Dr. Maxwell Mhlanga

Pregnancy Induced Hypertension is a pattern of high blood pressure during pregnancy. It is one of the major causes of maternal mortality and neonatal morbidity in the world, contributing about 5-14% of pregnant women globally (Arshad et al., 2014). In Zimbabwe, despite the availability of guidelines for PIH management, PIH still contribute about 19.4% (Muti et al., 2015) more than global statistics. For this reason, this study sought to assess barriers to PIH management and possible solutions or strategies. The strategies will help to curb both maternal and neonatal mortality. The study employed descriptive qualitative design. Focus group discussions (FGDs), each with 8 participants, were held in Bindura District and Bindura provincial Hospital. Women diagnosed with PIH, in age group 18 to 49 years were included in the study and these were able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semi-structured questionnaire. Comprehensive notes were taken during the interviews which were also being audiotaped. Data were analyzed thematically and manually. Themes identified were barriers and possible solutions to PIH management. Barriers were poor cultural practices, religious practices, employment and use of herbs. Possible solutions were to develop culture-specific health education and interventions to improve health seeking behavior of PIH patients and to reduce adverse perinatal outcomes. Husbands as family heads to be actively involved in the management of PIH and accompanying their wives to the hospital. This is critical in improving ANC visits and general management of PIH among pregnant women. Keywords: PIH, ANC, PIH management, Zimbabwe

Social marketing globally promotes social mobilization to increase uptake of recommended health services. The Ministry of Health and Child Care in Zimbabwe markets breast and cervical cancer screening for reproductive-age women. Despite efforts, uptake remains low, particularly in Mutare district. To address this, an analytical cross-sectional study was conducted in Dangamvura suburb to explore the relationship between service providers' customer-care initiatives and screening uptake. Qualitative and quantitative data was collected via interviews with 96 women aged 18 to 49, randomly selected from Dangamvura Poly-Clinic departments. Of these women, 13.5% were screened for breast cancer, 30.3% for cervical cancer, and 78.8% expressed intent to screen. 90.3% had accurate knowledge of breast and cervical cancer, but only 30.3% could identify screening sites. Among those screened, 75.8% intended to retest. Primary motivations for screening included a desire for health status knowledge (39.2%) and reproductive system issues (32.1%). Main barriers for non-screened women were lack of motivation (56%) and fear of positive results (16.7%). Logistic regression indicated protective factors for screening uptake: history of reproductive issues (AOR: 9.0678, p: 0.0029), prior breast cancer screening (AOR: 21.4347, p: 0.0006), and age 31 to 49 (AOR: 0.1754, p: 0.0066). Overall, uptake was low, influenced by customer factors (age, reproductive issues, prior breast cancer screening) and cost factors (perceived wait times, screening duration, perceived costs). Future interventions aimed at improving uptake of screening services should be tailored to address fears, misconceptions, and lack of motivation to screen among women of reproductive age.

Teenage pregnancies are a global problem mainly in marginalised communities resulting in complications, societal rejection and deaths. In Zimbabwe, 48% of the teenage pregnancies occurred between 13-19 years. Mutasa District, one of the Districts in Zimbabwe has high rate of teenage pregnancies. Teenage abortions rose from 3/1000 in 2018 to 5/1000 in 2019. We conducted a study on the factors associated with teenage pregnancies in Mutasa District in the year 2018 and 2019. The specific objectives were to determine the prevalence of teenage pregnancies, to determine the sociocultural, economic and religious factors influencing teenage pregnancies and to assess the availability and utilisation of Adolescent Sexual and Reproductive Health Services. A multi-methods+ study design was used with a sample size of 80 cases and 80 controls from four hospitals in Mutasa. Systematic sampling was employed where every <i>3<sup>rd</sup> </i>subject was systematically selected upon satisfaction of the inclusion criteria, with sampling interval observed. A quantitative survey and Focus Group Discussions (FGDs) were used to collect data. The results showed that 72 (90%) of the cases only had primary school education. Being single orphans 60 (75%), having information and education gaps 77 (96.3%), being chased off home to go to the male partner 49 (61.3%) were the prevalent factors linked to teenage pregnancies. Having been disciplined when found with contraceptives led to 41 (51.3%) of the pregnancies. Having the boyfriend as a source of livelihood allowances contributed to 59 (73.8%) of teenage pregnancies while being a member of an Apostolic Sect contributed 65 (82.3%) of the cases. The FGDs revealed that the Youth Friendly Centres were inadequate for the community, poorly resourced having no comprehensive preventive services and therefore poorly utilised. In addition, teenage pregnancy preventions were stereotyped to females only with current interventions being predominantly reactionary than preventive. The findings of this study suggest the need for reproductive health information, gender inclusive programming, and provision of a sundry of well-resourced Youth Friendly Centres in the District and a focus on tailor-made preventive interventions rather than punitive ones.

Introduction: Nurses, as gatekeepers of health, are expected to seek formal healthcare services, reflecting the advice they give patients. However, squalid working conditions, long hours, and heavy workloads expose them to occupational health hazards, limiting their ability to care for themselves. Properly implemented employee clinic services can help nurses address health problems, promote well-being, and reintegrate them into the workforce. Objective: This study sought to determine factors associated with the utilization of staff clinic services by nurses at Parirenyatwa Group of Hospitals. Materials and Methods: The study used an analytical cross-sectional design conducted in May 2023. A consecutive sampling method selected 50 participants. Data were collected via a structured questionnaire and presented as numbers and percentages. The questionnaire was divided into sections as follows: Participant demographic information (Age, gender, marital status, religion etc.); uptake of staff clinic services (Screening, treatment, awareness services etc), and factors associated with uptake of staff clinic services among nurses. Chi-square test or Fisher’s exact test to evaluate significant differences for unpaired data. Statistical analysis was performed using STATA 16. Results: Among the 50 participants, 66% were female. The study results show that the uptake of staff clinic services was low, with only 54% of the participants visiting the clinic on rare occasions. The most common barriers to utilizing the staff clinic were lack of time to go for screening (16%), fear of stigma (14%), and uncertainty about confidentiality (14%). Most participants utilized the acute illness treatment service (62%). Age was a significant factor associated with the utilization of the staff clinic (p = 0.021), with younger nurses using the clinic more often. Perceived benefits were also significantly associated with utilization (p < 0.05). Discussion: The utilization of staff clinic services by nurses remains suboptimal despite high knowledge and awareness of these services. Utilization was mainly associated with age, perceived benefits of accessing the staff clinic services, and reasons for not utilizing some of the services. There is need to strengthen promotional activities for the utilization of staff clinic health services as this has been proven to increase productivity and health outcomes of clinical staff.

Pre-exposure prophylaxis (PrEP) for HIV is a strategy that has been recently engineered to prevent individuals who are human immunodeficiency virus (HIV)-negative but are at high risk of being infected with HIV. Sex workers are one of the vulnerable groups that are targeted by PrEP, however effectiveness of PrEP is realised when there is maximum adherence. Empirical evidence from Mutare Urban district revealed that for the period April to November 2019, the adherence rate was 22 % (NAC, 2019).Therefore, this study sought to unearth the reasons why sex workers were not adhering to PrEP. A 1:1 unmatched casecontrol study was carried out in Mutare urban. The source population of this study was all female sex workers registered under NAC key population programs in two sites namely Forbes and Sakubva residing in Mutare urban. A total sample size of 64 participants calculated using Epi info 7 was used for this study. Participants were identified from records at the study sites and systematic sampling was done for both controls and cases. Proportional selection of participants was done for the two centres. Data was collected using an interviewer administered structured questionnaire and a key informant interview guide was used to interview health service providers. Data was analysed using Epi info version 7. A multivariate analysis showed age [AOR = 2.14, 95% CI (1.08 – 3.34)], household expenditure per month [AOR = 18.77, 95% CI (3.13 – 11.21)], consistent use of condoms [AOR = 11.78, 95% CI (1.03 – 13.41)], alcohol use [AOR = 2.55, 95% CI (1.01 –5.32)], experienced side effects [AOR = 16.06, 95% CI (5.71 – 22.56)] and satisfaction with health service provision [AOR = 10.01, 95% CI (2.32 – 43.25)] to be statistically significant predictors of uptake of PrEP services. There is need for tailor made interventions for young sex workers, furthermore use of mobile applications to remind clients, provision of safety nets and continued health education to both the female sex workers and the community at large to reduce stigmatization. Key Words: Pre-exposure prophylaxis, adherence

Background Unplanned pregnancies increased among adolescents in Zimbabwe, resulting in unsafe abortions, sexual and gender-based violence, and forced marriages. Access to Sexual and Reproductive Health and Rights (SRHR) has been scanty among pregnant adolescents and adolescent mothers owing to negative social norms, stigma and discrimination. This project specifically targeted pregnant adolescents and adolescent mothers through a differentiated and targeted care approach to improve uptake and sexual and reproductive health outcomes. Methods Target-specific peer support groups for pregnant adolescents and adolescent mothers were established in Epworth district of Zimbabwe. The Champions of Change, a peer-based approach, was used to facilitate comprehensive sexuality education. Mentors were adolescent mothers trained on how to use a tailor-made manual to facilitate sessions. Two health centers, namely Epworth Clinic and Overspill Clinic, were purposively selected to participate in this study. A total of 60 participants were recruited into this study, 30 from each clinic. Knowledge and attitude were measured using a semi-structured questionnaire administered before and after the intervention. A scorecard was used to assess friendliness and quality of service provision. A Chi-square test of association was used to determine the significance of the change in outcomes. Results A significant improvement in knowledge of SRHR, attitudes, and healthcare-seeking behaviors was noted. There was a significant improvement in attitudes and friendliness in service provision. Access to services significantly increased with improvements in relationships and trust. Conclusion A targeted and differentiated care approach increases the uptake of services and health outcomes among adolescent women by addressing their unique needs and circumstances. Lay summary Adolescent pregnancy and motherhood have significantly risen in Zimbabwe with the advent of the COVID-19 pandemic. The condition of these adolescent women has been worsened by poor access to and utilization of sexual and reproductive health services by this unique group, resulting in poor sexual health outcomes. Pregnant adolescents and adolescent mothers are less likely to access sexual and reproductive health services due to heightened stigma and discrimination by peers, communities and service providers themselves. We adopted a peer-based approach to increase the agency of adolescent women and empower them through comprehensive sexuality education, engaging healthcare service providers, and improving parent-child communication. With our intervention, we noted a significant improvement in the proportion of pregnant adolescents and adolescent mothers accessing services and reporting improvement in relationships with parents and healthcare providers. We encourage health providers to consider providing targeted services to this group to improve uptake and health outcomes.