Malawi Medical Journal最新文献

Introduction: Learner-centred teaching implies a paradigmatic shift in roles of a teacher from being a source of knowledge to that of a facilitator in the process of knowledge construction. Literature shows that perceptions which teachers hold about barriers to utilisation of learner-centred teaching methods influence how the teachers teach. Anecdotal records as well as observation of classroom teaching demonstrate that tutors at Holy Family College of Nursing and Midwifery dominantly use traditional teacher-centred teaching methods.

Research design and methods: This was a qualitative study based on the philosophical principle of constructivism.

Study population and sample: All tutors at Holy Family College of Nursing and Midwifery were the study population. Purposive sampling technique was used to select participants. In-depth interviews with 12 tutors were held using a semi-structured interview guide.

Data analysis: Data were analysed using the 6-step thematic method.

Findings: The participants suggested that effective utilization of learner-centred teaching methods is negatively affected by teacher-related as well as technical barriers.

Conclusion: Teachers clinging to power and need for more resources negatively affect utilisation of learner-centred teaching methods.

Angina bullosa haemorrhgica is a relatively uncommon condition characterized by blood-filled subepithelial lesions in the oral mucosa that is idiopathic and not caused by a systemic disease or a hemostatic abnormality. Middle-aged and elderly patients are usually affected and lesions heal spontaneously without scarring. A rapidly expanding hemorrhagic blister in the oropharynx can induce upper airway obstruction, so recognizing the lesion as soon as possible is essential. Because of its rarity, we wanted to highlight a 42-year-old male patient who presented with hemorrhagic bullae associated with insignificant local trauma in the oral mucosa and to emphasize that Angina bullosa haemorrhagica is a rare but recognizable lesion that clinicians should be aware of.

A challenge for the health system in Malawi is that funding allocation is heavily influenced by donor priorities. As a result, mandated routine elements of service delivery may not be fully offered owing to lack of resources or programmatic priority. Integration of currently active 'vertical' programmes (those focused on a specific priority disease entity) into existing 'horizontal' services (meaning provision across the range of clinical and public health need) has potential to improve access and quality of service delivery for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in Malawi. We identified and tabulated the main vertical funding streams currently available in Malawi and identified where these could intersect with existing horizontal health sector programmes in order to strengthen RMNCAH. We have indicated how each of the main vertical programmatic components can be adapted and integrated to support broader system strengthening within RMNCAH focusing especially on drug and commodity procurement, supply chain logistics, health facility and equipment maintenance/upgrading, health service activity data systems, human resources for 'front line' RMNCAH provision, as well as community engagement and mobilization. By circumventing the various limitations of vertical programmes in the delivery of health services in the country, they would complement existing funding streams rather than operating in a vacuum as independent activities. We therefore recommend the integration of horizontal and existing vertical programmes in order to improve RMNCAH in Malawi.

Background: Children with clefts lips often present with cardiac abnormalities, among them the tetralogy of Fallot. Anaesthesia for patients with unrepaired Tetralogy of Fallot coming for a non-cardiac surgery represents an additional risk of increased perioperative morbidity and mortality.

Case presentation: We present a case of a 8 years old boy with unrepaired Tetralogy of Fallot scheduled for cleft lip repair. The Child was referred to Mercy James Centre for Paediatric Surgery and Intensive Care from an Operation Smile Mission campaign. Anaesthesia consisted of a balanced general anaesthesia combined with regional anaesthesia by an infraorbital nerve block. The child developed hypercyanotic spells postoperatively which were successfully managed with noradrenaline, morphine, fluid, and oxygen therapy.

Conclusion: Children with unrepair Tetralogy of Fallot coming for non-cardiac surgery have increased risk of complications during anaesthesia. The anaesthesia provider should be aware and ready to manage them promptly.

Background: Tracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi.

Methods: This is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management.

Results: In our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%.

Conclusion: Tracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.

Background: Pragmatic clinical trials generally rely on real world data and have the potential to generate real world evidence. This approach arose from concerns that many trial results did not adequately inform real world practice. However, maintaining the real world setting during the conduct of a trial and ensuring adequate protection for research participants can be challenging. Best practices in research oversight for pragmatic clinical trials are nascent and underdeveloped, especially in developing countries.

Methods: We use the PRECIS-2 tool to present a case study from Lilongwe in Malawi to describe ethical and regulatory challenges encountered during the conduct of a pragmatic trial and suggest possible solutions.

Results: In this article, we highlight the following six issues: (1) one public facility hosting several pragmatic trials within the same period; (2) research participants refusing financial incentives; (3) inadequate infrastructure and high workload to conduct research; (4) silos among partner organisations involved in delivery of health care; (5) individuals influencing the implementation of revised national guidelines; (6) difficulties with access to electronic medical records.

Conclusion: Multiple stakeholder engagement is critical to the conduct of pragmatic trials, and even with careful stakeholder engagement, continuous monitoring by gatekeepers is essential. In the Malawian context, active engagement of the district research committees can complement the work of the research ethics committees (RECs).

Visceral artery aneurysm, especially splenic artery aneurysm, is rare and is usually associated with pregnancy. When such aneurysms rupture, they can be fatal, and they often require emergency surgery. This case report includes a review of the literature and describes a effective multidisciplinary approach to managing this type of aneurysm. We describe the treatment of a ruptured splenic artery aneurysm and the careful coordination of obstetric, vascular surgery, and intensive care teams. The uniqueness of this case arose from the metal embolization coil that was found to have fallen off from a recently embolized ruptured splenic artery aneurysm. The management of this ruptured splenic artery aneurysm and iatrogenic foreign body insult required a combination of multiple specialties to provide life-saving treatment. Such cases should be managed by multidisciplinary teams if institutional resources allow for it.

Background: The high global prevalence of mental disorders justifies the need to quantify their burden in the sub-Saharan Africa where there is a dearth of information. These mental disorders are linked to different socio-demographic factors.

Objective: To determine the prevalence of, and factors associated with mental disorders among children and adolescents in Blantyre City, Malawi.

Methods: Children and adolescents aged 6 to 17 years were interviewed to determine their socio-demographic characteristics and assess their mental health status using the Strengths and Difficulties Questionnaire (SDQ) and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Associations between mental disorders and socio-demographic characteristics were tested using Chi-square and logistic regression analysis.

Results: The prevalence of symptoms of psychopathology on the SDQ was 7.3% (95%CI 4.8-10.5%) while for the K-SADS was 5.9% (95% CI 3.7%-8.9%). The prevalence of mental disorders across the age ranges of 6 to 12 years and 13 to 17 years was 5.4% and 7.9 % respectively. Males had a higher prevalence (7.1%) compared to females (4.7%). Conduct disorder was most prevalent (3.4%), followed by either type of ADHD-Attention Deficit Hyperactive Disorders (2.0%). Having a single parent (p<0.001), staying with a non-biological guardian (p<0.030), engaging in paid work (p<0.039), not attending school (p<0.019) and having teacher difficulties(p<0.028) were positively associated with a mental disorder.

Conclusion: The socio-demographic factors associated with the risk of developing mental disorders may be important targets for mental health intervention programs.

Background: The pandemic called "Coronavirus Disease 2019" (COVID-19), which first appeared in China, then spread to the whole world, has had negative consequences in many areas, especially in health. The long-term quarantine process caused by the pandemic and the experienced stress had a great impact on nutritional habits.

Aim: In this study, it was aimed to determine the change in anxiety levels and eating habits of young adults after the COVID-19 pandemic.

Methods: The data were obtained through an online questionnaire between April and July 2020. In the questionnaire, the general and health information of the individuals, their nutritional habits, and anthropometric measurements (height and body weight) were questioned. In addition, the food frequency questionnaire form and Beck Anxiety Inventory were applied.

Results: A total of 823 (174 males and 649 females) participants were included in the study. The median ages of males and females were 27.0 (18.0) and 26.0 (8.0), respectively. According to the results of the food frequency questionnaire; it was found that among females, the consumption of egg, cheese, milk, yogurt, pickles, fruit, onion, garlic, lemon, salad, legumes, pastry, sweets, red meat, turmeric, and herbal tea were increased significantly in the post-pandemic period; and the consumption of milk, yogurt, garlic, and lemon significantly increased in males. It was also found that the anxiety levels of the females increased statistically significantly in the post-pandemic period.

Conclusion: It was determined that during the COVID-19 pandemic, there were statistically significant changes in the food intake patterns and anxiety levels of the participants. It is thought that the results obtained from this study may be a guide for further studies to determine the nutritional habits in the COVID-19 pandemic.

Aim: To analyse the trends and patterns of stunted only and stunted-underweight children in Malawi between the 2000 and 2015.

Methods: The study used the 2000 and 2015 Malawi Demographic and Health Survey data and employed bivariate and multivariate statistical analysis techniques to explore the difference in the levels of stunted only and stunted-underweight children and key socio-economic factors between 2000 and 2015 and identify key attributes of being stunted only and being stunted-underweight.

Results: The percentage of stunted only was 37.2% in 2000 and 26.8% in 2015 and the stunted-underweight percentage was 14.5% in 2000 and 8.8% in 2015. Out of the 6.9% children classified as wasted, 2.4% were also underweight and stunted, 2.4% were underweight and 2.1% did not have any other forms of undernutrition. The analysis did not identify any children that were both stunted and wasted. Only 0.7% in 2000 and 0.4% in 2015 were underweight and free of any other forms of undernutrition. There were improvements in mother education level and mother weight during this time-period which may explain the improvements in child nutritional status.

Conclusion: The most common form of undernutrition is stunting and nearly all children that are underweight are also stunted. Child nutrition practitioners and health professionals should consider focusing on tackling child stunting.