Biomedical subjects

K Mahomed

Publications and source records attributed to K Mahomed.

At least 19 recordsLinked to original sources

PubMed2006

Erythrocyte omega-3, omega-6 and trans fatty acids in relation to risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe.

We sought to examine the association between maternal erythrocyte omega-3, omega-6 and trans fatty acids and risk of preeclampsia. We conducted a case-control study of 170 women with proteinuric, pregnancy-induced hypertension and 185 normotensive pregnant women who delivered at Harare Maternity Hospital, Harare, Zimbabwe. We measured erythrocyte omega-3, omega-6 and trans fatty acid as the percentage of total fatty acids using gas chromatography. After multivariate adjustment for confounding factors, women in the highest quartile group for total omega-3 fatty acids compared with women in the lowest quartile experienced a 14% reduction in risk of preeclampsia (odds ratio 0.86, 95% confidence interval 0.45 to 1.63). For total omega-6 fatty acids the odds ratio was 0.46 (95% confidence interval 0.23 to 0.92), although there was suggestion of a slight increase in risk of preeclampsia associated with high levels of arachidonic acid. Among women in the highest quartile for arachidonic acid the odds ratio was 1.29 (95% confidence interval 0.66 to 2.54). A strong statistically significant positive association of diunsaturated fatty acids with a trans double bond with risk of preeclampsia was observed. Women in the upper quartile of 9-cis 12-trans octadecanoic acid (C(18:2n6ct)) compared with those in the lowest quartile experienced a 3-fold higher risk of preeclampsia (odds ratio = 3.02, 95% confidence interval 1.41 to 6.45). Among women in the highest quartile for 9-trans 12-cis octadecanoic acid (C(18:2n6tc)) the odds ratio was 3.32 (95% confidence interval 1.55 to 7.13). Monounsaturated trans fatty acids were also positively associated with the risk of preeclampsia, although of much reduced magnitude. We observed a strong positive association of trans fatty acids, particularly diunsaturated trans fatty acids, with the risk of preeclampsia. We found little support for the hypothesized inverse association between omega-3 fatty acids and preeclampsia risk in this population. Polyunsaturated fatty acids, particularly omega-3 fatty acids, were comparatively lower in Zimbabwean than among US pregnant women. Given the limited inter-person variation in omega-3 fatty acids among Zimbabwean women, our sample size may be too small to adequately assess the relation in this population.

Adult↗

PubMed2005

Maternal plasma VEGF, sVEGF-R1, and PlGF concentrations in preeclamptic and normotensive pregnant Zimbabwean women.

Vascular endothelial growth factor (VEGF), a disulphide-linked homodimeric glycoprotein that is selectively mitogenic for endothelial cells, plays an important role in vasculogenesis and angiogenesis. Preeclampsia, a relatively common complication of pregnancy that is characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation, has recently been associated with alterations in maternal serum/plasma concentrations of VEGF, and other related growth factors and their receptors. We examined the relationship of maternal plasma VEGF, sVEGF-R1 and PlGF levels to the risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. 131 pregnant women with preeclampsia and 175 controls were included in a case-control study. Maternal plasma concentrations of each biomarker were measured using enzymatic methods. We used logistic regression to calculate odds ratios (OR) and 95 % confidence intervals (CI). Preeclampsia risk was inversely related with quartiles of plasma VEGF (OR: 1.0, 1.0, 0.7, and 0.5, with the lowest quartile as reference; p for trend=0.06). We noted a strong positive association between preeclampsia risk and sVEGF-R1 concentrations (OR: 1.0, 6.5, 9.7, 31.6, with the first quartile as the referent group; p for trend<0.001). After adjusting for confounders, we noted that women with sVEGF-R1 concentrations in the highest quartile (>or=496 pg/ml), as compared with those in the lowest quartile (<62 pg/ml) had a 31.6-fold increased risk of preeclampsia (OR=31.6, 95 % CI 7.7-128.9). There was no clear evidence of a linear relation in risk of preeclampsia with PlGF concentrations. In conclusion, plasma VEGF, sVEGF-R1 and PlGF concentrations (measured at delivery) were altered among Zimbabwean women with preeclampsia as compared with normotensive women. Our results are consistent with some, though not all, previous reports. Prospective studies are needed to: 1) identify modifiable determinants of maternal plasma concentrations VEGF, sVEGF-R1, and PlGF; and 2) evaluate the temporal relationship between observed alterations of these biological markers in preeclamptic pregnancies.

Adult↗

PubMed2001

Treatments for iron deficiency anaemia in pregnancy.

BACKGROUND: Iron deficiency is the most common cause of anaemia in pregnancy worldwide. Iron treatment can be given by mouth, intramuscular or intravenous injection. Alternatively, blood transfusions and recombinant erythropoietin are also used. OBJECTIVES: To assess the effectiveness of different treatments for iron deficiency anaemia in pregnancy (defined as haemoglobin less than 11 g/dl) on maternal and neonatal morbidity and mortality. SEARCH STRATEGY: Cochrane Pregnancy and Childbirth Group Specialised Register of Trial was searched. Date of last search: December 2000. SELECTION CRITERIA: Randomised controlled trials comparing treatments for iron deficiency anaemia in pregnancy. DATA COLLECTION AND ANALYSIS: The search identified 54 trials. Five trials, involving approximately 1234 women, met the inclusion criteria. Trial quality was assessed. Study authors were contacted for additional information. MAIN RESULTS: Oral iron treatment in pregnancy was assessed in one small trial (n=125), where it was compared with placebo. This showed a reduction in the number of women with haemoglobins under 11g/dl (odds ratio (OR) 0.12, 95% confidence interval (CI) 0.06 to 0.24) and a greater mean haemoglobin level 11.3g/dl compared to 10.5 g/dl (weighted mean difference 0.80, 95% CI 0.62 to 0.98). However, there were no data on clinically relevant outcomes. When comparing different iron treatments, the intravenous (IV) route of administration was associated with an increased risk of venous thrombosis (1 trial, n=74. Iron dextran intramuscularly (IM) versus IV (n=49) OR 0.13, 95% CI 0.02-1.02. IM iron sorbitol-citric acid versus IV iron dextran, OR 0.12, 95% CI 0.02-0.94). Intravenous iron treatments were compared with placebo in one trial (n=54) but only scarce data on adverse outcomes were suitable for inclusion in this review. REVIEWER'S CONCLUSIONS: This review provides inconclusive evidence on the effects of treating iron deficiency anaemia in pregnancy due to the shortage of good quality trials.

Anemia, Iron-Deficiency↗

PubMed2001

HIV-1 seroconversion incidence following pregnancy and delivery among women seronegative at recruitment in Harare, Zimbabwe.

OBJECTIVE: To estimate the incidence of HIV seroconversion among women following pregnancy and delivery. DESIGN: A prospective cohort of women who were HIV negative at recruitment on first antenatal care visit. MATERIALS AND METHODS: Pregnant women were invited to undergo voluntary confidential HIV counselling and blood draw for HIV testing during the first antenatal care visit as part of a prospective study of mother-to-child transmission of HIV-1. Repeat tests were conducted at delivery, six weeks post partum and at three monthly intervals until 24 months or on termination due to subsequent pregnancy, death or loss to follow up. Logistic regression modelling was used to determine independent predictors of HIV seroconversion. RESULTS: Among 372 HIV negative pregnant women who were enrolled, 66 seroconverted during follow up, resulting in a sero-incidence of 4.8 per 100 person years (95% confidence interval [CI], 3.1 to 6.5). Women who did not seroconvert during the time of pregnancy or follow up were significantly more likely to have used a condom with their partners (OR = 0.68, 95% CI = 0.47 to 0.99). Women aged 17 years and below had the highest seroconversion incidence (6.25%) followed by those aged 18 to 19 years (5.42%). Women who seroconverted and those who were HIV positive at recruitment were more likely to be married. Lack of education by the partner of a pregnant woman constituted a significant risk factor for HIV seroconversion (OR = 2.8; 95% CI = 1.1 to 11.0). CONCLUSIONS: There is a high HIV seroconversion incidence among women during pregnancy and following delivery, especially those aged 19 years and below. Being married does not protect the women from the risk of HIV seroconversion. Strategies for HIV prevention should target pregnant women and their partners.

Adolescent↗

PubMed2001

Prenatal care utilization and foetal outcomes at Harare Maternity Hospital, Zimbabwe.

OBJECTIVES: To examine the association between adverse infant outcomes and maternal under utilization of prenatal care, among women delivering at Harare Maternity Hospital. DESIGN: Hospital based, cross sectional study. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: A random sample of 3,864 pregnant women. MAIN OUTCOME MEASURES: Prenatal care utilization, maternal socio-demographic information, as well as birth weight and other neonatal outcome characteristics. RESULTS: Of the total number of women who participated in this study 3,491 (90%) had at least one prenatal care visit. Women receiving no prenatal care, were more likely to be younger, unmarried and to have been transferred for delivery as compared with women receiving prenatal care. Women receiving no prenatal care were seven times more likely to deliver an infant weighing less than 1,500 grams, adjusted odd ratio (OR) = 7.22; 95% confidence interval (CI) 4.58 to 11.39 as compared with those who booked for care. Newborns of unbooked mothers were more likely to have a low apgar score at birth, adjusted OR = 1.71; to have been admitted to the neonatal intensive care unit, adjusted OR = 2.14, and to require intubation, adjusted OR = 3.35. A large proportion of women (31.4%) initiated prenatal care after 30 weeks gestation. CONCLUSIONS: There were significant differences between maternal characteristics and foetal outcomes in relation to booking status. Under utilization of prenatal care was associated with sub-optimal foetal outcomes. Improving the socio-economic status of women, their education and access to health care, and family planning methods are all strategies that should contribute to the reduction of adverse foetal outcomes.

Female↗

PubMed2000

Prenatal transmission of subtype C HIV-1 in Zimbabwe: HIV-1 RNA and DNA in maternal and cord blood.

Maternal and cord samples from HIV-seropositive women and their infants in Zimbabwe, where subtype C is the predominant strain of HIV, were analyzed to determine the frequency of detection of HIV RNA and DNA. HIV RNA was detected in 90% of maternal and in 38% of cord plasma at levels at least 25% of maternal plasma. Heteroduplex mobility assays and sequencing of virus envelope (C2-V5) demonstrated closely related, but unique, subtype C viruses in maternal and cord RNA, and a significantly greater frequency of cord viremia among women with homogenous, compared with heterogeneous viral envelope RNA. Quantification of RNA, measures of envelope viral diversity, and phylogenetic analysis of maternal and cord plasma RNA provide evidence for the frequent exposure and potential transmission of HIV from mother to infant before birth.

Adult↗

PubMed2000

Detection of Kaposi's sarcoma-associated herpesvirus in oral and genital secretions of Zimbabwean women.

Kaposi's sarcoma-associated herpesvirus (KSHV) in oral and genital secretions of women may be involved in horizontal and vertical transmission in endemic regions. Nested polymerase chain reaction assays were used to detect KSHV DNA sequences in one-third of oral, vaginal, and cervical specimens and in 42% of peripheral blood mononuclear cell (PBMC) specimens collected from 41 women infected with human immunodeficiency virus type 1 who had Kaposi's sarcoma (KS). KSHV DNA was not detected in specimens from 100 women without KS, 9 of whom were seropositive for KSHV. A positive association was observed between KSHV DNA detection in oral and genital mucosa, neither of which was associated with KSHV DNA detection in PBMC. These data suggest that KSHV replicates in preferred anatomic sites at levels independent of PBMC viremia. Detection of genital-tract KSHV only among relatively immunosuppressed women may provide an explanation for infrequent perinatal transmission of KSHV.

AIDS-Related Opportunistic Infections↗

PubMed2000

Prophylactic versus selective blood transfusion for sickle cell anaemia during pregnancy.

BACKGROUND: Sickle cells have a shorter life span than normal red blood cells. It has been suggested that pregnancy complications for women with sickle cell anaemia may be reduced by regular blood transfusions. The aim is to maintain haemoglobin at 60-70% of the normal total. OBJECTIVES: The objective of this review was to assess the effects of a policy of routine blood transfusion for pregnant women with sickle cell disease with a policy of selective transfusion. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Acceptably controlled trials of blood transfusion in pregnant women with sickle cell disease. DATA COLLECTION AND ANALYSIS: Eligibility, trial quality assessment and data extraction were done by one reviewer. MAIN RESULTS: One trial involving 72 women was included. Half the women received blood transfusion only if haemoglobin fell below 6g% and the other half received two units of blood every week for three weeks, or until haemoglobin level was 10-11g%. A policy of selective transfusion reduced the number of transfusions required at the expense of more frequent pain crises. REVIEWER'S CONCLUSIONS: There is not enough evidence to draw conclusions about the prophylactic use of blood transfusion for sickle cell anaemia during pregnancy.

Anemia, Sickle Cell↗

PubMed2000

Iron supplementation in pregnancy.

BACKGROUND: Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES: The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters, and on pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA: Acceptably controlled trials of iron supplementation for pregnant women. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS: Twenty trials were included. Iron supplementation raised or maintained the serum ferritin above 10 milligrams per litre. It resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Iron supplementation, however, had no detectable effect on any substantive measures of either maternal or fetal outcome. One trial, with the largest number of participants of selective versus routine supplementation, showed an increased likelihood of caesarean section and post-partum blood transfusion, but a lower perinatal mortality rate (up to 7 days after birth). REVIEWER'S CONCLUSIONS: Iron supplementation appears to prevent low haemoglobin at birth or at six weeks post-partum. There is very little information on pregnancy outcomes for either mother or baby. There are few data derived from communities where iron deficiency is common and anaemia is a serious health problem.

Anemia, Iron-Deficiency↗

PubMed2000

Maternal iodine supplements in areas of deficiency.

BACKGROUND: Iodine deficiency is the leading preventable cause of intellectual impairment in the world. Although iodine supplementation is generally considered to be safe, there is a possibility of high doses of iodine suppressing maternal thyroid function. OBJECTIVES: The objective of this review was to assess the effects of iodine supplementation before or during pregnancy in areas of iodine deficiency. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: All acceptably controlled trials of maternal iodine supplementation during pregnancy with clinical outcomes. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by two reviewers. MAIN RESULTS: Three trials involving 1551 women were included. In two trials, iodine supplementation was associated with a statistically significant reduction in deaths during infancy and early childhood (relative risk 0.71, 95% confidence interval 0. 56 to 0.90). Iodine supplementation was associated with decreased prevalence of endemic cretinism at the age of four years (relative risk 0.27, 95% confidence interval 0.12 to 0.60) and better psychomotor development scores between four to 25 months of age. REVIEWER'S CONCLUSIONS: Iodine supplementation in a population with high levels of endemic cretinism results in an important reduction in the incidence of the condition with no apparent adverse effects.

Child, Preschool↗

PubMed2000

Pyridoxine (vitamin B6) supplementation in pregnancy.

BACKGROUND: Pyridoxine (vitamin B6) contributes to the development of the central nervous system and may influence brain development and cognitive function. It may also prevent dental caries and protect the placental vascular bed. OBJECTIVES: The objective of this review was to assess the effects of vitamin B6 supplementation during pregnancy and labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials of pyridoxine administration compared to a control group. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by two reviewers. MAIN RESULTS: One trial involving 371 women was included. Pyridoxine supplementation either as oral capsules (odds ratio 0.63, 95% confidence interval 0. 41 to 0.95) or lozenges (odds ratio 0.33, 95% confidence interval 0. 22-0.51) was associated with decreased incidence of dental decay in pregnant women. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate pyridoxine supplementation during pregnancy, although the results of one trial suggest that it may have a beneficial effect on dental decay.

Dietary Supplements↗

PubMed2000

Folate supplementation in pregnancy.

BACKGROUND: Folate depletion may result in anaemia during pregnancy. OBJECTIVES: The objective of this review was to assess the effects of folate supplementation in pregnancy on haematological and biochemical parameters and measures of pregnancy outcome. This review did not address the role of periconceptual folate supplementation to diminish the risk of fetal malformation. SEARCH STRATEGY: A comprehensive electronic search included that of the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Acceptably controlled trials of folate supplementation compared with placebo or no treatment to pregnant women with normal haemoglobin levels. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. Study authors were contacted for additional information when necessary. MAIN RESULTS: Twenty-one studies were included. The trials varied in quality. Compared to placebo or no supplementation, folate supplementation was associated with increased or maintained serum folate levels (odds ratio 0.18, 95% confidence interval 0.13 to 0.24) and red cell folate levels (odds ratio 0.18, 95% confidence interval 0.09 to 0.38). Folate supplementation was associated with a reduction in the proportion of women with low haemoglobin level in late pregnancy (odds ratio 0.61, 95% confidence interval 0.52 to 0.71) and megaloblastic erythropoiesis (odds ratio 0.65, 95% confidence interval 0.45 to 0.95). Apart from a possible reduction in the incidence of low birthweight, folate supplementation appears to have no measurable effect on any other substantive measures of pregnancy outcome. REVIEWER'S CONCLUSIONS: Folate supplementation during pregnancy appears to improve haemoglobin levels and folate status. There is not enough evidence to evaluate whether folate supplementation has any effect, beneficial or harmful, on clinical outcomes for mother and baby.

Anemia↗

PubMed2000

Vitamin D supplementation in pregnancy.

BACKGROUND: Vitamin D deficiency can occur in people whose diet is relatively low in the vitamin and those who are not exposed to much sunlight. OBJECTIVES: The objective of this review was to assess the effects of vitamin D supplementation on pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (October 1998). SELECTION CRITERIA: Acceptably controlled trials of vitamin D supplementation during pregnancy. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Two trials involving 232 women were included. In one trial the mothers had higher mean daily weight gain and lower number of low birthweight infants. In the other trial the supplemented group had lower birthweights. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the effects of vitamin D supplementation during pregnancy.

Dietary Supplements↗

PubMed2000

Zinc supplementation in pregnancy.

BACKGROUND: It has been suggested that low serum zinc levels may be associated with abnormalities of labour, although this has not yet been established. OBJECTIVES: The objective of this review was to assess the effect of zinc supplementation in pregnancy on maternal and fetal mortality and morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Acceptably controlled trials of zinc supplementation in pregnancy. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Seven trials were included. Apart from possible reduction in induction of labour, caesarean section and preterm delivery in the supplemented group, no other differences were detected between groups of women who had zinc supplementation and those who had either placebo or no zinc during pregnancy. REVIEWER'S CONCLUSIONS: There is insufficient evidence to evaluate fully the affect of zinc supplementation during pregnancy. The possible beneficial effects on preterm delivery need to be evaluated in further trials.

Dietary Supplements↗

PubMed2000

Iron and folate supplementation in pregnancy.

BACKGROUND: Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES: The objective of this review was to assess the effects of routine iron and folate supplementation on haematological and biochemical parameters and on pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA: Acceptably controlled trials of routine iron and folate supplementation for pregnant women. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS: Eight trials involving 5449 women were included. Routine supplementation with iron or folate raised or maintained the serum iron and ferritin levels and serum and red cell folate levels. Supplementation resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Routine supplementation with iron and folate had no detectable effect on any substantive measures of either maternal or fetal outcome. REVIEWER'S CONCLUSIONS: Routine supplementation with iron and folate appears to prevent low haemoglobin at delivery. There is very little information on other outcomes for either mother or baby. There are few data derived from communities where iron and folate deficiency is common and anaemia is a serious health problem.

Anemia↗

PubMed2000

Methylenetetrahydrofolate reductase 677 C --> T polymorphism, plasma folate, vitamin B(12) concentrations, and risk of preeclampsia among black African women from Zimbabwe.

We conducted a case control study at Harare Maternity Hospital, Zimbabwe. We genotyped a total of 171 cases with preeclampsia or eclampsia and 185 normotensive control subjects for the methylenetetrahydrofolate reductase (MTHFR) 677 C --> T genotype. The wild-type allele frequency among cases and controls was 91.2 and 91.3%, respectively. Only one subject (0.3%) was homozygous for the 677 C --> T MTHFR genotype and this subject had preeclampsia. After adjustment for confounding factors, there was statistically no significant association between maternal MTHFR genotype and risk of preeclampsia (adjusted odds ratio = 1.0; 95% CI, 0.5-1.9). In addition, plasma homocyst(e)ine, vitamin B(12), and folate concentrations were not statistically different between normotensive control subjects with wild-type genotype as compared with normotensive subjects who were heterozygous for the mutant allele. Conversely, there was a strong graded association between maternal plasma folate concentration and risk of preeclampsia. Women with plasma folate concentrations less than 5.7 nmol/L experienced a 10. 4-fold increase in risk of preeclampsia. There was no clear pattern of preeclampsia risk and vitamin B(12) concentrations.

Adolescent↗

PubMed2000

Economic development and women's blood pressure: field evidence from rural Mashonaland, Zimbabwe.

A survey of 515 non-pregnant women at 12 geographically chosen research sites in rural Mashonaland shows significant differences in mean blood pressure, controlled by age cohorts. Three levels of economic development are identified: (1) the traditional economy on communal lands, with lowest blood pressure, (2) the wage economy in areas of large-scale commercial agriculture, with elevated blood pressure and (3) the wage economy in mining areas, with the highest elevation of blood pressure. The area is dominated by the primate city, Harare, up to distances of 300 km and beyond, from which forces of change and modernization emanate. It is seen that potassium, sodium and the sodium potassium ratio, are distance-related to Harare and that women's blood pressures tend to follow suit. The rise of body sodium in young persons at risk, often accompanied by declining potassium intake and other changes of modernization, suggest that more attention should be focused on rural areas in Africa, now in the throes of economic change.

Adolescent↗

PubMed2000

Home-based mother's record: operational feasibility, understanding and usage in a rural community in Zimbabwe.

Utilization of health services is variable but may contribute to the well being of women during pregnancy. If people understand when there is a risk of illness or death, they are likely to cooperate in reducing those risks and participate in their own care. In rural communities people need to be provided with simple but scientifically-sound technology adapted to their understanding and needs. One such technology is the home-based maternal record (HBMR). We assess the feasibility, understanding and usage of a locally adapted HBMR of the World Health Organization prototype in a rural community in Binga district, Zimbabwe.

Community Health Services↗