Malawi Medical Journal最新文献

Background: Diagnostic reference level (DRL) is an important tool used to identify abnormally high radiation doses, aid dose audits, and trigger investigations in diagnostic radiological imaging. This study aimed to develop local DRLs for the adult head, chest, and abdomen computed tomography (CT) examinations without contrast material at Mzuzu Central Hospital (MCH).

Methodology: This retrospective study was conducted at MCH radiology department using a NeuViz 16-slice Essence CT scanner from September 2023 to March 2024. The consecutive sampling method was used to extract data from patients' head, chest, and abdominal images from advanced visualization workspace (AVW) and Picture Archiving and Communication Systems (PACS) using a checklist. All images were anonymized, and the data was kept in password-locked folders. Data was exported into SPSS version 26.0 software for analysis. Continuous variables were expressed as means and medians. Categorical variables were presented in form of tables as frequencies. The local DRLs were obtained by calculating the median radiation dose values by anatomical region.

Results: Out of 802 patients enrolled in this study, 361 (45%) had head CT examinations, 187 (23%) had chest CT examinations, and 254 (32%) had abdomen CT examinations without contrast. Local DRLs obtained by calculating the median of volume CT dose index (CTDIvol) and dose length product (DLP) for the head, chest, and abdomen CT examinations were 31 mGy, 5 mGy, 7 mGy, and 699 mGy.cm, 227 mGy.cm, and 331 mGy.cm, respectively.

Conclusion: Local DRLs for the head, chest, and abdomen have been developed for a NeuViz 16 Essence multi-detector CT scanner at MCH. The CTDIvol and DLP median values were lower or comparable to other single-facility, regional, and international values. This study should serve as a baseline for developing national adult CT DRLs for Malawi.

Objective: The purpose of this literature review is to highlight information on the use of traditional eye medicine (TEM) within Malawi.

Methods: The papers included in the review were sourced from PubMed, African journals online (AJOL) and African Index Medicus (AIM). The search terms 'Traditional healers in Malawi' 'Traditional Eye care in Malawi' and 'Traditional medicine in Malawi' were used and studies were selected from 1990 through to August 2023.

Conclusions: There is a need to strengthen blindness prevention in Malawi. Due to the already well-established use of traditional healers in the rural regions, it has been suggested that collaborating with them rather than working independently of them will be a better approach to tackling vision impairment. There are multifactorial apprehensions on the part of biomedical practitioners to work with traditional healers which range from a genuine concern that healers practice in a way that may be harmful to patients, to a lack of knowledge of the actual practices of traditional healers. More research needs to be done on how to bridge the gap between the two groups to tackle vision impairment in Malawi.

Background: Continued progress in early diagnosis and therapeutic options has contributed to the increased survival of infants with CHD with attendant NDD which is of profound personal and public health significance.

Aim: To determine the prevalence and patterns of neuro-developmental problems in children with CHD.

Methods: A cross-sectional study consisting of 40 children with CHD attending the Cardiology clinic of University of Nigeria Teaching Hospital (UNTH), as well as 40 age and gender-matched controls with no heart disease recruited from children's outpatient and well-baby clinics. A semi-structured pretested questionnaire was used in documenting socio-demographic data. General and systemic examinations including cardiovascular and central nervous system assessments were done. The echocardiography report from UNTH was reviewed and the type of CHD documented. Neurodevelopmental assessment using The Malawi Developmental Assessment Tool (MDAT) was carried out by the researchers. Data were analysed using IBM Statistical Package for Social Sciences (SPSS 20.0 version). Chi-Square were used to compare age and gender and other demographic variables with Yates correction where appropriate. Bivariate analysis was performed using the type of CHD to identify cardiac lesions associated with NDD. Significant statistical level was set as a p-value < 0.05.

Results: Forty subjects and 40 controls aged 6-60months with a male to female ratio of 3:2 were studied. Thirty-seven (92.5%) of the subjects had one or more symptoms of CHD. NDD was noted in 23 (57.50%) children with CHD compared to six (15.0%) of the controls. (χ = 15.63, p< 0.0008). The differences in the number of children with delay across all domains for both groups were (p= <0.001). While 17 (42.5%) patients with CHD had a delay in more than one domain (global delay), none of the control had a delay in more than one domain. The difference in the number of domains with NDD for patients and their controls was statistically significant (p<0.001). Though there is no significant correlation between age (χ² =7.243; p = 0.203) and gender (χ² =0.017; p = 0.896) of children with NDD, the younger age group were more affected. NDD was also commoner in children with Tetralogy of Fallot (TOF) 5 (62.5%).

Conclusion: NDD was common in children with CHD and a significant number had a global delay when compared with their controls.

Objective: This study evaluated the diagnostic value of cytomorphological examination in malignant serous cavity effusion (MSCE) and optimized clinical strategies by integrating routine cytological and biochemical analysis.

Methods: A retrospective analysis was conducted on 3,998 patients with serous cavity effusion at the First Affiliated Hospital of Xi'an Jiaotong University. Based on cytopathological results, patients were classified into MSCE (1,078 cases) and benign serous cavity effusion (BSCE, 2,920 cases) groups. Diagnostic performance of cytomorphological examination was assessed, and routine cytological and biochemical parameters were compared. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic efficacy.

Results: Cytomorphological examination showed a sensitivity of 82.9%, specificity of 86.3%, and accuracy of 85.0%, with high concordance with cytopathological diagnosis (κ = 0.687, P < 0.001). High fluorescence cell count (HFC) and total protein (TP) were significantly elevated in the MSCE group and positively correlated with MSCE (P < 0.001). HFC (AUC: 0.765, 95% CI: 0.748-0.782; cutoff: 24.5×10⁶/L) and TP (AUC: 0.735, 95% CI: 0.719-0.750; cutoff: 29.75 g/L) combined with cytomorphological examination provided supplementary diagnostic value. Two combinatorial diagnostic strategies based on cytomorphological examination, HFC, and TP were developed, with Strategy I achieving 93.4% sensitivity and 72.6% specificity, and Strategy II achieving 92.3% specificity and 78.9% sensitivity. Both strategies showed substantial concordance with cytopathological diagnosis (κ=0.622/0.724, P < 0.001).

Conclusion: Cytomorphological examination showed high sensitivity and high specificity in the diagnosis of MSCE. Its combination with HFC and TP effectively enhances diagnostic performance by achieving a balance between reducing missed diagnoses and minimizing misdiagnoses.

Introduction: Happiness is an important indicator of physical and mental health, especially in older persons. Despite the growing interest, empirical insights into the factors influencing happiness among older persons in many low- and middle-income countries, including Nigeria, are lacking. The present study assessed the factors associated with happiness among older persons.

Methods: A cross-sectional study of 378 older persons (≥60 years) attending a geriatric care facility in Ibadan city, Oyo State, southwestern Nigeria, was conducted. A semi-structured, interviewer-administered questionnaire was used for data collection. Happiness was determined using the Oxford Happiness Questionnaire. Data were analysed using descriptive and inferential statistics at a 5% significance level.

Results: Mean age of the respondents was 72.8±7.1 years, and 67.5% were females. Overall, 313 (82.8%) respondents were happy. The most significant factors associated with happiness on logistic regression analysis were having fewer children (OR=2.041; 95%CI=1.091-3.818, p=0.025), formal education (OR=2.850; 95%CI= 1.280-6.344, p=0.010), absence of depression (OR=12.942; 95%CI=4.699-35.641, p<0.0001) and engagement in occupational activities (OR=2.870; 95%CI= 1.006-8.187, p=0.049).

Conclusion: A high level of happiness was reported among the older persons in the study and influenced by non-modifiable socio-demographic and modifiable mental health factors. Holistic healthcare provision must include screening for mental health issues and targeted intervention to alleviate such problems among older persons to improve their happiness.

Background: Sustainable nutrition is crucial for addressing malnutrition, food insecurity, and health issues. Studies highlight the importance of education in shaping environmental attitudes. This study aims to assess the knowledge and behaviours related to sustainable nutrition among highly educated adults.

Methods: This cross-sectional study included 397 highly educated adults who completed an online questionnaire assessing socio-demographics, sustainable nutrition knowledge (SNK), and behaviours (SNB). Construct validity was tested using exploratory factor analysis; internal consistency was evaluated with Cronbach's alpha. Statistical tests included Chi-square, ANOVA, and regression analysis. A medium effect size (f=0.25) was used for power calculation. Post-hoc tests were conducted where applicable to determine specific group differences.

Results: Among 397 participants (48.6% women, mean age 28.08±6.7), women demonstrated significantly higher levels of both sustainable nutrition knowledge (p=0.023) and behaviours (p<0.001) compared to men. SNB was significantly associated with age (p<0.001), education (p=0.004), and marital status (p<0.001). Participants with higher SNK scores consumed significantly less red meat (p=0.028) and processed meat products (p=0.046) than those with lower SNK scores.

Conclusion: The study found that sustainable nutrition behaviour scores differed significantly across education levels, with higher scores observed among participants with advanced degrees. The perspectives of these adults on sustainable nutrition may also raise awareness of sustainable nutrition in society and serve as a valuable source of information for decision-makers.

Background: Stroke affects not only patients but also their caregivers. The level of readiness of caregivers to give care has a significant effect on the quality of life and recovery process of their patients. This descriptive cross-sectional study was conducted to determine the effects of caregiver readiness of individuals providing care for stroke patients on their caregiving burden and burnout.

Methods: This study was conducted with 69 individuals who gave care to inpatients receiving stroke treatment in the Neurology Clinic of a hospital between April 2022 and January 2023. Data collection was carried out using the Patient and Caregiver Identification Form, Cheltenham Patient Classification Scale (CPCS), Preparedness for Caregiving Scale (PCS), Bakas Caregiving Outcomes Scale (BCOS), and Burnout Measure (BM). In the comparisons of two independent groups, the Independent Samples t-test was used when numerical variables were normally distributed, and Mann Whitney U test was used when numerical variables were not normally distributed. In the comparisons of more than two independent groups, One-Way ANOVA was used when numerical variables were normally distributed, and Kruskal Wallis test was used when numerical variables were not normally distributed. Pearson Correlation test was used to analyze the relationship between the scores obtained from the scales.

Results: The analysis of the distribution of stroke patients according to the Cheltenham Patient Classification Scale revealed that 44.9% of them were in the Type 2 care group. The mean scores they obtained from the data collection tools were as follows: PCS: 22.20±6.98, BCOS: 54.46±11.80, BM: 2.73±1.33.

Conclusion: There was a moderately significant negative relationship between the caregivers' BM and PCS scores. Their BM scores decreased as their PCS scores increased. On the other hand, there was a moderately significant positive correlation between their PCS and BCOS scores. As their PCS scores increased, so did their BCOS scores.

Introduction: Prediabetes is a high-risk state for developing diabetes, yet its prevalence in Malawi remains understudied. This study was conducted to determine the prevalence of prediabetes and its associated risk factors in peri-urban communities of Blantyre, Malawi.

Method: A quantitative cross-sectional study design was employed, enrolling 204 participants from South Lunzu, Nkolokoti, and Misesa. Systematic probability sampling was conducted to recruit study participants. Data were collected using the WHO STEP-wise questionnaire. The following data were collected: demographic characteristics (age, sex, education, employment), lifestyle behaviours (smoking, alcohol consumption, physical activity), anthropometric measures (body mass index, waist circumference, waist-hip ratio), blood pressure, and Fasting Plasma Glucose (FPG) levels. Prediabetes was defined as an FPG level of 110-125 mg/dl. Bivariate and multivariate logistic regression analyses were performed to examine relationships between prediabetes and independent factors.

Results: The mean age of participants was 39±13.40 years (range: 18 - 76 years). Female participants constituted 76% (n=155) of the sample. The prevalence of prediabetes was 9.8% (n=20). Participants' characteristics included 3.4% active smokers, 18.6% alcohol consumers, 67.6% engaging in vigorous physical activity, and 81.9% in daily moderate physical activities. Additionally, 24.5% were obese, 53.9% had high waist circumference, and 23.0% had a high waist-hip ratio. Obesity was significantly associated with prediabetes (AOR=8.850 95% CI=1.172 - 29.208). All other variables were not significantly associated with prediabetes.

Conclusion: Results from this study reveal a significant association between obesity and prediabetes, highlighting the importance of maintaining a healthy weight to prevent prediabetes.