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The Epidemiology of District Surgery in Malawi: a Two Year Study of Surgical Rates and Indices in Rural Africa
PM Fenton
East and Central African Journal of Surgery , 2011,
Abstract: Background: The true surgical requirement of a rural African population is also not precisely known. Methods: Data gathered over a 2-year period from 1993 to 1995 on surgical and anaesthetic activities in 18 District Hospitals in Malawi are presented. Results: Theatre records showed that 45,032 operations were carried out at District Hospitals in the study area which had a catchment population of 6,100,000 giving an average annual rate of 369 operations per 100,000 population (range 151-1337). Of the total, 11,466 operations were classed as major, giving an average annual rate of 94 per 100,000 population (range 31-242 / 100,000). Comparable rates for total and major operations carried out in the central referral hospital were 865 and 269 per 100,000, respectively, allowing for referrals. A total of 7,288 caesarean sections (CS) were carried out, constituting 65.6% of all major operations. The rural CS rate was 60 per 100,000 compared to the central hospital rate of 151 per 100,000. In the district hospitals, 75% of all surgery, including most major operations, was carried out by paramedical cadres (Clinical Officers or Medical Assistants), 8.2% by the resident District Health Officer and 0.8% by visiting specialists. All general and regional anaesthesia was given by paramedical cadres. The ratios of CS to all operations and laparotomy to all major operations showed a different pattern of surgery between district hospitals and between district and central hospitals. The value of these indices in identifying deficiencies in the surgical services is discussed. East and Central African Journal of Surgery. 2011 Nov/ December;16 (3)
Analysis of Schistosomiasis haematobium Infection Prevalence and Intensity in Chikhwawa, Malawi: An Application of a Two Part Model  [PDF]
Michael G. Chipeta ,Bagrey Ngwira,Lawrence N. Kazembe
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002131
Abstract: Background Urinary Schistosomiasis infection, a common cause of morbidity especially among children in less developed countries, is measured by the number of eggs per urine. Typically a large proportion of individuals are non-egg excretors, leading to a large number of zeros. Control strategies require better understanding of its epidemiology, hence appropriate methods to model infection prevalence and intensity are crucial, particularly if such methods add value to targeted implementation of interventions. Methods We consider data that were collected in a cluster randomized study in 2004 in Chikhwawa district, Malawi, where eighteen (18) villages were selected and randomised to intervention and control arms. We developed a two-part model, with one part for analysis of infection prevalence and the other to model infection intensity. In both parts of the model we adjusted for age, sex, education level, treatment arm, occupation, and poly-parasitism. We also assessed for spatial correlation in the model residual using variogram analysis and mapped the spatial variation in risk. The model was fitted using maximum likelihood estimation. Results and discussion The study had a total of 1642 participants with mean age of 32.4 (Standard deviation: 22.8), of which 55.4 % were female. Schistosomiasis prevalence was 14.2 %, with a large proportion of individuals (85.8 %) being non-egg excretors, hence zero-inflated data. Our findings showed that S. haematobium was highly localized even after adjusting for risk factors. Prevalence of infection was low in males as compared to females across all the age ranges. S. haematobium infection increased with presence of co-infection with other parasite infection. Infection intensity was highly associated with age; with highest intensity in school-aged children (6 to 15 years). Fishing and working in gardens along the Shire River were potential risk factors for S. haematobium infection intensity. Intervention reduced both infection intensity and prevalence in the intervention arm as compared to control arm. Farmers had high infection intensity as compared to non farmers, despite the fact that being a farmer did not show any significant association with probability of infection. These results evidently indicate that infection prevalence and intensity are associated with risk factors differently, suggesting a non-singular epidemiological setting. The dominance of agricultural, socio-economic and demographic factors in determining S. haematobium infection and intensity suggest that disease transmission and control strategies
Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi
Victoria L Ewing, David G Lalloo, Kamija S Phiri, Arantxa Roca-Feltrer, Lindsay J Mangham, Miguel A SanJoaquin
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-32
Abstract: Two cross-sectional household surveys were conducted in the Chikhwawa district of Malawi; one during each of the wet and dry seasons. Half the participating villages were located near the hospital, the others were in areas defined as hard-to-reach. Data were collected on attendance to formal health facilities and economic costs incurred due to recent childhood febrile illness.Those living in hard-to-reach villages were less likely to attend a formal health facility compared to those living near the hospital (Dry season: OR 0.35, 95%CI0.18-0.67; Wet season: OR 0.46, 95%CI0.27-0.80). Analyses including community health workers (CHW) as a source of formal health-care decreased the strength of this relationship, and suggested that consulting a CHW may reduce attendance at health facilities, even if indicated. Although those in hard-to-reach villages were still less likely to attend in both the dry (OR 0.53, 95%CI 0.25-1.11) and wet (OR 0.60, 95%CI 0.37-0.98) seasons. Household costs for those who attended a health facility were greater for those in HTR villages (Dry: USD5.24; Wet: USD5.60) than for those living near the district hospital (Dry: USD3.45; Wet: USD4.46).Those living in hard-to-reach areas were less likely to attend a health facility for a childhood febrile event and experienced greater associated household costs. Consulting CHWs was infrequent, but appeared to reduce attendance at a health facility, even when indicated. Health service planners must consider geographic and financial barriers to accessing public health facilities in designing appropriate interventions.The link between poverty and malaria has been well established [1-3]. Countries that have successfully eliminated malaria have shown considerable economic growth when compared to other countries that have not [4]. Poor households living in malarious regions struggle to meet the financial cost of repeated bouts of illness [5]. Direct and indirect costs of seeking appropriate health care result in
Barriers to maternal health service use in Chikhwawa, Southern Malawi
C Kambala, T Morse, S Masangwi, P Mitunda
Malawi Medical Journal , 2011,
Abstract: Introduction: Research was conducted to get a community’s perspective on the factors contributing to continued maternal and neonatal deaths. The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization. Methods: Qualitative data was obtained through focus group discussions with community leaders, women, men and youth in the catchment areas of three remote health centres. A total of fourteen focus groups were held: three each with community leaders, men, women, boys and two with girls. Data was transcribed and analyzed manually through the use of thematic analysis. Results: The discussions revealed the following as barriers to maternal health service utilization: walking long distances to access health facilities, lack of midwives, lack of or insufficient items to be used during delivery, long stay and rude health personnel. Seeking help from Traditional Birth Attendants (TBAs) during delivery was a common option because TBAs are within reach, do not demand many items for delivery, and treat the women with respect. Conclusion: This study suggests some factors that are contributing to the high burden of maternal deaths in Malawi. Interventions should be developed and implemented to improve the barriers reported.
Epidemiological and entomological aspects of malaria in forestfringed villages of Sonitpur district, Assam  [PDF]
N.G. Das, P.K. Talukdar , S.C. Das
Journal of Vector Borne Diseases , 2004,
Abstract: Background & objectives : Detailed epidemiological and entomological studies were undertaken inforest-fringed villages and a Tea Estate in Sonitpur, Assam to assess the malaria situation.Methods : Door-to-door active surveillance was carried out to collect blood samples. Thick and thinblood smears stained with Giemsa were used for malaria parasite detection. Mosquito collectionswere made using CDC miniature light-traps and hand catch methods from dusk-to-dawn.Results : 48% SPR, 49.1 Pf % was recorded from the study villages. Children between 10 and 14 yearswere most sufferers. Per trap night density of mosquitoes in human dwellings was 204.3 and incattlesheds — 908.7, An. minimus accounted for 20.7% of total malaria vectors.Interpretation & conclusion : The results showed high malaria risk in the study villages. High vectordensity with high parity rate, poor socio-economic conditions, lack of awareness, poor sanitation andcongenial atmosphere for mosquito proliferation are aggravating the malaria situation more complex inthe study area.
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.
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.
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.

Optimum Tilt Angle for Photovoltaic Solar Panels in Zomba District, Malawi  [PDF]
B. Kamanga,J. S. P. Mlatho,C. Mikeka,C. Kamunda
Journal of Solar Energy , 2014, DOI: 10.1155/2014/132950
Abstract: A study to determine the optimum tilt angle for installing photovoltaic solar panels in Zomba district, Malawi, has been conducted. The study determined the optimum monthly tilt angles of PV solar panels and the seasonal adjustments needed for the panels in order to collect maximum solar radiation throughout the year. In this study, global solar radiation (GSR) on four tilted surfaces was measured. The north-facing surfaces were titled at angles of 0°, 15°, 20°, and 25°. The GSR data was used to determine the daily and monthly optimum tilt angles for the PV panels. The optimum tilt angles were found to be 0° or 25° depending on the time of the year. From October to February, the optimum tilt angle has been determined to be 0° and, from March to September, the optimum tilt angle is observed to be 25°. There are only two seasonal adjustments that are needed for PV solar panels in Zomba district and these should be carried out at the end of February and at the end of September. For fixed solar panels with no seasonal adjustments, the optimum tilt angle for the PV solar panels that are northfacing has been determined to be 25°. 1. Introduction Non-renewable energy sources, such as fossil fuel, have been the major source of energy in many countries, including Malawi. But because of the problems associated with the use of these non renewable energy sources, there is a need for alternative energy sources that are sustainable and nonpolluting. Kalogirou [1] observed that solar energy offers one of the best solutions to the problem of climate change. It also offers the possibility of reducing high demand for grid electricity and shortage of cooking and heating energy in rural and poor-urban households [2]. Madhlopa [3] further observed that Malawi has abundant solar radiation for most of the year. There are several ways in which solar energy is being used, either directly or indirectly [4]. For direct usage, solar energy can be used as thermal energy or indirectly by converting it into electrical energy using photovoltaic systems. For larger, utility-scale applications, solar energy can feed vast photovoltaic (PV) solar panel farms or can be concentrated to vaporize fluids or to run heat engines [5]. Photovoltaic (PV) solar panels are used to convert solar radiation directly into electricity. Among the many renewable energy alternatives, solar energy remains one of the most well-known and adaptable methods for producing heat and electricity [1]. The conversion of solar energy into electricity by the solar panels is affected by, amongst other factors, absorption
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