high proportion of the
community indicated prior knowledge of schistosomiasis
during both knowledge, attitudes and practices (KAP)
surveys. In the follow up KAP survey changes in the
community's water contact behaviour as well as their
practices in relation to sanitation were reported. The
involvement of the community in the application of P.
dodecandra during the course of the study ensured
continued support and participation of the community.
This was evidenced in the follow up survey when it was
apparent that the community's attitude towards
schistosomiasis had been influenced by the different
activities that had taken place.
Conclusion: Changes in the community's
KAP with regards to schistosomiasis control, can be
interpreted as an indication of the impact of the
health education delivered during the course of the
study. Health education should, therefore, precede
programmes that require full participation of the
community, as this enables the community to make informed
decisions regarding their participation.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 97-100
Diagnostic performance of two antigen capture tests
for the diagnosis of Plasmodium falciparum
malaria in Zimbabwe
FC MURAHWA, S MHARAKURWA, SL MUTAMBU, R RANGARIRA, BJ
MUSANA
Objective: The objective was to compare
the diagnostic performance of two antigen capture tests, ParaSightTM-F
test and Immunochromatographic test (ICT), for the
diagnosis of Plasmodium falciparum malaria.
Design: A comparative study.
Setting: Burma Valley, Mutare District,
Manicaland in Zimbabwe.
Subjects: Patients attending the local
clinic with clinical signs and symptoms associated with
malaria infection. A blood film was collected from the
patient and at the same time blood for the ParaSightTM-F
test and the ICT was collected too. A total of 123
patients were diagnosed using the ICT test, the ParaSightTM-F
test and microscopy which was used as a "gold"
standard.
Main Outcome Measures: True positives
and negatives, false positives and negatives with
reference to microscopy.
Results: The results indicate that ICT
had a higher sensitivity (100%) than the ParaSightTM-F
test (93.94%) but showing a lower specificity. The
specificity for ICT (75%) is lower than the ParaSightTM-F
test (81.2%) because of the presence of circulating P.
falciparum histidine-rich protein-2 (PfHRP-2) in
blood even after two weeks post treatment. Two slides
that were negative for ParaSightTM - F
tests showed positive on microscopy. However, 21 and 12
slides which were negative on microscopy, showed positive
with ICT and ParaSightTM- F
respectively. The fact that ICT detects very low
quantities of PfHRP-2 puts it at a comparative advantage
because it detects positives even at very low parasite
rates.
Conclusion: The availability of these
two antigen capture tests, which are easy to perform,
will reduce the number of severe cases by providing early
diagnosis. The tests will also reduce the number of
unnecessary treatments and irrational use of
antimalarials.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 100-102
Penicillin resistant Streptococcus
pneumoniae isolates in Harare, Zimbabwe
C SIMANGO, F MVUDUDU
Objective: To determine the
susceptibility of Streptococcus pneumoniae
isolates to penicillin and other antimicrobial drugs.
Design: This was a laboratory
based study.
Setting: Department of Medical
Laboratory Sciences, University of Zimbabwe and the
Bacteriology Unit, Public Health Laboratories, Harare.
Subjects: 71 S. pneumoniae
isolates from Parirenyatwa and Harare hospitals.
Main Outcome Measures: Penicillin
resistance, MIC of penicillin to S. pneumoniae,
multi-drug resistance.
Results: 71 S.pneumoniae isolates
were tested for their susceptibilities to penicillin G,
erythromycin, tetracycline, ampicillin, ciprofloxacin and
clindamycin. Five (7%) of the isolates were resistant to
penicillin G and were also all resistant to erythromycin.
Isolates resistant to other antibiotics were;
tetracycline (4), ampicillin (3) and ciprofloxacin (2).
The five isolates that were resistant to penicillin G
showed resistance to two or more antibiotics. Four S.
pneumoniae isolates were designated highly resistant
to penicillin (MIC _ 2 mg/ml) and one isolate was
designated intermediate in resistance to penicillin (MIC
between 0.1 and 1.0 mg/ml).
Conclusions: A low percentage of S.pneumoniae
isolates were resistant to penicillin and were also
resistant to erythromycin. The penicillin resistant
strains showed multi-drug resistance.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 102-103
CASE REPORT:
"A little reminder does no harm": case
report
R MASANGANISE, F CHIKWANDA
A case of falsified non-accidental ocular injury of a
29 year old male is presented. The importance of an
accurate history and appropriate investigations in the
management of ocular injuries is highlighted to promote a
high standard of health care delivery in Zimbabwe.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 104-105
CASE REPORT:
Burkitt's lymphoma of the ovary
AU MUKHTAR, B MUGERWA
Two cases of a unilateral ovarian Burkitt's lymphoma
are presented. One patient is 32 years and the other 15
years old. The case report highlight the clinical
presentation and differential diagnosis of unilateral
ovarian Burkitt's lymphoma in adults.
Central African Journal of Medicine,
Vol. 45, No. 4, 1999, pp 105-107
Letters To The Editor And Editorials:-
Abstracts:-
LETTERS TO THE EDITOR:
PVC bags considerably reduce availability of Diazepam Cent
Afr J Med 1998;44(7)
D Ball and K Tisocki
I believe that the publishing of the article by
Mahomed and colleagues in the July 1998 issue of the Cent
Afr J Med raises two issues.
Firstly, they report on something which, as they
admit, is already well recognised and researched. It is
reported "so as to alert clinicians of this effect
and to promote efforts to utilize non-PVC bags".
More may have been gained through a review article.
Secondly, the paper provides no basic data with which
to assess the results presented. One cannot judge if the
amount of diazepam and volumes of IV fluids used are
comparable to those in clinical practice. It is also not
possible to evaluate whether the zero time point
concentration was consistent with the expected
concentration (to assess immediate incompatibility
effects on mixing and/or accuracy of the analytical
method). In addition, there is no measure of the
variability of the results.
EDITORIALS:
Pain: friend or foe
HM CHINYANGA, KK KALANGU
Pain, the most urgent of symptoms usually signals the
presence of potential or on-going injury to tissue which
requires attention.
The warning that pain provides is, therefore, a good
thing and in a way friendly. When pain continues or
resumes after the healing process of injury is complete,
it is no longer signalling on-going tissue damage but
becomes a disease in its own right. That, in essence, is
the presentation of most chronic pain syndromes referred
to Pain Clinics for investigation and treatment.
Central African Journal of
Medicine, Vol. 45, No. 4, 1999, pp 107-109
FACTS AND OPINIONS
Clinical pharmacologist wanted - where?
K BHAGAT, K TISOCKI
Many people could define with ease the job of a
cardiologist, a paediatrician or an obstetrician.
However, only a few would have any clear idea of how a
clinical pharmacologist might fill a day. Indeed, within
the medical profession, and often within the scientific
community, there has been a sneaking suspicion that
clinical pharmacologists are themselves unsure of their
remit. This article describes the possible role for
clinical pharmacologists and different areas where they
can make significant contributions to medical services.
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