Malawi Medical Journal最新文献

Background: Viral Hepatitis is a serious public health concern globally with an estimated 1.3 million deaths annually due to hepatitis B and C viruses. Prevention of mother to child transmission is a critical step toward elimination of hepatitis B and C. The main aim of this study was to assess the prevalence of HBV and HCV among pregnant women at Queen Elizabeth Central Hospital in Blantyre.

Method: A descriptive cross-sectional study was conducted among consecutive pregnant women attending routine antenatal care, and/or admitted at QECH in last quarter of 2021. Of the 114 pregnant women, 84 women consented to participate. Serum was tested for HBsAg and Anti-HCV markers using rapid diagnostic tests (RDT) and compared to Enzyme Linked Immunosorbent Assay (ELISA).

Results: Of the 84 consenting pregnant women, the median age was 25.0 years (IQR: 21.0, 33.0). Hepatitis B surface antigen (HBsAg) was detected in 6.0% (n=5/84, 95% CI: 0.03-6.4) of participants using ELISA and in 1.2% (0.2-6.4; n=1/84), using RDTs, while none tested positive for anti-HCV antibodies. There were no significant associations between HBV infection and any of the socio-demographic characteristics or assessed risk factors.

Conclusion: The prevalence of HBV (6%) and HCV (0%) in this population was lower than reported in previous studies of the general Malawian population, where HBV seroprevalence was estimated at 8.1% and HCV below 1%. We highlight potential underdiagnosis using RDTs for HBV, an ongoing significant rate of HBV infection, and a very low prevalence of HCV. Accessible screening and treatment for all positive pregnant women remains essential to eliminate vertical transmission.

Low-income countries including Malawi face persistent challenges in health service delivery primarily due to a critical shortage of human resources for health (HRH). Artificial intelligence (AI) technologies are gaining traction as tools to support diagnosis, treatment monitoring and health systems efficiency. In this paper, we discuss the potential role of AI in supporting health workers through task-shifting strategies and explore circumstances under which AI-led diagnosis and monitoring could substitute for human providers in a safe, ethical, cost-effective and affordable manner. We highlight opportunities in areas with large service delivery constraints such as radiology, pathology, prevalent and chronic disease monitoring. We discuss the use of discrete choice experiments (DCEs) to investigate preferences of patients, providers, and policymakers on AI integration into healthcare. Finally, we outline policy implications for Malawi. While AI is not a panacea, we argue that it could be an important adjunct to the health workforce if strategically deployed, regulated, and aligned with health system priorities.

Background: Musculoskeletal discomfort (MSD) and burnout syndrome (BS) represent frequently occurring issues among physicians and nurses. Psychosocial conditions having a critical role in BS may be a factor in MSD.

Objective: This study aimed to evaluate MSDs and BS, socio-demographics (gender, marital status, education, profession, sleep), work-related characteristics (working year, resting period, working hours, number of shifts) associated with MSDs/BS, and the relationship between MSDs and BS in physicians and nurses.

Methods: The study was cross-sectional and was conducted on 217 physicians and nurses at Trakya University Health Centre for Medical Research and Practice (Hospital) from December 2019 to February 2020 using a pre-designed questionnaire for demographics, Copenhagen Burnout Inventory and Cornell Musculoskeletal Discomfort Questionnaire. SPSS v.24.0 software and statistical techniques were used to analyse the data.

Results: 59% of the participants were physically strained and the average score for BS was 50.33. An association was found between MSDs/BS, and demographic/work-related characteristics (gender, marital status, education, profession, sleep, working year, resting period, working hour, number of shifts). The most common MSDs was in the upper and lower back, left/right lower leg, and left/right leg. The Pearson correlation test showed a statistically significant relationship between MSDs (neck, left/right shoulder, upper back, left upper arm, lower back, left/right forearm, right wrist, left/right lower leg, left/right foot) and BS.

Conclusion: This study concludes that the existence of MSD and BS and the significant association of different demographics with MSD/BS among physicians and nurses needs to be adequately addressed. The interaction of MSD with BS suggests the need for more interdisciplinary research. Protective measures should focus on the most exposed parts of the body.

Objectives: This study aimed to characterise the expression profiles of long non-coding RNA (lncRNA) and messenger RNA (mRNA) in plasma samples from individuals with preeclampsia (PE) during early pregnancy (7-14 weeks of gestation). We sought to identify key signalling pathways and biological functions linked to these transcripts and evaluate their potential for early PE diagnosis and therapeutic intervention.

Methods: From January to June 2019, we analysed frozen plasma samples from eight PE patients and eight normotensive pregnant women matched for gestational age. Transcriptome sequencing was performed using the Illumina HiSeq 4000 platform. Differentially expressed lncRNAs and mRNAs were identified with thresholds of |fold change (FC)| ≥ 2 and P ≤ 0.05. Functional enrichment analyses (Gene Ontology [GO] and Kyoto Encyclopedia of Genes and Genomes [KEGG]) were conducted to elucidate associated pathways, and a lncRNA-mRNA coexpression network was constructed to explore regulatory interactions.

Results: We identified 361 significantly dysregulated lncRNAs (171 up- and 190 down-regulated) and 3,798 mRNAs (3,320 up- and 478 down-regulated). Top dysregulated transcripts included ENST00000440816 (lncRNA, log₂FC = +175.29) and TEX35 (mRNA, log₂FC = +8.70). Gene Ontology analysis revealed enrichment in inflammatory response, cell adhesion, and transferase activity, while Kyoto Encyclopedia of Genes and Genomes pathways implicated phosphoinositide 3-kinase-protein kinase B, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and mechanistic target of rapamycin (mTOR) signalling. Coexpression networks highlighted strong associations between dysregulated transcripts and oxidative stress/inflammatory processes.

Conclusion: Early-pregnancy plasma lncRNAs and mRNAs are markedly dysregulated in PE and correlate with pathogenic pathways. Notably, lncRNAs with |log₂FC| ≥ 5 and mRNAs with |log₂FC| ≥ 6 may serve as novel biomarkers for early PE prediction.

Background: Dysmenorrhea is a gynecological condition with symptoms ranging from mild pain to severe pain. In students especially those enrolled in rigorous academic programs like pharmacy, the condition may disrupt their academic participation and performance. However, there have been limited evidence on how it impedes this population's academic activities.

Objectives: To assess the impact of dysmenorrhea on participation in academic activities among pharmacy students in Nigerian universities.

Methods: This study was conducted using a cross-sectional self-administered questionnaire-based design among pharmacy students in Nigeria universities. Cluster random sampling technique (one school of pharmacy per each of the six geopolitical zones) was employed in selecting the participating pharmacy schools. Descriptive analysis was done to summarize the data. Chi-square test was performed to identify the relationships between various study variables across the universities. Binary logistic regression was used to determine predictors of the impact of dysmenorrhea on the respondents' participation in academic activities.

Results: Out of 1387 respondents, the majority [972(70.08%)] were aged 20-25 years. Almost all respondents [1311(90.52%)] were single. Most of them [975 (70.30%)] saw their menses for the first time at ages 12-15 years. Among the respondents, 1220(87.96%) reported experiencing dysmenorrhea (p=0.017). Of these, 669(54.84%) had their onset of pain on the first day of their menses (p=0.017). Moderate [587(48.11%)] and severe [432(35.41%)] pain were reported. The reported impacts of dysmenorrhea included decrease in physical activities [1151(94.34%)], decreased concentration during lectures [1079(88.44%)], decrease in studying time [1011(82.87%)], absence from classes [643(52.70%)], and poor examination performance [299(24.51%)]. Predictors of the impact of dysmenorrhea were age, institution, level of study and pain intensity.

Conclusion: The study revealed a high prevalence of primary dysmenorrhea, characterized by predominantly moderate pain lasting 1-2 days. The impacts included decreased physical activities, reduced concentration in lectures, decreased study time, class absenteeism, and poor examination performance.

Background: The vaccination status and risk perception towards the vaccine of individuals varies according to their level of knowledge about the vaccine. But the anti-vaccination or vaccine hesitancy movement that has emerged in pandemic period. It was aimed to evaluate the factors affecting Covid-19 vaccine literacy and vaccine hesitation levels of adults in pandemics.

Methods: This study was conducted with individuals working in a public institution between June and September 2022 as a cross-sectional design (n=435). The data were collected through the Introductory Information Form, the Covid-19 Vaccine Literacy Scale and the Vaccine Hesitancy Scale in Pandemics.

Results: The rate of the participants who had the Covid-19 vaccine was found to be 96.8%. The total mean score of the Covid-19 Vaccine Literacy Scale was found to be 2.71±.49 and the Vaccine Hesitancy in Pandemics Scale total mean score to be 27.94±5.19. The Covid-19 vaccine literacy level of the participants had a statistically significant effect on the vaccine hesitancy in pandemics (p<.05). Vaccine hesitancy may be associated with many different variables; educational status and vaccine literacy are predictors of vaccine hesitancy.

Conclusion: Covid-19 vaccine literacy was found to be moderate in the group examined, and it affected the level of vaccine hesitancy and the predictors of them. It is crucial that the health professionals especially nurses and social media resources preferred by the society as a source of information convey accurate and up-to-date information to individuals. Nurses should be a facilitator for community getting right and currrent knowledge of vaccines via social media, face to face contact, scientific programmes.

Objective: This retrospective study explored the clinical impact of hepatitis C virus (HCV) infection in maintenance hemodialysis (MHD) patients through comprehensive analysis of liver/renal function parameters, cellular immunity profiles, and long-term survival outcomes.

Methods: The study enrolled 28 HCV-infected MHD patients (MHD-HCV group), 28 HCV-negative MHD patients (MHD group), and 21 healthy controls (NC group) retrospectively. Liver and renal functions, lymphocyte subset analysis, and interleukin-10 (IL-10) levels were assessed. Overall survival at a median follow-up of 4 years was compared between the MHD-HCV and MHD groups.

Results: Biochemical analysis demonstrated significantly elevated liver enzymes in the MHD-HCV group compared to MHD group, with mean alanine aminotransferase (ALT) levels of 26.6 ± 18.6 vs. 10.1 ± 7.1U/L (P < 0.001) and aspartate aminotransferase (AST) levels of 20.0 ± 9.0 vs. 11.8 ± 5.5U/L (P = 0.001). Furthermore, the MHD-HCV group had elevated total bile acid (7.70 ± 7.17 vs. 3.44 ± 1.75, P = 0.007), total protein (67.9 ± 5.2 vs. 63.9 ± 5.6, P = 0.012), globulin (31.1 ± 5.9 vs. 26.5 ± 3.6, P = 0.003). Immunological profiling revealed significant upregulation of both regulatory T cells (Tregs: 4.48 ± 2.94 vs. 2.48 ± 1.81, P < 0.001) and interleukin-10 (IL-10: 78.7 ± 45.1 vs. 34.2 ± 15.2, P < 0.001). The patients in the MHD-HCV group had higher mortality risk compared with those in the MHD group (χ²=4.383, P = 0.036).

Conclusion: HCV infection in MHD patients leads to non-negligible liver dysfunction, elevated Tregs and IL-10, as well as higher mortality.

Introduction: Large-scale health surveys like the Demographic and Health Surveys (DHS) and WHO STEPS are essential for tracking health trends and guiding policies in low- and middle-income countries. However, when these datasets are imported into tools like R, they often lose crucial metadata, variable and value labels, turning clear categories into cryptic codes. This slows analysis, risks errors, and weakens data reuse.

Methods: We developed a reproducible workflow in R to import and process survey data while preserving variable and value labels. Using open-source packages such as haven, labelled, and tidyverse, we automated reading of datasets, extraction of metadata, replacement of codes with readable labels, and renaming of variables with full descriptions. The workflow was designed to be modular, easy to adapt, and accessible for analysts with basic R skills.

Results: We tested the workflow on the contraceptive use module from the 2015/16 Malawi DHS and the tobacco use module from Malawi's Global Youth Tobacco Survey. Without our process, variables appeared as vague codes (e.g., v312) and responses as plain numbers. After applying our workflow, these were transformed into clear, labelled categories like "Injectable" or "Never Married." Frequency tables generated from the cleaned data were easier to interpret and share. This automated approach saved several hours of manual recoding and reduced the risk of errors.

Conclusion: By maintaining metadata, our workflow improves transparency, reproducibility, and efficiency in digital health research. This supports better training, clearer communication, and more reliable use of health data for policy and program decisions.