Warfarin pharmacogenetics in a black Zimbabwean cohort: an observational prospective study

Aim: A prospective observational study was conducted to evaluate the feasibility of implementing clinical guidelines for warfarin dosing in black Zimbabwean patients. Methods: CYP2C9*5, CYP2C9*6, CYP2C9*8 and CYP2C9*11 and VKORC1 c. 1639 G>A variations were observed in 62 study patients. Results & Conclusion: Overall, 39/62 (62.90%) participants did not receive a warfarin starting dose as would have been recommended by Clinical Pharmacogenetics Implementation Consortium guidelines. US FDA and Dutch Pharmacogenetics Working Group guidelines are based on CYP2C9*2 and CYP2C9*3 only, hence, unlikely useful in this cohort, where such variants were not detected. Clinical Pharmacogenetics Implementation Consortium guidelines, on the other hand, have a specific recommendation on the African-specific variants CYP2C9*5, CYP2C9*6 and CYP2C9*11, and are hence suitable for implementation in Zimbabwe and would help optimize warfarin doses in patients in the study cohort.

Investigation on the hereditary basis of colorectal cancers in an African population with frequent early onset cases

Background

Approximately 25% of colorectal cancer patients in sub-Saharan Africa are younger than 40 years, and hereditary factors may contribute. We investigated the frequency and patterns of inherited colorectal cancer among black Zimbabweans.

Methods

A population-based cross-sectional study of ninety individuals with a new diagnosis of colorectal cancer was carried out in Harare, Zimbabwe between November 2012 and December 2015. Phenotypic data was obtained using interviewer administered questionnaires, and reviewing clinical and pathology data. Cases were screened for mismatch repair deficiency by immunohistochemistry and/or microsatellite instability testing, and for MLH1, MSH2 and EPCAM deletions using multiplex ligation-dependent probe amplification. Next generation sequencing using a 16-gene panel was performed for cases with phenotypic features consistent with familial colorectal cancer. Variants were assessed for pathogenicity using the mean allele frequency, phenotypic features and searching online databases.

Results

Three Lynch syndrome cases were identified: MSH2 c.2634G>A pathogenic mutation, c.(1896+1_1897–1)_(*193_?)del , and one fulfilling the Amsterdam criteria, with MLH1 and PMS2 deficiency, but no identifiable pathogenic mutation. Two other cases had a strong family history of cancers, but the exact syndrome was not identified. The prevalence of Lynch syndrome was 3·3% (95% CI 0·7–9·4), and that of familial colorectal cancer was 5·6% (95% CI, 1·8–12·5).

Conclusions

Identifying cases of inherited colorectal cancer in sub-Saharan Africa is feasible, and our findings can inform screening guidelines appropriate to this setting.

A case-control study of risk factors for colorectal cancer in an African population

The interplay between hereditary and environmental factors in the causation of colorectal cancer in sub-Saharan Africa is poorly understood. We carried out a community based case-control study to identify the risk factors associated with colorectal cancer in Zimbabwe. We recruited 101 cases of colorectal cancer and 202 controls, matched for age, sex and domicile. Potential risk factors including family history, socioeconomic status, urbanization, diabetes mellitus and previous schistosomiasis were evaluated. Conditional logistic regression was used to estimate the odds ratios associated with the different factors. Cases were more likely to have a tertiary education (32.7 vs. 13.4%, P<0.001) and a higher income (18.8 vs. 6.9%, P=0.002). After multivariate analysis, diabetes mellitus [odds ratio (OR): 5.3; 95% confidence interval (CI): 1.4-19.9; P=0.012], previous urban domicile (OR: 2.8; 95% CI: 1.0-7.8; P=0.042), previous schistosomiasis (OR: 2.4; 95% CI: 1.4-4.2; P=0.001) and cancer in a first-degree relative (OR: 2.4; 95% CI: 1.2-4.8; P=0.018) were associated independently with colorectal cancer. Our findings suggest that family history, diabetes mellitus, previous schistosomiasis and approximation to a western lifestyle are the predominant associations with colorectal cancer in Africans. This offers opportunities for targeted prevention and hypothesis-driven research into the aetiology of colorectal cancer in this population.

Dietary patterns and colorectal cancer risk in Zimbabwe: A population based case-control study

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Three main dietary patterns in Zimbabwe; traditional African, urban and processed foods.

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Traditional African diet associated with a reduced risk of colorectal cancer.

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No association between colorectal cancer and the urban or processed food patterns.

Background

The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe.

Methods

One hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer.

Results

Three main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00–1.59), and a low income (OR1.48; 95% CI, 1.06–2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38–2.10), secondary (OR 1.30; 95% CI, 1.07–1.59) or tertiary education (OR 1.48; 95% CI, 1.11–1.97), and monthly incomes of $201–500 (OR 1.30; 95% CI, 1.05–1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05–1.92), and income >$1000/month (OR 1.48; 95% CI, 1.02–2.15).

Conclusion

A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.

The incidence and histo-pathological characteristics of colorectal cancer in a population based cancer registry in Zimbabwe

BACKGROUND

Data on colorectal cancer (CRC) in sub-Saharan Africa is mainly based on hospital series which suggest low incidence and frequent early onset cancers. This study characterises colorectal cancer in a population-based cancer registry in Zimbabwe.

METHODS

Cases of CRC recorded by the Zimbabwe National Cancer Registry between 2003 and 2012 were analysed. Demographic and pathological characteristics were compared according to ethnicity and age. Trends in age standardised incidence rates (ASR) were determined.

RESULTS

There were 886 and 216 cases of CRC among black Africans and Caucasians respectively, and 26% of the black Africans were younger than 40 years. Signet ring cell carcinomas were more common among black Africans compared to Caucasians (4% vs 1%, p=0.027). ASR increased by 1.9%/year and 3.9%/year among black African males and females respectively.

CONCLUSION

CRC incidence is rising among black Africans and has unique demographic and pathological characteristics.

Rheumatic fever and rheumatic heart disease among children presenting to two referral hospitals in Harare, Zimbabwe

BACKGROUND

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant causes of morbidity and mortality in resource-limited settings. In Zimbabwe ARF/RHD characteristics have not been systematically documented.

OBJECTIVES

To document cases of ARF/RHD among children presenting at referral hospitals in Harare, Zimbabwe, determine their clinical and echocardiographic characteristics, and identify opportunities for improving care.

METHODS

A cross-sectional survey was carried out in which consecutive children aged 1 - 12 years presenting with ARF/RHD according to the 2002/3 World Health Organization modified Jones criteria were enrolled.

RESULTS

Out of 2 601 admissions and 1 026 outpatient visits over 10 months, 50 children were recruited, including 31 inpatients with ARF/RHD and 19 outpatients with chronic RHD. Among inpatients, 9 had ARF only, 7 recurrent ARF with RHD, and 15 RHD only. The commonest valve lesions were mitral regurgitation (26/31) and aortic regurgitation (11/31). The commonest reason for admission was cardiac failure (22/31). The proportion of ARF/RHD cases among inpatients aged 1 - 12 years was 11.9/1 000. Of the 22 with RHD, 14 (63.6%) presented de novo and 1 had bacterial endocarditis. Among the outpatients, 15 had cardiac failure while echocardiographic findings included mitral regurgitation (18/19) and aortic regurgitation (5/19). At presentation, 18/26 known cases were on oral penicillin prophylaxis and 7 on injectable penicillin. Of those on secondary prophylaxis, 68.0% reported taking it regularly.

CONCLUSION

ARF/RHD remains a major problem and cause of hospital admissions in Harare, Zimbabwe. Children often present late with established RHD and cardiac failure. With the majority on oral penicillin, secondary prophylaxis was suboptimal in a resource-limited setting unable to offer valve replacement surgery.

Metabolic syndrome disorders in urban black Zimbabweans with type 2 Diabetes mellitus

OBJECTIVE

The main aim of the study was to determine the prevalence of metabolic syndrome disorders and their interrelations in black Zimbabwean type 2 diabetic patients.

STUDY DESIGN

Prospective cross sectional study.

SETTING

Outpatient diabetic clinics at Harare and Parirenyatwa tertiary hospitals.

MAIN OUTCOME MEASURES

We recruited 109 adult diabetic subjects attending a tertiary hospital Diabetic Clinic. Anthropometric and metabolic parameters were measured by standard methods. Eighty percent of the patients were hypertensive, 32% dyslipidaemic, 32% obese, 50% hyperinsulinaemic, 61% had poor glycaemic control and 43% of the participants had the metabolic syndrome. The means of BMI and triglycerides were significantly different in hyperinsulinaemic versus non-hyperinsulinaemic patients (p < 0.001 and 0.041 respectively), and diastolic blood pressure was significantly raised in the obese group (p = 0.043). The following significant associations were observed, hyperinsulinaemia with the metabolic syndrome (odds ratio = 3.9, p < 0.001) as well with obesity (odds ratio = 4.8, p < 0.001), however, only a weak association was observed between hypertension and hyperinsulinaemia (odds ratio = 2.5, p = 0.064). Patients exhibiting three metabolic disorders (dyslipidaemia, hypertension and obesity) were five times more likely to be hyperinsulinaemic (p = 0.025) and hypertensive patients were almost three times more likely to be hyperinsulinaemic.

CONCLUSION

In comparison to their counterparts from certain ethnic groups, this urban diabetic population is also burdened with a variety of metabolic disorders which are risk factors for coronary artery disease. In this population, hyperinsulinaemia has a relatively weak association with hypertension and the relationship between obesity versus diastolic blood pressure as well as hypertriglyceridaemia versus serum insulin levels requires further investigation.

Urinary iodine concentrations and thyroid function in adult Zimbabweans during a period of transition in iodine status

BACKGROUND

In 1993 the compulsory iodization of salt was introduced in Zimbabwe, a country that was previously an area of severe iodine deficiency.

OBJECTIVE

The objective of this study was to document urinary iodine excretion and biochemical thyroid function in seemingly healthy, community-dwelling adults after the introduction of iodization.

DESIGN

A multistage, random sampling method was used in rural and urban settings to identify households from which the senior household member (aged >35 y) was recruited (alternating male and female recruits). Demographic data were collected for each subject and urinary and venous blood samples were taken. Urinary iodine excretion and serum thyroid hormone status (thyrotropin and total thyroxin) were evaluated according to age, sex, and area of residence.

RESULTS

A total of 736 adults were recruited (253 men; mean age: 64 y). Urinary iodine concentrations were high [median (first and third quartiles): 4.41 (2.84, 6.78) micromol/L, or 560 (360, 860) microgram/L] and were significantly higher in rural areas than in urban areas [4.73 (3.07, 7.14) micromol/L, or 600 (390, 906) microgram/L, compared with 3.47 (2.05, 4.73) micromol/L, or 440 (260, 600) microgram/L; P < 0.001]. Urinary iodine excretion declined significantly with increasing age (r = -0.29, P < 0.001). Serum thyroid status suggested that the prevalence of biochemical hyperthyroidism in the study was 3%, with 13 of 415 cases in rural and 3 of 149 cases in urban subjects.

CONCLUSION

This study reaffirms the need to continuously monitor iodine replacement programs to ensure efficacy.

Effect of variation in environmental temperature on blood pressure: is it important?

OBJECTIVES

To study the effect of variation in environmental temperature on blood pressure and pulse.

DESIGN

Repeated blood pressure and pulse measurements in volunteers on two days when environmental temperatures differed by 10 degrees C.

SETTING

Part of an ongoing community based study.

SUBJECTS

25 Black subjects (23 males and two females) volunteered from a population cohort participating in an ongoing longitudinal study examining cardiovascular risk factors in an urban African Black environment.

MAIN OUTCOME MEASURE

Mean systolic and diastolic blood pressures and pulse rates.

RESULTS

The systolic and diastolic blood pressures were significantly higher when recorded at 15 degrees C than at 25 degrees C, mean difference 32.2 +/- 4.2, p < 0.001 and 19.5 +/- 3.0 p < 0.001) for systolic and diastolic blood pressures respectively. The pulse rate per minute at 15 degrees C was significantly lower than at 25 degrees C (mean difference 11.1 +/- 3.2 p = 0.002).

CONCLUSIONS

A decrease in environmental temperature by 10 degrees C appears to increase blood pressure. Awareness of this phenomenon is important, especially when surprisingly high blood pressures are observed during low ambient temperatures, to avoid over diagnosis of hypertension. This phenomenon, together with that already established of the white coat hypertension, may lead to the erroneous diagnosis of hypertension.

Diet and nutritional status in elderly Zimbabweans

BACKGROUND

nutritional studies in developing countries tend to focus on women of reproductive age and children. Little is known about the diet or nutritional status of elderly Africans.

OBJECTIVE

to record the diet, anthropometric, haematological and biochemical measurements which might reflect nutrition and social factors in a group of elderly Zimbabweans.

DESIGN

cross-sectional community survey.

SETTING

a remote rural area in north-eastern Zimbabwe and two urban townships located approximately 80 km from Harare.

SUBJECTS

278 subjects (154 women, 174 rural), aged >60 years (range 60-92), living at home.

METHOD

subjects were selected by random cluster sampling. Diet was assessed by a food frequency questionnaire. Anthropometric measurements were body mass index (BMI), waist : hip ratio (WHR), triceps and subscapular skinfold thickness (SFT). Laboratory analysis included serum albumin, calcium, haemoglobin, alkaline phosphatase (ALP), cholesterol, triglycerides, vitamin B12 and red blood cell folate levels.

RESULTS

the staple diet was maize meal and vegetables; 74 (27%) ate a protein-containing meal less than once a week; 135 (49%) took milk less than once a week and 27% had serum Ca2+ < 2 mmol/l. The frequency of eating meat, milk, bread and fried food varied with income and education and declined with age. For all anthropometric measurements median values were higher in the urban area (BMI 21.1 vs 18.3, WHR 0.98 vs 0.9, triceps SFT 10 vs 6.7 mm; P < 0.001 for all) and related to the frequency of eating meat and fried food. The BMI was higher in those with more years of education. Within the rural area physical measurements were higher in a more prosperous area. Serum lipid concentrations were higher in urban residents (median cholesterol 4.4 vs 3.9 mmol/l, triglycerides 1.8 vs 1.5 mmol/l; P < 0.001 for both) and correlated with BMI, WHR and triceps SFT. Vitamin B12 concentrations were higher in urban residents, whereas folate concentrations were higher in rural residents.

CONCLUSIONS

dietary patterns, anthropometric measurements and biochemical values in a group of randomly-selected elderly Zimbabweans are influenced by area of residence, age, income and educational level.

Anaemia, macrocytosis, vitamin B12 and folate levels in elderly Zimbabweans

OBJECTIVES

To establish the ranges of full blood count (FBC), vitamin B12 and folate levels and to determine the prevalence of occult haematological abnormalities in older Zimbabweans.

STUDY DESIGN

Community based cross sectional survey.

SUBJECTS

278 randomly selected healthy Zimbabweans aged > 65 years. INTERVENTIONS/STUDY FACTORS: Haemoglobin level, MCV, folate, B12 alcohol consumption.

RESULTS

The median Hb was males 14.0 (range 8 to 18.3), females 13.1 g/dl (7.9 to 18.1). 23% were anaemic (Hb < 13 g/dl in males, < 12 g/dl in females), 3% with microcytic and 20% with macrocytic indices. Overall 13% had low vitamin B12 and 30% had low folate levels. Folate levels were significantly lower in urban subjects and B12 levels were significantly lower in rural subjects. Fifty four subjects (21%) had an MCV > 100 fl. In this group, low folate levels were found in 22, low B12 levels in nine, excessive alcohol in eight and two subjects had elevated TSH. The MCV was higher in urban subjects.

CONCLUSIONS

This study has revealed a large amount of occult haematological abnormality and interesting differences between rural and urban subjects. It focuses attention on low levels of folate, which should be preventable by simple nutritional education, as an extensive problem in the community.

Hypertension management in Zimbabwe--awareness, treatment and blood pressure control. A community-based study

OBJECTIVE

To evaluate the level of awareness of hypertension, treatment and blood pressure control in rural and urban communities in Zimbabwe.

DESIGN

Community-based cross-sectional survey.

SUBJECTS AND SETTING

749 male and female heads of households aged > 34 years recruited from alternate households of randomly selected villages in two adjacent rural areas and randomly selected streets in an urban area.

MAIN OUTCOME MEASURES

Blood pressure, awareness of hypertension, treatment and control for those on drug therapy.

RESULTS

250 subjects were found to have a diastolic blood pressure (DBP) > 94 mmHg or were on treatment with a DBP < 95 mmHg. Only 56 (22.4%) were on treatment. Of those not on treatment, 73.9% were not aware that they were hypertensive, while only 26.1% were aware but were untreated. Of those on treatment, control was inadequate in 24 (52.2%).

CONCLUSION

Awareness is low and treatment and control of hypertension are inadequate in this population. There is an urgent need to set up a national policy for the prevention and control of hypertension in Zimbabwe. The main focus should be on prevention, as this may be more cost-effective for a developing country with limited resources.

Morbidity and disability in elderly Zimbabweans

BACKGROUND

the population aged over 60 years in Zimbabwe is expanding. Despite the likely increased demand on medical services that this will bring, little is known about the health needs of this elderly population.

OBJECTIVE

to record the prevalence of disability (impairment of activities of daily living), subjective morbidity (symptoms), the social circumstances and the utilization of health services in a group of elderly Zimbabweans.

DESIGN

cross-sectional community survey.

SETTING

a remote rural area in North Eastern Zimbabwe and two urban townships located approximately 80 km from Harare.

SUBJECTS

278 subjects (154 women, 174 rural), aged > 60 years (range 60-92) living at home.

METHOD

subjects were selected by random cluster sampling. They were assessed in a structured interview and underwent physical examination including visual acuity, inspection for cataracts and assessment of mobility.

RESULTS

less than 4% experienced difficulty with self-maintenance activities of daily living, but 30% had difficulty with instrumental activities. The former were all visually impaired and both visual and mobility problems contributed to the latter. Elderly people experienced many symptoms but had inadequate access to health services and used medication infrequently. Subjects were mainly self-sufficient for financial income and 60% still worked. They had declining resources with age and received little help from the social welfare department. Their health and functional abilities deteriorated with age but it was older subjects who had most difficulty getting to the clinic. Simple measures such as cataract surgery and analgesics were available only to the minority or not at all.

CONCLUSIONS

this study highlights problem areas where simple, low-cost measures could make a difference to the morbidity and disability of elderly Zimbabweans.

Determinants of happiness and life satisfaction in elderly Zimbabweans

OBJECTIVE

To assess determinants of happiness and life satisfaction in elderly Zimbabweans.

DESIGN

Community based cross sectional survey.

SETTING

Randomly selected villages and two urban areas in north eastern Zimbabwe.

SUBJECTS

278 subjects aged 60 to 92 years (124 male, 154 female).

METHOD

One subject per randomly selected household was interviewed, at home, by a trained interviewer to complete a questionnaire.

RESULTS

Independent determinants of happiness were: rural residence, whether children gave material support and satisfaction with financial circumstances. [Adjusted odds ratios and confidence intervals 0.25 (0.13 to 0.49), 0.45 (0.22 to 0.94) and 0.11 (0.01 to 0.87) respectively]. Independent determinants of life satisfaction were: feeling better off than their neighbours, receiving adequate respect from their children and satisfaction with financial circumstances. [Adjusted odds ratios and confidence intervals 0.73 (0.59 to 0.91), 0.13 (0.03 to 0.59) and 0.24 (0.1 to 0.61) respectively].

CONCLUSIONS

We have demonstrated that, despite physical hardship, the majority of Zimbabwean elders are happy and 50% are satisfied with their lives and we have identified independent determinants of happiness and life satisfaction in this group. Characterization of these determinants allows us to predict that social changes such as rural/urban migration, declining family support and diminishing respect from children will have a negative effect on happiness and life satisfaction in our elders. It is important that, when planning intervention programmes for the elderly, these facets of wellbeing are not neglected.

Endomyocardial fibrosis in Zimbabwe--how rare is it? A report of two cases

In Africa endomyocardial fibrosis (EMF) is rare outside countries where it is endemic, such as Uganda, Mozambique and Ivory Coast. The only published case in Zimbabwe was in 1957. We describe two female patients aged 22 and 19 years who presented within seven months of each other with typical clinical, electrocardiographic and echocardiogaphic features of right ventricular EMF. We would like to suggest that EMF exists in Zimbabwe and needs to be considered in the differential diagnosis of patients presenting with suggestive clinical features.

Comparison of the Omron HEM-713C automated blood pressure monitor with a standard ausculatory method using a mercury manometer

OBJECTIVES

To compare the Omron HEM-713C automated blood pressure machine with the standard ausculatory method using a mercury manometer.

DESIGN

Blood pressures of randomly selected subjects were measured using both the Omron HEM-713C and the mercury manometer.

SETTING

Dombotombo surburb in Marondera, Zimbabwe.

SUBJECTS

One hundred and sixteen subjects 25 years and above (47 males and 69 females) randomly selected in Marondera.

MAIN OUTCOME MEASURE

Systolic blood pressure and diastolic blood pressure.

RESULTS

The Omron HEM-713C passed with a grade B for both systolic and diastolic blood pressures when using the British Hypertension Society protocol. It also passed both systolic and diastolic criteria for Association of the Advancement of Medical Instrumentation.

CONCLUSION

The Omron HEM-713C compares well with the standard mercury manometer, we therefore recommend its use in both research and clinical applications which require blood pressure measurements.

Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study of 157 patients in hospital in Zimbabwe

OBJECTIVE

To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in acutely ill hospital patients infected with human immunodeficiency virus (HIV) in Zimbabwe.

DESIGN

A prospective echocardiographic survey of acutely ill HIV seropositive patients.

SETTING

General medical ward, Harare Central Hospital, Zimbabwe.

PATIENTS

One hundred and fifty seven HIV seropositive patients admitted with various acute medical conditions over a 12 month period, January to December 1994.

MAIN OUTCOME MEASURES

Detection of myocardial dysfunction and other cardiac abnormalities by cross sectional echocardiography.

RESULTS

Eighty (51%) men and 77 women were studied (mean (SD) age 34.4 (8.5), range 15-60 years for males and 31.6 (9.0), range 16-65 years for females). They were all heterosexual. None was haemophiliac or an intravenous drug user. Echocardiographic abnormalities were found in 79 (50%) patients: 14/151 (9%) had dilated cardiomyopathy, 33/151 (22%) left ventricular dysfunction, 9/151 isolated right ventricular dilatation, and 30/157 (19%) pericardial disease (28 with effusions, three having tamponade). There were two cases of constrictive pericarditis and one of ascending aortic aneurysm.

CONCLUSIONS

There is a high prevalence of echocardiographically detected myocardial and pericardial disease in this group of acutely ill HIV infected patients. Left ventricular dysfunction without dilatation was common, but its significance was not ascertained.

Abbreviated Mental Test (AMT) in the elderly: shortcoming of an adapted AMT in Zimbabwe

OBJECTIVE

To measure the abbreviated mental test (AMT)-and to determine factors which might influence this in a group of Zimbabwean elders.

DESIGN

Community based cross sectional survey.

SETTING

Randomly selected households within randomly selected villages and two high-density urban areas in north eastern Zimbabwe.

SUBJECTS

278 subjects aged 60 to 92 years (124 male, 154 female).

INTERVENTIONS

A questionnaire, including the AMT, was administered, at home, by trained research nurses.

MAIN OUTCOME MEASURES

AMT-literacy rates, visual acuity, social and demographic information.

RESULTS

128 (46pc) scored less than seven, a level normally associated with significant mental impairment. Only one subject was actually disoriented in time and place. Multiple regression analysis confirmed that increasing age, female sex, rural evidence, lack of formal education, reduced visual acquity and not currently living with a spouse were all independent factors associated with low AMT score.

CONCLUSION

It was apparent that the AMT was not a valid tool for screening for confusion in Zimbabwean elderly, since the prevalence of senile-dementia is increasing in the developing world. It is important to develop a screening test for use in Zimbabwe which is sensitive but is independent of these confounding variables.