Malawi Medical Journal最新文献

Background: Each year, nearly 400,000 new cases of paediatric hydrocephalus are estimated to occur worldwide, and almost half of these cases are expected to affect children in Africa. At Queen Elizabeth Central Hospital (QECH), an urban tertiary hospital in Blantyre, Malawi, located in south-east Africa, around 200 children received neurosurgical treatment for hydrocephalus in 2023. These children require lifelong follow-up and care, which places significant demands on their caregivers.

Objectives: The following research objectives guided the study: 1) To explore how mothers of children with hydrocephalus perceive the condition. 2) To examine the care pathways that mothers and their children with hydrocephalus engage in. 3) To identify the implications of having a child with hydrocephalus.

Methods: We applied a qualitative method with an explorative design. We conducted 15 in-depth interviews and two focus group discussions among 16 mothers (aged 20-35 years) of inpatient or outpatient children with hydrocephalus at QECH. Convenience sampling was used to recruit the 16 participants. We conducted a thematic analysis.

Results: 1) Mothers referred to various disease explanations, often switching between attributing the condition to God, supernatural causes such as bewitchment, and biomedical factors. 2) The care pathways for mothers and their children with hydrocephalus at QECH are fraught with challenges, creating strenuous trajectories that hinder access to care and present significant challenges. 3) Having a child with hydrocephalus has extensive social implications, including stigma and disruption of daily living.

Conclusions: Our findings highlight the need for intersectoral action to optimise treatment and reduce stigma. This involves educational programs and awareness-raising campaigns to improve maternal health literacy. Additionally, targeted initiatives are urgently needed to improve healthcare infrastructure, transportation, and pathways to care. Since hydrocephalus management is a lifelong process, the possibility of conducting follow-up through outreach clinics or telemedicine and community-based rehabilitation should be further explored. Finally, to improve management for children with hydrocephalus in Blantyre and across Malawi includes efforts to bolster the educational, economic, social, and legal position of women.

Background: Children with Tetralogy of Fallot (TOF) usually present with right heart abnormalities, however much is not known if these children presents with left ventricular dysfunction.

Objectives: This article is aimed to ascertain the left ventricular function of children with TOF compared with those without any congenital heart disease. It also elicits the correlation if any, between left ventricular mass and descending aorta blood flow.

Methods: This is a comparative study involving 91 children with TOF with age and gender matched control. Echocardiographic evaluation of left ventricular function and their parameters in children with TOF were compared with controls. The data was analyzed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago).

Results: The mean LVIDd of subjects without TOF, 25.7±10.1 was higher than that of those with TOF, 21.2±7.1 and the difference in mean was found to be statistically significant, (Student t=3.455, p=0.001). The mean EF of respondents with TOF, 61.9±19.3 was lower than that of subjects without TOF, 67.2±9.3 and the difference in mean was found to be statistically significant, (Student t=2.333, p=0.021). The mean FS of respondents with TOF, 43.1±16.6 was significantly lower than that of respondents without FS 46.7±8.2 (Student t=3.519, p=0.001). The mean velocity of respondents without TOF, 1.3±0.3 was significantly higher than that of respondents with TOF, 1.2±0.2. (Student t=4.199, p<0.001).For respondents who had TOF, there was a weak negative correlation between LV mass and velocity, increases with LV mass correlates with decreases in velocity but this was not found to be statistically significant, (n=63, r=-0.214, p=0.093).

Conclusion: Though it is generally known that children with TOF present with right ventricular dysfunction, however this study has shown that they also present with various degrees of left ventricular systolic abnormalities. Though left ventricular systolic function in children with TOF is lower than that in normal children, all values still fall within normal refrence ranges.

Introduction: While antipsychotics are key requirement in acute and long-term management of schizophrenia, medication adherence remains a major unmet need in its care. This paper assessed the prevalence of oral antipsychotic non-adherence among outpatients with schizophrenia and its associated clinico-demographic factors.

Method: Three hundred and ten adult outpatients (18-64 years of age) were cross-sectionally interviewed after being diagnosed of schizophrenia using ICD-10 criteria, and the diagnosis confirmed with the Mini International Neuropsychiatric Interview (MINI). The socio-demographic questionnaire, Morisky Medication Adherence scale (MMAS-8), Brief Psychiatric Rating Scale (BPRS), Liverpool University Neuroleptic Side Effects Scale (LUNSERS), Drug Attitude Inventory (DAI-10), Scale to Assess Unawareness of Mental Disorders (SUMD) were used to obtain participants' demographic profile, level of medication adherence, illness severity, attitude towards antipsychotics, and level of insight respectively.

Results: At least one in every two outpatients with schizophrenia (n=158; 51.0%) did not adhere to their antipsychotics as prescribed. The independent risk factors for poor oral antipsychotic adherence were illness severity (p= 0.001; AOR 1.13), psychoactive substance use (p= 0.009; AOR 1.87), young age (p= 0.014; AOR 2.09), perceived poor social support (p= 0.025; AOR 3.58), use of first generation antipsychotics alone (p= 0.006; AOR 17.99), use of second generation antipsychotics alone (p= 0.02; AOR 29.36), and awareness of symptoms (p= 0.025; AOR 1.18).

Conclusion: The high rate of poor medication adherence should necessitate much emphasis on the highlighted modifiable risk factors and the need for continuous adherence assessments and education in clinical practice.

Background: Patient satisfaction is an important indicator used to measure quality of care and the performance of healthcare services. This study assessed patient satisfaction with the quality of hypertension care received by both insured and uninsured patients with systemic hypertension.

Methods: This comparative cross-sectional study was conducted among insured and uninsured patients with systemic hypertension attending the Medical Outpatient Department clinics of the University of Ilorin Teaching Hospital, Kwara State, Nigeria, from May to July, 2023. Data were collected from 95 patients from each group, selected by systematic random sampling; using an interviewer-administered, anonymous, structured close ended questionnaire. Different aspects of the healthcare services were assessed; these include patient registration process, waiting time, staff attitudes, laboratory services, availability and cost of prescribed drugs etc. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27.0 software.

Results: The insured patients with systemic hypertension had a higher overall mean satisfaction (74.1±20.8) compared to the uninsured group (69.3±23.2), though this was not statistically significant (p value = 0.417). However, the insured patients with systemic hypertension had significant satisfaction scores compared to uninsured hypertensive group in the domains of waiting time (63.6 ± 24.9 vs 48.0 ± 25.8, p=0.000), drug cost and availability (73.9 ± 24.1 vs 56.2 ± 25.0, p=0.000), and cost of service and care (74.1±24.0 vs 59.8±26.0, p=0.000).

Conclusions: This study concluded that both insured and uninsured patients with systemic hypertension had comparable treatment, though the insured group had some better satisfaction scores in some of the assessed healthcare domains. The healthcare policy makers should endeavour to improve health insurance coverage, and utilize identified factors in policy formulation and implementation to encourage utilization of health insurance among patients.

Aim: An end colostomy is a potentially life-saving surgical intervention, but postoperative ostomy management is challenging in resource-limited settings. Socioeconomic, health system, and surgical capacity barriers may delay colostomy reversal. A surgery camp model for addressing the burden of unreversed colostomies has not previously been undertaken in Malawi. The study aims to present our institution's experience with the surgery camp model, assess patient outcomes, and identify improvement strategies for future efforts.

Methods: The surgery department at Kamuzu Central Hospital (KCH) carried out a two-day surgical camp in partnership with Access Health Africa (AHA) to reduce the local burden of reversible colostomies and train KCH surgery registrars in stapled end-to-end anastomosis (EEA). New, standardized preoperative and postoperative order sets for colostomy reversal were developed and implemented. Patient records were retrospectively reviewed, and descriptive analysis was performed. 13 patients underwent colostomy reversal via exploratory laparotomy. Twelve patients were male, median age was 41 (IQR 27 - 51), and average delay to reversal was 4.3 ± 6.6 months after clinical readiness.

Results: Sigmoid volvulus was the most common indication for Hartmann's procedure (62%) among patients undergoing reversal. One major complication was reported, a return to theatre for suspected anastomotic leak with no adverse findings. Patients were discharged 5.3± 2.8 days after surgery. Operating theatre staff successfully prepared for increased surgical volume, and standard pre- and postoperative order sets remain in use. Distribution of administrative responsibility and communication between visiting and host teams were noted as targets for improvement.

Conclusion: Given the clinical, educational, and organizational success of the two-day surgery camp, a second, expanded effort is anticipated. Goals include inclusion of ileostomy patients, advanced notification in district facilities and clinics, and additional administrative support with case allocation, supply acquisition, and personnel coordination.

Introduction: C-type Natriuretic Peptide (CNP) is the third natriuretic peptide (NP) identified from the nervous system and endothelial cells. CNP is believed to be produced locally in tubular cells and glomeruli of kidneys. We aim to determine the clinical value of CNP levels at lower extremity muscle ischemia/reperfusion (I/R), kidney I/R, and both I/R models and evaluate them in laboratory practices.

Method: This study is an original experimental study and was carried out on a total of 40 rats. (8-12 weeks and 321±69 gr). The rats were assigned into 5 groups, each containing 8 rats. CNP levels in the plasma were evaluated in the control group. CNP and muscle biopsies were held after ischemia/reperfusion from the left lower extremity in Group E and bilateral muscle ischemia/reperfusion in Group BE. CNP and renal biopsies were held after right nephrectomy+left renal I/R at Group R. CNP, muscle, and renal biopsies were held after right nefrectomy+left renal ischemia+bilateral renal ischemia in Group BER.

Results: The plasma level of CNP in the control group was determined as 144.99±33.04 pg/ml. There was no significant difference between groups at plasma CNP levels in predicting ischemia. Although in terms of reperfusion between Control-Group E, Control-Group BER, Group E-Group BE, Group E-Group R, Group BE-Group BER, Group R-Group BER; statistical significance was determined (p<0.05).

Conclusion: This study suggests that as a laboratory test, the endothelial-derived vasodilator CNP level cannot predict the location and degree of muscle and renal ischemia at the specified time. Similarly, the CNP level is valuable in evaluating adjunct muscle reperfusion to renal reperfusion. As a result, CNP levels may not be useful in predicting ischemia at a particular period, but they can be used to predict reperfusion.

Objective: By establishing routine image interpretation presentation in the Radiology Department of Mzuzu Central Hospital (MCH), radiographers can conduct technical analysis and quality control of DR, CT among other medical imaging techniques used in clinical practice, which can effectively improve the overall level of radiographers.

Methods: Formulate the general principles of radiographer image interpretation for the Radiology Department: (1) Select typical cases and special cases to analyze the examination methods and image standard interpretation; (2) Select cases that individuals have done relatively satisfactory or unsatisfactory, or even failed to analyze the lessons learned; (3) Select normal cases to identify important imaging anatomy and describe imaging manifestations, so as to improve the basic knowledge level of imaging diagnosis and the ability to interpret images. Secondly, establish an imaging technology reading system under the perspective of new media, and extend it to real-time discussion of technical issues in an online chat group.

Results: (1) Through image interpretation, the overall quality of radiographers have been significantly improved; (2) Through continuous learning of the imaging manifestations of typical cases, the level of imaging diagnosis can be effectively improved; (3) Find out the causes of some failed examinations, put forward rectification suggestions, and avoid mistakes again; (4) Special patients and special patients formulate personalized plans based on common practical experience to quickly complete the examination.

Conclusion: By establishing routine image interpretation presentations for radiographers and incorporating new media perspectives into image interpretation, we have observed higher levels of radiographer participation in learning discussions within technical groups. This approach has significantly improved the comprehensive business capabilities of radiographers and fostered greater unity within the technical team.

Introduction: There were no systematic studies about hypoxia-related long noncoding RNAs (lncRNAs) signatures to predict the survival of patients with lung adenocarcinoma (LUAD). Setting up matching hypoxia-related lncRNA signatures was necessary.

Objective: This study aimed to establish hypoxia-related lncRNAs signatures and to seek new biomarkers to predict the prognosis of the patients with lung adenocarcinoma.

Methodology: The Cancer Genome Atlas (TCGA) database provided the expression profiles of lncRNAs that includes 535 lung adenocarcinoma samples. The coexpression network of lncRNAs and hypoxia-related different expression genes (DEGs) was utilized to select hypoxia-related lncRNAs. The lncRNAs were further screened using univariate Cox regression. In addition, Lasso regression and multivariate Cox regression were used to develop a hypoxia-related lncRNAs signature. A risk score based on the signature was established, and Cox regression was used to test if it was an independent prognostic factor.

Results: Nine prognostic hypoxia-related lncRNAs (LINC01150, AC010980.2, AL606489.1, AL034397.3, LINC00460, LINC02081, FAM83AAS1, AL365181.2, and AC026355.1) were identified to be significantly different, which made up a hypoxia-related lncRNAs signature. The high-risk group had shorter OS compared with the low-risk group (P = 3.329e - 09, log-rank test). A risk score based on the signature was a significantly independent factor for the patients with LUAD (HR = 1.449, 95% CI = 1.312 - 1.602, P < 0.001).

Conclusion: The nine hypoxia-related lncRNAs and their signature might be molecular biomarkers and therapeutic targets for the patients with LUAD.

Background: Spontaneous reporting of adverse drug reaction (ADRs) is low in Malawi. We assessed the impact of training intervention on knowledge, attitudes, and practices of health care professionals (HCPs) in pharmacovigilance (PV).

Methods: We employed a mixed-methods study design. A questionnaire was administered among HCPs who were trained in PV, followed by face-face interviews. We further extracted individual case safety reports which were submitted to the local databasewithin a period of six months prior and after the PV training. Quantitative data was analyzed using STATA 14.1. Paired t-test was used to assess the differences in PV knowledge among HCPs before and after the training. For qualitative data, we manually derived key themes from the participant's responses.

Results: Overall, the mean knowledge score was significantly improved across all the participants from a mean of 56% (95% CI 53% to 58%) to 66% (95% CI 64% to 69%) after the training, p< 0.001. There was a 2.8-fold increase in the number of participants who were able to detect an ADR after the training and a 1.8-fold increase in the percentage of reporting the detected ADRs after the training. Participants expressed preference of a paper-based reporting system to other reporting tools. However, they outlined several challenges to the system which discourages HCPs from reporting ADRs, such as lack of feedback, unavailability of reporting forms and delay to transmit data to the national centre.

Conclusion: The survey found that in-service training for HCPs improves KAP of PV and reporting rates of ADRs. We recommend widening of the training and introducing PV courses in undergraduate programs for health care workers in Malawi.

Background: The school environment provides an important opportunity for children and educators to develop health education and health literacy the ability to make rational health decisions and identify and determine factors that affect health. The aim of this study is to determine the correlation between health literacy and eating self-efficacy levels of primary school students and the affecting factors.

Methods: The study was conducted with 486 fourth graders studying in a primary school located in eastern Turkey between September 2021 and June 2022. The data were collected through face-to-face interviews using the Personal Information Form, the Health Literacy for School-Age Children Scale (HLSAQ, and the Healthy Eating Self-Efficacy Scale for Children (HESES-C). Data were analyzed by number, percentage, mean, independent samples t-test, non-parametric Mann-Whitney U and Kruskal-Wallis tests, and Pearson's correlation tests.

Results: The gender of the students and the education level of their mothers had a statistically significant correlation with their mean HESES-C and HLSAC scores scores (p<0.05). There was a significant negative correlation between the students' HLSAC and their HESES-C mean scores.

Conclusions: According to the findings of the study, the students had a moderate level of health literacy and a low level of healthy eating self-efficacy. There was a negative relationship between health literacy levels and healthy eating self-efficacy.