Malawi Medical Journal最新文献

Background: Patient retention is important for proper adherence to clinical trial protocols. Mobile-phone and physical tracing have been implemented at clinics across Malawi to improve retention but tracing effectiveness and attitudes towards tracing have not been sufficiently studied.

Methods: In a site-specific phone retention pilot study embedded within the HIV Prevention Trials Network (HPTN) 052 study in Lilongwe, Malawi, all tracing records and additional semi-structured questionnaires from 50 participants were used to obtain attitudes towards tracing efforts and methods. During a retrospective evaluation study at UNC Project, over 20,000 tracing records were analyzed across 49 studies from 2011 to 2019. Success in reaching participants, bringing participants to clinic, and overall tracing costs were analyzed.

Results: In the phone retention pilot study, 47 participants (94%) had positive attitudes towards tracing and 41 (82%) preferred mobile-phone tracing. Of all tracing attempts in the phone retention pilot study, mobile-phone tracing (232/309, 75%) was more successful than physical tracing (147/244, 60%) in reaching patients, and the cost of mobile-phone tracing was less ($4.21 versus $36.63 per tracing attempt). During the retrospective study period, mobile-phone tracing (7808/9522, 82%) was more successful than physical tracing (7742/10606, 73%) in returning patients to the clinic. Mobile-phone tracing saved approximately $32.08 and 92 minutes per tracing attempt.

Conclusion: Mobile-phone tracing is acceptable, feasible, and efficient for clinical trials in Lilongwe, Malawi. Mobile-phone tracing can be used to strengthen patient engagement and improve collection of primary-outcome data for clinical trials.

Aim: Individualized care is patient-centred and personalized care. The Covid-19 disease affects the individualized care perceptions of both patients and nurses. The aim of this study was to determine the individualized care perceptions of patients and nurses in the Covid-19 pandemic.

Methods: This descriptive study was conducted between December 2020 and March 2021 with 154 nurses working in Covid-19 clinics and intensive care units of a training and research hospital in Istanbul/Turkey and 213 patients hospitalized due to Covid-19. The data were collected with "Patient Information Form" and "Individualized Care Scale-B-Patient" for patients, and "Nurse Information Form" and "Individualized Care Scale-B-Nurse" for nurses.

Results: While 64.3% (n=137) of the patients considered that they received individualized care, only 45.5% (n=70) of the nurses stated that they believed they provided individualized care to their patients. The mean individualized care scale scores of patients and nurses were 4.02±0.93 and 4.15±0.44, respectively, and it was determined that there was no significant difference between the scale scores of patients and nurses.

Conclusion: In this study, the individualized care perceptions of Covid-19 patients and nurses providing care were found to be quite high considering the conditions in the pandemic process. It is believed that improving the working conditions of nurses and overcoming barriers to provide individualized care will improve the quality of care.

Background: Cleaners are a high-risk group for contact dermatitis in healthcare settings due to frequent exposure to cleaning agents, gloves, and wet work, yet they remain understudied in Tanzania. This study investigated the prevalence of contact dermatitis and its associated factors among hospital cleaners in Dar es Salaam, Tanzania.

Methods: A cross-sectional study was conducted between March and July 2022 among hospital cleaners from three regional referral hospitals and one national hospital. Data were collected using the Standardized Nordic Occupational Questionnaire. Modified Poisson regression was applied to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs). Contact dermatitis was defined as the presence of two or more skin symptoms affecting the hands, wrists, or forearms within the past 12 months.

Results: A total of 323 cleaners took part in the study. The median age was 26 years (range 18-64), and 65% were female. The prevalence of contact dermatitis was 48.9%. The most frequently reported symptoms were itching (48.6%), dry skin (44.6%), and rashes (22.0%). Work-related factors positively associated with contact dermatitis included use of floor-cleaning products (aPR = 1.70, 95% CI: 1.18-2.44), bleach (aPR = 1.64, 95% CI: 1.22-2.22), handwashing >10 times a day (aPR = 1.63, 95% CI: 1.12-2.35), and latex glove use (aPR = 1.61, 95% CI: 1.29-2.01). Prevalence varied across hospitals. Individual factors such as age, sex, smoking, and allergy history were not significantly associated with disease.

Conclusions: Contact dermatitis is highly prevalent among hospital cleaners in Dar es Salaam, with its occurrence mainly associated with occupational exposures rather than individual susceptibility. Preventive measures should prioritize safer cleaning products, improved hand hygiene practices, appropriate glove use, and tailored skin protection programs.

Background: Natural killer cells, which play a role in the innate immune system, are cells in the early defence system against infections and tumours. The aim of this study was to investigate the role of NK cells in stage 3 colorectal cancer (CRC) and their relationships to serum carcinoembryonic antigen (CEA) levels, obesity, and survival.

Method: CD16+CD56+ NK cells were analyzed by flow cytometry in newly diagnosed stage 3 CRC patients and healthy controls. Associations with survival, obesity, and serum CEA were evaluated.

Results: The rate of NK cells was found to be lower in the CRC patients than in the healthy control subjects. The reduced NK cell rate was associated with reduced survival. A negative correlation was determined between NK cells and age, serum CEA levels, and obesity at the time of diagnosis.

Conclusion: As the study results suggest that the NK cell rate could be effective in predicting prognosis in stage 3 CRC patients, they could also be of guidance for further studies with larger patient populations.

Introduction: Birth preparedness (BP) has been globally endorsed as an essential component of safe motherhood programs to reduce delays for care, so as to reduce maternal and neonatal mortality rate. In spite of the benefit of BP, no study has been documented that assessed the knowledge and determinants of birth preparedness in Mangochi District, Malawi. Therefore, this study aimed at investigating knowledge and determinants of BP among pregnant women attending antenatal clinic in Mangochi District, South-east Malawi.

Methods: A descriptive cross-sectional study was conducted involving 382 respondents for the quantitative component and five focus group discussions for the qualitative component. Simple random sampling was used to select respondents in the study area for quantitative data collection while purposive sampling was used for focus group participants. A researcher-administered questionnaire was used to collect quantitative data.

Results: A total of 382 mothers participated, achieving a response rate of 99.5%. Majority of women (97.6%) had heard about BP. Of the total mothers, 73.3% had adequate knowledge on birth preparedness. However, from the focus group discussion conducted, pregnant mothers pointed out communication as a barrier in accessing health care services as most of the health care workers could not communicate to them in Yao, which is the dominant local language in the study area. Among the factors associated with birth preparedness were religion (r=-0.013, p<0.05), maternal education (r=-0.017, p<0.05), maternal occupation (r=-0.044, p<0.05) and husband occupation (r=-0.000, p<0.05) showed statistically significant association.

Conclusion: About 73 % of pregnant women in this study had adequate knowledge in birth preparedness. The factors most associated with birth preparedness were maternal and husband occupation, maternal education and religion. There is a need to continue providing health education on birth preparedness to all women in the reproductive age band.

Background: The Malawi National Tuberculosis Program (MNTP) switched the MDR-TB treatment regimen from a combination of injectable and oral anti-TB drugs to an all-oral regimen in 2018. This has increased the pill burden and increased the treatment period from 12 to 18 months. The change was necessitated by the need to minimize amikacin-induced side effects which include vertigo, convulsions, and numbness. However, the longer treatment period and pill burden may affect treatment adherence.

Objective: The purpose of the study was to assess factors that influence adherence to the all-oral drugs for MDR-TB.

Methods: This descriptive qualitative study employed 10 in-depth interviews, 2 focus group discussions and 7 key informant interviews with patients, guardians and health workers. Participants were identified through purposive sampling from Traditional Authorities Chowe and Chimwala in Mangochi district. Data analysis was done through a thematic approach.

Results: Patients expressed satisfaction with the newly-introduced oral treatment for MDR-TB owing to the fewer side effects the treatment has, absence of pain from injections, desire to accomplish plans, delivery of drugs close to patients through drones, and home visits by health care workers. However, some patients highlighted barriers to adherence such as delayed food provision, and delayed transport refunds by the Malawi National Tuberculosis Control Program through its partners. Other barriers were medication stockouts, bad weather, and traveling away from home. Participants recommended that to improve adherence, interventions should include involving ex-MDR-TB patients and guardians in giving out MDR-TB adherence messages, and intensifying community sensitisation on MDR-TB.

Conclusion: MDR-TB treatment non-adherence is associated with patient factors, economic factors, access to health facility factors and environmental factors. Addressing the barriers is key to preventing MDR-TB relapse and new infections.

Background: ResearchGate as a main scientific social medium and Scopus as a known citation database have main role in sharing research output among specialists in different disciplines.

Objective: This study aimed to evaluate the performances of Iranian researchers in occupational health field and correlate some related variables. It also used regression analysis as one of machine learning approaches for predicting researchers' scientific performance.

Methods: This descriptive cross-sectional study was conducted in 2024 on ResearchGate and Scopus indicators of Iranian researchers in the Occupational Health Engineering affiliated in Iranian universities (n=213). Data were extracted from ResearchGate and Scopus and the researches' demographic information was collected from Iranian Scientometrics Information Database in medicine.

Results: 149 researchers (70%) were active in ResearchGate. 144 researchers (96.6%) had RG scores with the mean rate of 11.70. in ResearchGate, they shared total 4,275 research items with the mean rate of 28.89 items per researcher. With total 24,235 citations, the mean rate of citations per paper was 169.48. Of them,143 (95.9%) had ResearchGate h-indexes with the mean rate of 5.38. In Scopus, 198 researchers (93%) had total 2,935 published documents in the database with mean rate of 14.82 documents per researcher. 186 researchers (87.3%) had total 18,749 citations with the mean rate of 100.80 citations and mean h-index amounted to 4.41. Researchers with more shared documents in ResearchGate had better performance in Scopus. Linear regression analysis showed that the researchers' presence in ResearchGate can predict their citation counts (R2=.82, β=.911, p=.000) and h-indexes (R2=.83, β=.900, p<.001) in Scopus.

Conclusion: Iranian researchers in the Occupational Health Engineering field fairly use the capacities of ResearchGate for influencing their research output. However, their interactions in social media tools should be encouraged for more reach and influence of their scientific productions.

Background: Children with cerebral palsy require multidisciplinary and holistic care to manage their medical needs and maximise their developmental and educational potential. Exploring experiences of caregivers on healthcare and psychosocial services available for children with cerebral palsy is key in addressing gaps existing in provision of quality health care and psychosocial services both at community and hospital settings.

Methods: We conducted a qualitative exploratory descriptive study. Twelve caregivers of children with cerebral palsy were interviewed face-to-face using interview guides at Mangochi district. Twelve caregivers of children with cerebral palsy were interviewed face-to-face using interview guides at Mangochi district. Purposive and snowball sampling were used to select the study participants.

Results: The findings of the study showed that some of the participants received inadequate information related to the etiology and prognosis of cerebral palsy, alternative treatments, and information related to childcare at home. There was also a lack of follow-up and home visits by health care workers. The majority of participants received informal psychosocial support from their relatives and friends. However, there was lack of formal psychosocial services, such as counselling services, unavailability of support groups, and lack of assistive devices. Challenges encountered by children with cerebral palsy and their caregivers were related to inadequate finances, transport challenges, and lack of basic needs, which resulted in the inability to provide necessities to children with cerebral palsy and inability to take their children to the hospital for regular physiotherapy services. In addition, caregivers face physical strain and burden during care.

Conclusion: The study found that there was inadequate provision of health care and psychosocial services to children with cerebral palsy. The study recommends the provision of comprehensive cerebral palsy information to caregivers, the formation of support groups, conducting outreach clinics and home visits to children with cerebral palsy, and provision of assistive ambulation devices by healthcare professionals and the department of social welfare.

A 27 year old man presented with a history of weight loss and generally feeling unwell for more than 2 years. He had several negative HIV rapid tests. His wife had a positive HIV test in 2023 during screening while she was pregnant with their first child. When HIV RNA test was requested, it was positive with a viral load of 1,740, 000 copies/ml. In patients in high HIV prevalence settings suspected to have HIV infection with repeated negative rapid antibody diagnostic tests, HIV RNA testing should be requested to exclude infection.