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Simegn W, Mohammed SA, Moges G. Adherence to Self - Care Practice Among Type 2 Diabetes Mellitus Patients Using the Theory of Planned Behavior and Health Belief Model at Comprehensive Specialized Hospitals of Amhara Region, Ethiopia: Mixed Method. Patient Prefer Adherence 2023; 17:3367-3389. [PMID: 38106363 PMCID: PMC10725631 DOI: 10.2147/ppa.s428533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023] Open
Abstract
Background Diabetes mellitus is one of the major public health problems that requires appropriate self-care practices to reduce complications. The current study assessed adherence to self-care practices and associated factors using the theory of planned behavior and the health belief model among type 2 diabetes mellitus patients. Methods A facility-based, sequential explanatory mixed-method was undertaken at comprehensive specialized hospitals in the Amhara region of Ethiopia. A single population proportion formula was used to calculate sample size. Proportional allocation to the three study settings and systematic random sampling techniques were used to select 846 study participants. Logistic regression analysis was used to identify associated factors. Variables with a P-value less than 0.05 were declared statistically significant. For the qualitative study, purposive sampling was used to select sixteen key informants, and thematic analysis was performed. Results About 42.4% of the study participants had good adherence to self-care practices. Being a member of a diabetes association (AOR = 2.57, 95% CI: 1.51, 4.38), having a home glucometer (AOR = 2.52, 95% CI: 1.59, 4.02), having good glycemic control (AOR = 4.07, 95% CI: 2.53, 6.53), having low perceived barriers (AOR = 8.65, 95% CI: 4.65, 16.07), and having middle perceived barriers (AOR = 3.26, 95% CI: 1.88, 5.66) were significantly associated with good adherence to self-care practice. On the other hand, poor wealth index (AOR = 0.27, 95% CI: 0.16, 0.46), poor behavioral control (AOR = 0.59, 95% CI: 0.36, 0.97), poor behavioral intention (AOR = 0.36, 95% CI: 0.21, 0.64), low perceived benefits (AOR = 0.20, 95% CI: 0.08, 0.51), and middle perceived benefits (AOR = 0.57, 95% CI: 0.31, 0.83) were significantly associated with poor adherence to self-care practice. The key informants explored the influence of patients' beliefs, self-efficacy, social support, and barriers on their self-care practices. Conclusion Less than half of type 2 diabetes mellitus patients had good adherence to self-care practices. This was more evident for patients who are members of a diabetes association, having a high wealth index, having a home glucometer, good behavioral control, good behavioral intentions, high perceived benefit, and poor perceived barriers. Appropriate intervention should be designed based on the aforementioned factors.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Wali S, Ssinabulya I, Muhangi CN, Kamarembo J, Atala J, Nabadda M, Odong F, Akiteng AR, Ross H, Mashford-Pringle A, Cafazzo JA, Schwartz JI. Bridging community and clinic through digital health: Community-based adaptation of a mobile phone-based heart failure program for remote communities in Uganda. BMC DIGITAL HEALTH 2023; 1:20. [PMID: 38800672 PMCID: PMC11116269 DOI: 10.1186/s44247-023-00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2024]
Abstract
Background In Uganda, limited healthcare access has created a significant burden for patients living with heart failure. With the increasing use of mobile phones, digital health tools could offer an accessible platform for individualized care support. In 2016, our multi-national team adapted a mobile phone-based program for heart failure self-care to the Ugandan context and found that patients using the system showed improvements in their symptoms and quality of life. With approximately 84% of Ugandans residing in rural communities, the Medly Uganda program can provide greater benefit for communities in rural areas with limited access to care. To support the implementation of this program within rural communities, this study worked in partnership with two remote clinics in Northern Uganda to identify the cultural and service level requirements for the program. Methods Using the principles from community-based research and user-centered design, we conducted a mixed-methods study composed of 4 participatory consensus cycles, 60 semi-structured interviews (SSI) and 8 iterative co-design meetings at two remote cardiac clinics. Patient surveys were also completed during each SSI to collect data related to cell phone access, community support, and geographic barriers. Qualitative data was analyzed using inductive thematic analysis. The Indigenous method of two-eyed seeing was also embedded within the analysis to help promote local perspectives regarding community care. Results Five themes were identified. The burden of travel was recognized as the largest barrier for care, as patients were travelling up to 19 km by motorbike for clinic visits. Despite mixed views on traditional medicine, patients often turned to healers due to the cost of medication and transport. With most patients owning a non-smartphone (n = 29), all participants valued the use of a digital tool to improve equitable access to care. However, to sustain program usage, integrating the role of village health teams (VHTs) to support in-community follow-ups and medication delivery was recognized as pivotal. Conclusion The use of a mobile phone-based digital health program can help to reduce the barrier of geography, while empowering remote HF self-care. By leveraging the trusted role of VHTs within the delivery of the program, this will help enable more culturally informed care closer to home. Supplementary Information The online version contains supplementary material available at 10.1186/s44247-023-00020-5.
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Affiliation(s)
- Sahr Wali
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, R. Fraser Elliott Building, 4th floor, 190 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Isaac Ssinabulya
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, MulagoNational Referral Hospital, Kampala, Uganda
| | | | | | | | - Martha Nabadda
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | | | - Ann R. Akiteng
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, MulagoNational Referral Hospital, Kampala, Uganda
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Angela Mashford-Pringle
- Dalla Lana School of Public Health, Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, Toronto, ON Canada
| | - Joseph A. Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, R. Fraser Elliott Building, 4th floor, 190 Elizabeth St, Toronto, ON M5G 2C4 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON Canada
- Department of Computer Science, University of Toronto, Toronto, ON Canada
| | - Jeremy I. Schwartz
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, USA
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Molla IB, Berhie MA, Germossa GN, Hailu FB. Perceived social supports and associated factors among diabetes mellitus patients. J Diabetes Metab Disord 2022; 21:1651-1659. [PMID: 36404834 PMCID: PMC9672226 DOI: 10.1007/s40200-022-01116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
Purpose The aim of this study was to assess the Perceived Social Supports and Associated Factors Among Diabetes Mellitus Patients. Methods and materials A facility-based cross-sectional study on 399 randomly selected adult diabetes patients was conducted at JUMC with data collection between August and September 2021.The data was collected using diabetic social support tool through face-to-face interviews and document review checklist. Logistic regression was used to determine factors associated with perceived social support in diabetes patients. Result Two hundred nineteen (54.9%) out of 399 diabetes patients reported a good level of perceived social support. Informational support was the most reported (55.4%), followed by emotional support (52.9%), companionship support (52.9%), and instrumental or tangible support (48.8%). Having a family history of diabetes (AOR = 1.90, CI: 1.09, 3.51) and presence of chronic comorbidities (AOR = 2.01; CI: 1.08, 3.75) were positively associated with social support. Whereas unemployment (AOR = 0.09, CI: 0.02, 0.38) was negatively associated with social support. Conclusion and recommendations One of every two diabetes patients got adequate level of social support. Health care system, along with other stakeholders could strengthen social support in line with diabetes patients' lifestyle.
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Peer support and social networking interventions in diabetes self-management in Kenya and Uganda: A scoping review. PLoS One 2022; 17:e0273722. [PMID: 36155494 PMCID: PMC9512220 DOI: 10.1371/journal.pone.0273722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Diabetes mellitus is a growing worldwide health challenge especially in sub-Saharan Africa. While the use and effectiveness of diabetes self-management interventions is well documented in high-income countries, little information exists in sub-Saharan Africa. Therefore, this study attempted to synthesize information in the literature on the use and efficacy of peer support and social networking in diabetes self-management in Kenya and Uganda.
Objective
The purpose of this scoping review is to summarize research on the extent of use and efficacy of peer support and social networking interventions in diabetes self-management in Kenya and Uganda.
Design
We searched PubMed, ScienceDirect and Cochrane Library databases for articles reporting peer support and social networking interventions in Kenya and Uganda published in English between 2000 and September 2021. Key words encapsulated three major themes: peer support, social networking and self-management. Hand searches were also conducted to select eligible papers. Data was extracted using a form prepared and piloted in line with PRISMA-ScR guidelines.
Results
Thirteen peer reviewed articles were selected for analysis. Eleven studies reported peer support interventions while two focused on social networks in diabetes self-management. Peer support and social networking interventions incorporated microfinance and group medical visits, diabetes self-management education, telephone support and Medication Adherence Clubs. Most interventions were delivered by multidisciplinary teams comprising nurses and other professionals, peer educators, peer leaders and community health workers. Most interventions were effective and led to improvements in HbA1c and blood pressure, eating behaviors and physical activity and social support.
Conclusions
The limited studies available show that peer support and social networking interventions have mixed results on health and other outcomes. Importantly, most studies reported significant improvements in clinical outcomes. Further research is needed on the nature and mechanisms through which peer support and social network characteristics affect health outcomes.
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Moor SE, Tusubira AK, Wood D, Akiteng AR, Galusha D, Tessier-Sherman B, Donroe EH, Ngaruiya C, Rabin TL, Hawley NL, Armstrong-Hough M, Nakirya BD, Nugent R, Kalyesubula R, Nalwadda C, Ssinabulya I, Schwartz JI. Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment. BMJ Open 2022; 12:e059949. [PMID: 35863829 PMCID: PMC9310153 DOI: 10.1136/bmjopen-2021-059949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions. SETTING Three health facilities in Nakaseke District, Uganda. DESIGN Discrete choice experiment (DCE). PARTICIPANTS 496 adults with HTN and/or DM. MAIN OUTCOME MEASURES Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility. RESULTS Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal. CONCLUSIONS Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.
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Affiliation(s)
- Sarah Eg Moor
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Dallas Wood
- Center for Applied Economics and Strategy, RTI International, Research Triangle Park, North Carolina, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Evelyn Hsieh Donroe
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mari Armstrong-Hough
- Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | | | - Rachel Nugent
- Global Non-Communicable Diseases, RTI International, Seattle, Washington, USA
| | - Robert Kalyesubula
- African Community for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Christine Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
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Zhang S, Du Y, Cai L, Chen M, Song Y, He L, Gong N, Lin Q. Obstacles to home-based dietary management for caregivers of children with citrin deficiency: a qualitative study. Orphanet J Rare Dis 2022; 17:256. [PMID: 35804387 PMCID: PMC9264664 DOI: 10.1186/s13023-022-02437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dietary management is the most important and effective treatment for citrin deficiency, as well as a decisive factor in the clinical outcome of patients. However, the dietary management ability of caregivers of children with citrin deficiency is generally poor, especially in East Asia where carbohydrate-based diets are predominant. The aim of this study was to identify the difficulties that caregivers encounter in the process of home-based dietary management, and the reasons responsible for these challenges. Results A total of 26 caregivers of children with citrin deficiency were recruited, including 24 mothers, one father, and one grandmother. Grounded theory was employed to identify three themes (covering 12 sub-themes) related to the dilemma of dietary management: dietary management that is difficult to implement; conflicts with traditional concepts; and the notion that children are only a part of family life. The first theme describes the objective difficulties that caregivers encounter in the process of dietary management; the second theme describes the underlying reasons responsible for the non-adherent behavior of caregivers; the third theme further reveals the self-compromise by caregivers in the face of multiple difficulties. Conclusions This study reflects the adverse effects of multi-dimensional contradictions on the adherence of caregivers to dietary management. These findings reveal that the dietary management of citrin deficiency is not only a rational process, rather it is deeply embedded in family, social, and dietary traditions.
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Affiliation(s)
- Shuxian Zhang
- School of Nursing, Jinan University, Guangzhou City, 510632, Guangdong Prov., China
| | - Yun Du
- The First Affiliated Hospital of Jinan University, Guangzhou City, 510630, Guangdong Prov., China
| | - Lingli Cai
- School of Nursing, Jinan University, Guangzhou City, 510632, Guangdong Prov., China
| | - Meixue Chen
- School of Nursing, Jinan University, Guangzhou City, 510632, Guangdong Prov., China
| | - Yuanzong Song
- The First Affiliated Hospital of Jinan University, Guangzhou City, 510630, Guangdong Prov., China
| | - Lilan He
- The First Affiliated Hospital of Jinan University, Guangzhou City, 510630, Guangdong Prov., China
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou City, 510632, Guangdong Prov., China.
| | - Qingran Lin
- School of Nursing, Jinan University, Guangzhou City, 510632, Guangdong Prov., China. .,The First Affiliated Hospital of Jinan University, Guangzhou City, 510630, Guangdong Prov., China.
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Kamvura TT, Dambi JM, Chiriseri E, Turner J, Verhey R, Chibanda D. Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses. BMC Nurs 2022; 21:64. [PMID: 35303865 PMCID: PMC8932172 DOI: 10.1186/s12912-022-00841-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe. Methods In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational analysis of NCDs care in Zimbabwe and views from patients with lived experiences. Results Saturation was reached after interviewing 10 participants from five busy urban clinics. For all three NCDs, we identified four cross-cutting barriers, a) poor access to medication and functional equipment such as blood pressure machines, urinalysis strips; b) high cost of private care; c)poor working conditions; and d) poor awareness from both patients and the community which often resulted in the use of alternative potentially harmful remedies. Participants indicated that empowering communities could be an effective and low-cost approach to positive lifestyle changes and health-seeking behaviours. Participants indicated that the Friendship bench, a task-shifting programme working with trained community grandmothers, could provide a platform to introduce NCDs care at the community level. Also, creating community awareness and initiating screening at a community level through community health workers (CHWs) could reduce the workload on the clinic nursing staff. Conclusion Our findings reflect those from other LMICs, with poor work conditions and resources shortages being salient barriers to optimal NCDs care at the facility level. Zimbabwe's primary health care system faces several challenges that call for exploring ways to alleviate worker fatigue through strengthened community-led care for NCDs. Empowering communities could improve awareness and positive lifestyle changes, thus optimising NCD care. Further, there is a need to optimise NCD care in urban Zimbabwe through a holistic and multisectoral approach to improve working conditions, basic clinical supplies and essential drugs, which are the significant challenges facing the country's health care sector. The Friendship Bench could be an ideal entry point for providing an integrated NCD care package for diabetes, hypertension and depression. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00841-1.
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Affiliation(s)
- Tiny Tinashe Kamvura
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Jermaine M Dambi
- The Friendship Bench, Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ephraim Chiriseri
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jean Turner
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ruth Verhey
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Dixon Chibanda
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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