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The epidemiology of trypanosomiasis in Rumphi district, Malawi: a ten year retrospective study
M Madanitsa, J Chisi, B Ngwira
Malawi Medical Journal , 2009,
Abstract: Background Human African Trypanosomiasis (HAT) is caused by two species of the tsetse fly vectored protozoan hemoflagellates belonging to Trypanosma brucei, namely T.b gambiense which predominates in Western Africa and follows a chronic disease course and T.b rhodensiense which is more prevalent in Southern and Eastern Africa, Malawi included, and follows a more acute and aggressive disease course. Previous studies in the Democratic Republic of Congo, Angola, Uganda and Sudan have demonstrated that the prevalence rates of T.b rhodensiense infection have reached epidemic proportions. Objectives To describe the epidemiology of Trypanosomiasis in Rumphi District over the past ten years. Methodology A total of 163 records from January 2000 to December 2006 were retrospectively studied. Results There were more males than females (121 vs. 40) with the 20 – 29 years age bracket having the highest number of cases (26.3%, n=160). Stage 2 HAT was the commonest stage at presentation (58.2%, n=158) with the patients in the same being 3.5 times more likely to die than those with stage 1 HAT. Case fatality rates for late and early stage disease were 21.5% (n = 92) and 7.2% (n = 66) respectively with 84.6% having been cured (n=162). Convulsions were associated with fatal disease outcome and the majority of cases (97.2%, n=103) lived within 5 kilometres of the Vwaza game reserve boundary. Conclusion More men have been infected than women, with a high involvement in the 20 – 29 age brackets. A dramatic increase with active case finding indicates a high under-detection of the disease with late stage HAT being predominant at presentation. Though it has been found that cases with late stage disease have an increased likelihood of dying compared to those in early stage HAT, the high proportion of successful treatment indicates that the disease still carries a high degree of favourable outcome with treatment. It has also been demonstrated in this study that more than 95% of trypanosomiasis cases live within 5 km of game reserve boundary. Disease interventions should be implemented in areas within 5km of marshland game reserve boundary as priority areas. Malawi Medical Journal Vol. 21 (1) 2009: pp. 22-27
Entomological indices of malaria transmission in Chikhwawa district, Southern Malawi  [cached]
Mzilahowa Themba,Hastings Ian M,Molyneux Malcolm E,McCall Philip J
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-380
Abstract: Background Although malaria is highly prevalent throughout Malawi, little is known of its transmission dynamics. This paper describes the seasonal activity of the different vectors, human biting indices, sporozoite rates and the entomological inoculation rate in a low-lying rural area in southern Malawi. Methods Vectors were sampled over 52 weeks from January 2002 to January 2003, by pyrethrum knockdown catch in two villages in Chikhwawa district, in the Lower Shire Valley. Results In total, 7,717 anophelines were collected of which 55.1% were Anopheles gambiae sensu lato and 44.9% were Anopheles funestus. Three members of the An. gambiae complex were identified by PCR: Anopheles arabiensis (75%) was abundant throughout the year, An. gambiae s.s. (25%) was most common during the wet season and Anopheles quadriannulatus occurred at a very low frequency (n=16). An. funestus was found in all samples but was most common during the dry season. Anopheles gambiae s.s. and An. funestus were highly anthropophilic with human blood indices of 99.2% and 96.3%, respectively. Anopheles arabiensis had fed predominantly on humans (85.0%) and less commonly on cattle (10.9%; 1.2% of blood meals were of mixed origin). Plasmodium falciparum (192/3,984) and Plasmodium malariae (1/3,984) sporozoites were detected by PCR in An. arabiensis (3.2%) and An. funestus (4.5%), and in a significantly higher proportion of An. gambiae s.s. (10.6%)(p<0.01). All three vectors were present throughout the year and malaria transmission occurred in every month, although with greatest intensity during the rainy season (January to April). The combined human blood index exceeded 92% and the P. falciparum sporozoite rate was 4.8%, resulting in estimated inoculation rates of 183 infective bites/ person per annum, or an average rate of ~15 infective bites/person/month. Conclusions The results demonstrate the importance of An. gambiae s.s., An. arabiensis and An. funestus in driving the high levels of malaria transmission in the south of Malawi. Sustained and high coverage or roll out of current approaches to malaria control (primarily insecticide-treated bed nets and indoor residual house spraying) in the area are likely to reduce the observed high malaria transmission rate and consequently the incidence of human infections, unless impeded by increasing resistance of vectors to insecticides.
A Retrospective Study of Directed Blood Donations in the Kasungu District of Malawi  [PDF]
David S. Chung, Fenjun Shen, Sumin Lee, Taekwon Kong, Jonathan Ko, Jin Young Choe, Sang Min Lee, George Talama
Open Journal of Blood Diseases (OJBD) , 2018, DOI: 10.4236/ojbd.2018.84008
Abstract: Since the discovery of blood circulation and transfusion, there has been an insatiable demand for voluntary blood donations throughout the world. However, gathering blood donors has never been easy because eligible donors constitute only a fraction of the general population and are often reluctant to donate. This is especially challenging in underprivileged countries of sub-Saharan Africa such as Malawi whose nationally run blood transfusion service struggles to maintain hospital blood banks. As a result, hospitals turn to their local communities for directed donations. A retrospective analysis from January 2014 to June 2016 of directed blood donor data from two hospitals in the Kasungu District of Malawi was conducted. The analysis of 2134 donations was carried out with respect to sex, age, hemoglobin concentration, blood group, and presence of transfusion-transmissible infections. On average, donors were 30 years of age and predominately male. Blood group O+ constituted more than half of all directed blood donations. Ultimately, about one third of donations were unable to be utilized for transfusion.
Surgical facilities available at district hospitals in Malawi
A Tindall, C Lavy, C Steinlechner, N Mkandawire, S Chimangeni
Malawi Medical Journal , 2007,
Abstract:
Distribution of Eye Diseases in Kasungu District, Malawi, Central Africa—A Retrospective Cross-Sectional Study  [PDF]
Richard Kang, Jae Jun Kim, Paul Chung, Gyuri Hwang, Jung Sung Kim, Seunghan Baek, Eun Jung Im, George Talama
Advances in Infectious Diseases (AID) , 2018, DOI: 10.4236/aid.2018.82008
Abstract: Analysis of eye diseases of patients at Kasungu District Hospital in Malawi was made. Malawi is one of the poorest countries in the world and the health system faces a lot challenges in terms of resources. The study was, therefore, done to understand the burden and distribution of eye diseases in this resource-limited setting. A retrospective study was conducted by extracting data from data registers in the outpatient eye department for the period of May 2015 to June 2016. The data of the reported eye diseases analyzed with variables such as patient gender, eye disease type, patient age and times of the year. There was no association between eye diseases and gender nor with times of the year. However, it was noted that the commonest type of eye disease was conjunctivitis. And, there was strong association of some disease type with age, for example, conjunctivitis was common in young age group while cataract was common in the elderly. It was shown in this study that many of the eye diseases endemic in Africa do generally occur in this selected district as well. However, the analysis presents the possibility of reducing the incidences of many diseases by preventive measures and access to health facilities on time.
Reverse transcriptase drug resistance mutations in HIV-1 subtype C infected patients on ART in Karonga District, Malawi
Vijay B Bansode, Simon AA Travers, Amelia C Crampin, Bagrey Ngwira, Neil French, Judith R Glynn, Grace P McCormack
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-38
Abstract: Fifteen individuals showed DRMs, and in ten individuals DRMs were seen from baseline samples (reported to be ART na?ve). Three individuals in whom no DRMs were observed at baseline showed the emergence of DRMs during ART exposure. Four individuals who did show DRMs at baseline showed additional DRMs at subsequent time points, while two individuals showed evidence of DRMs at baseline and either no DRMs, or different DRMs, at later timepoints. Three individuals had immune failure but none appeared to be failing clinically.Despite the presence of DRMs to drugs included in the current regimen in some individuals, and immune failure in three, no signs of clinical failure were seen during this study. This cohort will continue to be monitored as part of the Karonga Prevention Study so that the long-term impact of these mutations can be assessed. Documenting proviral population is also important in monitoring the emergence of drug resistance as selective pressure provided by ART compromises the current plasma population, archived viruses can re-emergeIt has been estimated that in sub-Saharan Africa, approximately 3.9 million people have started antiretroviral treatment (ART) since its introduction (UNAIDS, 2010). Given the large population on treatment, viral diversity coupled with low adherence could lead to the emergence and large-scale transmission of drug resistant strains. Rates of drug resistance among patients who received ART in sub-Saharan Africa range from 3.7%-49% after 24-163 weeks of HAART [1]. Various factors contribute to this large range in resistance among African cohorts such as variation in available healthcare systems and practices, adherence, and access to monitoring [2]. Development of DRMs to Trioimmune?, the drug combination used as first line therapy in Karonga District, Malawi, has been reported in Zambia [3], South Africa [4], Cameroon [5], Kenya [6] and Uganda [7]. Previous studies on drug resistance in Malawi showed various DRMs to both NRTIs an
Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi
Gerald Manthalu, Dominic Nkhoma, Sanderson Kuyeli
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-6
Abstract: Principal components analysis was used to calculate asset indices for all districts from variables that capture living standards using data from the Malawi Multiple Indicator Cluster Survey 2006. These were normalized and used to weight district populations. District proportions of national population weighted by both the simple and composite indicators were then calculated for all districts and compared. District allocations were also calculated using the two approaches and compared.The two types of indicators are highly correlated, with a spearman rank correlation coefficient of 0.97 at the 1% level of significance. For 21 out of the 26 districts included in the study, proportions of national population weighted by the simple indicator are higher by an average of 0.6 percentage points. For the remaining 5 districts, district proportions of national population weighted by the composite indicator are higher by an average of 2 percentage points. Though the average percentage point differences are low and the actual allocations using both approaches highly correlated (ρ of 0.96), differences in actual allocations exceed 10% for 8 districts and have an average of 4.2% for the remaining 17. For 21 districts allocations based on the single variable indicator are higher.Variations in district allocations made using either the simple or composite indicators of socioeconomic status are not statistically different to recommend one over the other. However, the single variable indicator is favourable for its ease of computation.Health care systems adopt various ways of allocating resources to sub-national areas and agencies. The four commonly used methods are: i) political patronage ii) historical allocations iii) bids by local governments and iv) needs-based resource allocation formulae [1]. Political patronage entails government rewarding loyal constituencies and potential strongholds. Under historical allocation, funds are allocated according to past year's expenditures adj
Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi
Enarson,Penny; La Vincente,Sophie; Gie,Robert; Maganga,Ellubey; Chokani,Codewell;
Bulletin of the World Health Organization , 2008, DOI: 10.1590/S0042-96862008000500011
Abstract: problem: hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in malawi. approach: the child lung health programme in malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals' paediatric wards. five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained. local setting: the paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in malawi. relevant changes: main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered. lessons learned: it is feasible to implement an oxygen system using concentrators throughout a low-income country. oxygen delivery requires trained staff with necessary equipment and supplies. regular maintenance and supervision are essential to ensure optimal utilization.
Experiences of Community Members on Reporting Community Maternal Deaths in Mangochi District of Malawi  [PDF]
Jane Dzoole, Mercy Pindani, Alfred Maluwa
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.53027
Abstract: The purpose of this study was to explore and describe the experiences of community stakeholders on reporting community maternal deaths to relevant authorities in Mangochi District of Malawi. The study employed qualitative hermeneutic phenomenology approach to data collection, analysis and interpretation. It was conducted in three health zones of Mangochi district which are Monkey-bay, Mangochi boma and Namwera zones. Purposive sampling was used to select major community stakeholders on issues of safe motherhood and these were; Village heads, Health Surveillance Assistants (HSAs), safe motherhood volunteers and members of village health committees (VHCs). A total of eighteen in-depth interviews and three focus group discussions were conducted. Descriptive statistics were computed for the demographic variables and the qualitative data were analysed using modified Colaizzi (1978) method based on Heideggerian and Gademerian philosophy. Findings showed that community maternal deaths were not always reported because there were no records in the district. Most participants lacked knowledge on the process and their role in reporting community maternal deaths despite knowing the importance of reporting such deaths. However, findings indicated a positive perception of participants towards reporting community maternal deaths to authorities. The study recommends that health education be offered to community members and Health Surveillance Assistants regarding reporting maternal deaths to improve the situation.
Scaling up of trachoma mapping in Salima District, Central Malawi  [PDF]
Khumbo Kalua, Isaac Singini, Mavuto Mukaka, Kelias Msyamboza, Michael Masika, Robin Bailey
Health (Health) , 2014, DOI: 10.4236/health.2014.61009
Abstract:

Background: A number of suspected endemic districts with Trachoma have not been mapped in Malawi, and this contributes to delays for scaling up trachoma control activities. Objectives: To determine the prevalence of trachoma and associated risk factors in one of the suspected endemic districts (Salima District) in central Malawi and to generate information to guide policy decisions. Methods: A population-based survey conducted in randomly selected clusters in Salima District (population 418,672), centralMalawi. Children aged 1-9 years and adults aged 15 and above were assessed for clinical signs of trachoma. Results: In total, 884 households were enumerated within 36 clusters. A total of 2765 persons were examined for ocular signs of trachoma. The prevalence of trachomatous inflammation, follicular (TF) among children aged 1-9 years was 17.1% (95% CI 14.9-19.4). The prevalence of trachoma trichiasis (TT) in women aged 15 years and above was 1.3% (CI 0.7-2.3), while the prevalence in men was zero. The presence of a dirty face and lack of sanitation were significantly associated with trachoma follicular (P < 0.001). Conclusion: Prevalence rate of trachoma follicles (TF) in Central Malawi exceeds the WHO guidelines for the intervention with mass antibiotic distribution (TF > 10%), and warrants the trachoma SAFE (Surgery, Antibiotics, Face washing and Environmental hygiene) control strategy to be undertaken in Salima District.

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