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Evaluation of the Notifiable Diseases Surveillance System in Beitbridge District, Zimbabwe 2015  [PDF]
Juru P. Tsitsi, Ncube Nomagugu, Notion T. Gombe, Mufuta Tshimanga, Bangure Donewell, More Mungati, Chikodzore Rudo
Open Journal of Epidemiology (OJEpi) , 2015, DOI: 10.4236/ojepi.2015.53024
Abstract: Back ground: Notifiable Disease Surveillance system serves as an early warning system for public health emergencies. Since January 2013 to August 2014, Beitbridge never submitted T2 forms to the province. Four suspected cases of rabies were reported through the generic report. The electronic District Health Information System 2, T2 forms had not been updated. This discrepancy may imply under reporting of Notifiable Diseases. The study was conducted to evaluate the NDSS in Beitbridge district. Methods: Descriptive cross-sectional study was conducted. Health workers in sampled health facilities were interviewed using questionnaires. Checklists were used to assess resource availability. Epi InfoTM was used to calculate frequencies and proportions. Results: From 11 facilities, 53 respondents were interviewed of which the 59% were females. For Knowledge, 57% recalled at least 9 Notifiable diseases, 11% knew the T1 form required to notify. Respondents willing to participate in the NDSS were 87%. Responsibility to notify was placed other health workers other than themselves by 55% of the respondents. All facilities did not have completed T1 forms. T1 forms were available in 1/11 health facilities. Three outbreaks were reported using the Weekly Disease Surveillance System (WDSS). NDSS information was used for planning and mobilizing resources for indoor residual spraying. It costs an average $12.15 to notify a single case, against $1.50 if it was electronic. Conclusion: NDSS is acceptable, simple, flexible, unstable, not sensitive and useful. Reasons for under reporting were lack of forms, lack of induction and poor knowledge on the NDSS. The cost of operating the NDSS could be reduced if the system is electronic. T1 forms and guidelines for completing the forms should be distributed to all health facilities. On the job training of health workers through tutorials, supervision is recommended.
Sexually Transmitted Illnesses in Masvingo Province, 2012-2015: A Secondary Data Analysis  [PDF]
Noriah M. Hwami, Tsitsi P. Juru, Amadeus Shamu, Gerald Shambira, Notion Tafara Gombe, Mufuta Tshimanga
Open Journal of Epidemiology (OJEpi) , 2017, DOI: 10.4236/ojepi.2017.71006
Abstract: Background: Masvingo province is among the top three provinces with high Genital Ulcer Disease incidence rates in Zimbabwe. There has been no documented evidence to establish the burden and epidemiology of STIs in Masvingo province. We analysed these data to describe trends in STIs from 2012 - 2015. Methods: A retrospective records review of Masvingo STI data set was conducted. We assessed trends in STIs from 2012-2015. Microsoft Excel 2010 software was used to generate bar and linear graphs. Epi info 7TM was used to calculate Chi-square for trends and p values. Results: Most affected age group was 25 - 49 years (incidence rate of 73.9 cases per 1000). The 50 and above age group had a higher incidence rate than the 10 - 24 year age group (27.5 compared to 15.5 cases per 1000). STI incidence was higher in females (31.9 cases per 1000) than in males (20.6 cases per 1000). The most prevalent STIs were vaginal discharge 48,972 (30.7%) and other forms of STIs 35,777 (22.3%). Masvingo district recorded the highest STI incidence rate (34.1 cases per 1000). There was a decline in HIV testing rates from 36 (100%) to 12,190 (64.4%) (p < 0.001) from 2012-2015. Conclusion: There was a general decline in the STI trends for all age groups. Age group most affected by STIs was the 25 - 49 years with females being more affected. HIV testing services among STI clients declined. We recommend advocacy on safe sexual practices and further research to identify reasons for low uptake of HIV testing services among STI clients.
A Comparative Evaluation of the Voluntary Medical Male Circumcision Program for Seke and Goromonzi Districts, Mashonaland East Province, Zimbabwe, 2017  [PDF]
Hamufare Mugauri, Owen Mugurungi, Gerald Shambira, Tsitsi Juru, Notion Tafara Gombe, Mufuta Tshimanga
Open Journal of Preventive Medicine (OJPM) , 2017, DOI: 10.4236/ojpm.2017.77011
Background: In 2009, Zimbabwe incorporated Voluntary Medical Male Circumcision (VMMC) to a consortium of measures to eliminate HIV transmission by 2030. Seke and Goromonzi districts simultaneously commenced implementing VMMC. These districts have comparable population, geography, and support yet scored varied performances. Cumulatively, (2009-2016) Seke achieved 83% while Goromonzi achieved 15% of set circumcision targets. We compared the performance of the VMMC program in the 2 districts. Methodology: A process evaluation was conducted modelled on a logical framework. Interviewer-administered questionnaires and checklists were used to collect data. Epi info7 was used to generate frequencies and proportions. Results: Three health facilities in Seke and four in Goromonzi were implementing VMMC. Material resources were maintained at three months buffer stock and human resources equitably distributed between the two districts. Additional support (three nurses), from the national army, was received by Seke, and management provided vehicle support for program activities. Goromonzi conducted half of the targeted mobilisations (6/12) and Seke 12/12. Similar amounts of financial support were simultaneously disbursed. Seke circumcised 99.5% (4716) and Goromonzi 48.5% (2372) of annual targets. Adverse reactions were 0.04% (2) for Seke and 2.3% (55) for Goromonzi for same period with no review meetings conducted. Seke participants attributed performance to effective demand creation (22; 100%), effective coordination (20; 90.9%) and management support (21; 95.5%). Goromonzi participants cited delayed payments (20; 90.9%), lack of active leadership involvement in planning and execution (14; 63.6%) and weak mobilisations (11; 50%) to have worked against the program. Conclusion: Effective demand creation and coordination, manpower boost and leadership support enhanced VMMC program performance for Seke and was therefore recommended for Goromonzi. Resource availability did not translate to performance in Goromonzi where lack of active leadership involvement in planning and execution, weak mobilisations resulted in poor results. Robust demand creation strategies were suggested for both districts.
Trend Analysis of HIV Testing Services in Zimbabwe, 2007-2016: A Secondary Dataset Analysis  [PDF]
Sithabiso Dube, Tsitsi Juru, T. Magure, Gerald Shambira, Notion Tafara Gombe, Mufuta Tshimanga
Open Journal of Epidemiology (OJEpi) , 2017, DOI: 10.4236/ojepi.2017.73023
Abstract: Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value < 0.05). Repeat tests increased exponentially from 9% in 2012 to 78% in 2016. Significantly more individuals (1,924,410: 2015) tested than couples (227,868: 2015) but couples consistently had a higher yield (χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.
Evaluation of the Babies At Risk Surveillance System in Rushinga District, Mashonaland Central Province, Zimbabwe, 2015  [PDF]
Alice Kudzaishe Dzvukamanja, Cremance Tshuma, Donewell Bangure, More Mungati, Tsitsi Juru, Notion Tafara Gombe, Mufuta Tshimanga
Open Journal of Therapy and Rehabilitation (OJTR) , 2017, DOI: 10.4236/ojtr.2017.54013
Abstract: Background: About 15% of world’s population lives with some disability. Zimbabwe’s prevalence of disability was at 7% in 2013. ARSS is a paper-based system to monitor and detect neuro-developmental conditions and childhood disability early. Indicators for registering a baby into ARSS include: low Apgar score, low birth weight and birth asphyxia. Active case finding in Rushinga District in July 2015 identified nine cerebral palsy cases that were missed by the system out of 14 randomly chosen babies delivered at Chimhanda District Hospital. We evaluated the performance of the ARSS in Rushinga District. Methods: We evaluated the system using CDC guidelines for surveillance systems evaluation. All 12 health facilities in Rushinga were included. Health workers involved in ARSS were purposively recruited. Interviewer administered questionnaire, key informant interview guide, checklists and records review were used for data collection. Knowledge of participants on the system was assessed using five-point Likert scale. Data were analyzed using Epi Info 7. Results: Fifty-one participants were recruited for the study. Median years in service for all participants was 7 (Q1 = 6; Q3 = 12). Average knowledge score was 3. Majority participants (82.4%) were not trained on ARSS and cited lack of: knowledge, reporting guidelines, induction and focal persons as reasons for missing AR cases. Currently, ARSS is able to detect only 12.5% of cases. Prevalence of AR babies in Rushinga for period November 2014 to November 2015 was 21.1%. Monthly cost of detecting and registering a case was USD$52.46. Conclusions: ARSS was found to be useful, simple, acceptable and affordable, however was found to be unstable and not sensitive. Training of health workers particularly village health workers and integrating ARSS with the DHIS2 could improve system performance. As a result of the evidence from this evaluation, it has been agreed to include ARSS data on the monthly return form (T5) beginning June 2016.
Wokó w asno ci. Próba uporz dkowania stanowisk w filozofii politycznej (PRIVATE PROPERTY. AN ATTEMPT AT CLASSIFICATION THE KEY POSITIONS IN POLITICAL PHILOSOPHY)
Dariusz Juru
Analiza i Egzystencja , 2007,
Abstract: In the paper the author proposes a new model of political spectrum. Instead - as so far - arranging political philosophies in two or four dimensional diagrams (from the left to the right, from the top to the bottom) he suggests a form of spiral, where political philosophies evolve naturally from amoralistic anarchism to communism. He also puts some names of philosophers who represent respective political views. Thus we start from amoralistic anarchism by Max Stirner, then we have moralistic anarchism by Murray N. Rothbard, then moralistic minarchism by Robert Nozick, which in turn evolves into utilitarian minarchism by Ludwig von Mises, then utilitarian liberalism by Friedrich A. von Hayek, socialist liberalism by John Rawls and socialism leading to communism by Karl Marx. In this model one organizes political views not as usually around the concept of freedom (personal and economic), but around the concept of private property. Therefore we are able to include in this model anarchism, which is usually ignored, as a non-political view.
Prevalence and associated factors of smoking among secondary school students in Harare Zimbabwe
Tsitsi Bandason, Simbarashe Rusakaniko
Tobacco Induced Diseases , 2010, DOI: 10.1186/1617-9625-8-12
Abstract: A 3-stage stratified random sampling was employed to select six participating schools and students. A descriptive analysis was conducted to describe the demographic characteristics of the participants. The prevalence of smoking was estimated and the comparison of prevalence was performed according to its associated factors. Logistic regression analysis was used to identify risk factors for smoking.650 students with a mean age 16 years and 47% of them female participated. Prevalence of ever-smoked was 28.8% (95% CI 25.3 to 32.3). Prevalence of ever-smoked among males (37.8%) was significantly (p < 0.001) much higher than among females (18.5%). In the multivariate analysis, smoking was found to be statistically associated with having friends that smoke (OR 2.8), getting involved in physical fights (OR 2.3), alcohol use (OR 5.7), marijuana use (OR 8.1) and having had sexual intercourse (OR 4.4).The study provides recent estimates of prevalence of smoking, and indicates that there is still a high prevalence of smoking among urban secondary school students. Exposure to friends who smoke, risky behaviour like substance abuse, premarital sex and physical fights are significantly associated with smoking. Interventions to stop or reduce the habit should be implemented now and future studies should monitor and evaluate the impact of the interventions.Adolescence is the time of life when people are more interested in taking risks and testing the boundaries of the world outside as well as their own limits. Throughout history countless adolescence has smoked tobacco [1]. This habit carries on into adult life and we find that of the 6.6 billion people on this planet, 1.3 billion are smokers and 1 billion of these are males [1]. By 2030, tobacco is expected to be the single biggest cause of death worldwide causing more deaths than HIV, malaria, tuberculosis, maternal mortality, automobile crashes, homicides and suicides combined[2]. Furthermore, it is expected that tobacco-related
Evaluation of Notifiable Disease Surveillance System in Centenary District, Zimbabwe, 2016  [PDF]
N. Mairosi, C. Tshuma, T. P. Juru, N. T. Gombe, G. Shambira, M. Tshimanga
Open Journal of Epidemiology (OJEpi) , 2017, DOI: 10.4236/ojepi.2017.73019
Background: Notifiable disease surveillance system (NDSS) data guides immediate action for events of public health importance. In July 2016, 12 patients suspected of typhoid were reported to Centenary District Medical Officer by phone. Following reporting, notification forms (T1) were not submitted to district, hence province did not receive district consolidated report (T2) for the notifications. This implies underreporting of notifiable diseases. Study was conducted to evaluate NDSS in Centenary district. Methods: Using updated Centres for Disease Control and Prevention (CDC) guidelines, descriptive cross sectional study was conducted among health workers sampled from all health facilities in Centenary district. Interviewer administered questionnaire and checklists were used to collect data, assess data quality and resource availability. Epi InfoTM 7 generated frequencies and proportions. Results: We interviewed 50 respondents from 13 health facilities and 64% were females. Health worker knowledge was rated low, 26% knew whom to notify and 40% knew forms are completed in triplicate. Reasons for failure to notify notifiable diseases included, unavailability of reporting forms 32% and lack of reporting guidelines 16%. Ninety-two percent were willing to participate. Four health facilities had at least six standard case definitions. The first two patients were only diagnosed at district level. NDSS information was used to procure antirabies vaccine and implement control measures. Conclusion: NDSS is useful, acceptable, unstable and not sensitive. Failure to notify was mainly due to lack of knowledge on NDSS. We recommend training of health workers and mentoring. Fifteen (IEC) case definitions and reporting guidelines were distributed to five health facilities.
Uptake of Cervical Cancer Screening among Women Attending Health Facilities in the City of Bulawayo, 2012  [PDF]
Munekayi Padingani, Gladys Marape, Zanele Hwalima, Notion Gombe, Ms T. Juru
Open Journal of Epidemiology (OJEpi) , 2018, DOI: 10.4236/ojepi.2018.83013
Abstract: Introduction: In Zimbabwe, where cervical cancer is the leading female malignancy, no systematic cervical screening program has been introduced. However, selective or opportunistic screening has been performed since the late 1980s. The Ministry of Health and Child Care is relying on screening, which allows early detection of pre-cancerous cells and diagnosis at early stages but many women are not going for the test and no studies have been done to find out why. This study investigated the women’s perception about cervical cancer and its screening using health belief model (HBM) in Bulawayo, where they are two new screening clinics. Methods: We conducted an analytic cross-sectional study. Women from 18 years and above attending health facilities were included in the study. Interviewer administrated questionnaire was used to determine the proportion of screened women and elicit their perception about cervical cancer and its screening. Epi-info version 3.3.2 was used to do bivariate and multivariate analysis. Results: Two hundred women were recruited into the study. The proportion of women who had cervical cancer screening was 52 (26%). Pap smear only had 35 (17.5%) had VIAC only, 13 (6.5%) and Pap smear and VIAC had 4 (2%). Knowledge of cervical cancer and its screening was poor among participants. In multivariate analysis, awareness of cervical cancer screening [adjusted OR 42.05 (95% CI 5.63 - 314.04)] was associated with the uptake of cervical cancer screening and perceiving that having multiple sexual partners[adjusted OR 0.33 (95% CI 0.12 - 0.88)] was independently associated to the uptake of cervical cancer screening. Conclusion: This study demonstrated that lack of awareness of cervical cancer screening is a barrier to the uptake of the screening. Perceiving multiple sexual partners was associated to the uptake of cervical cancer screening. It is therefore necessary to increase awareness in Bulawayo City and educate the community about other risk factors.
Is Tourism in Zimbabwe Developing with the Poor in Mind? Assessing the Pro-poor Involvement of Tourism Operators Located Near Rural Areas in Zimbabwe
Sarudzai Mutana,Tsitsi Chipfuva,Blessing Muchenje
Asian Social Science , 2013, DOI: 10.5539/ass.v9n5p154
Abstract: The paper explores the contribution of tourism industry operators to pro-poor tourism development in Zimbabwe. This research investigates a possible nexus between the aforementioned tourism growth and its potential for poverty reduction in communities surrounding Victoria Falls and Hwange. The researchers conducted semi-structured interviews with tourism industry businesses that exhibited their products and services at the International Travel Expo held on the 18th- 21st of October 2012 at the Harare International Conference Centre in Zimbabwe. Findings indicate that the tourism industry is keen to engage in pro-poor tourism initiatives for the rural people despite the political and economic turmoil that the industry has suffered over the past years. In Zimbabwe, 80% of the population resides in rural areas and a sizable fraction of these are near National Parks and Tourism Resorts, for example, Hwange National Park, the biggest Park in Zimbabwe and Victoria Falls, respectively. The findings point to the fact that tourism operators appreciate the need to incorporate pro-poor initiatives in their operations as evidenced by their commitment towards education funding initiatives, employment of the poor and generation of income from village tours. However more could be done to enhance the pro-poor tourism benefits that accrue to the rural poor by establishing close linkages between tourism operators and local communities.
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