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The Central African Journal of Medicine

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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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