Malawi Medical Journal最新文献

Aim: The objective of this review is to identify the types of sexual and reproductive health (SRH) services that had been provided to internally displaced persons (IDP) and refugees in Africa, the key stakeholders and partners who provide these services, and the modes of service delivery.

Method: A systematic review was done using published quantitative and qualitative study designs, and grey literature, the provision and delivery of SRH services for displaced persons was reviewed. Studies included met at least two criteria. Only studies carried out from 2010 till date were included. Data of interest were extracted and the mixed-methods appraisal tool (MMAT) was used to evaluate the quality of each study. Primary outcomes included SRH services delivery, including family planning services; sexually transmitted infections (STI); reproductive cancer prevention, diagnosis, care and treatment; and response to sexual gender-based violence (SGBV).

Results: Twenty-one publications met the criteria for the review. While some SRH services are available for women in IDP and refugee camps, adolescent SRH services, preventive care for gynaecological cancers and voluntary abortion care were generally not available. Service delivery was faced with some limitations, including lack of funds, authorization and policy issues, training gaps and lack of supplies. Nurses, midwives, community health workers (CHWs) and lay refugees were the key personnel providing services. They were overworked in most places. Services were primarily funded by the United Nations (UN) and non-governmental organizations (NGOs), but governments, private enterprises and community-based organizations (CBO) worked together to provide care.

Conclusion: There is a need to expand service delivery for women IDPs and refugees in Africa to include comprehensive SRH care. Deploying more qualified/trained personnel can improve the effectiveness and reliability of the care provided. Better funding for SRH care can help to improve service delivery and the incorporation of other aspects of SRH into care provision.

Background: Pregnancy is a process that involves social, psychological, and physical changes which may be a turning point for improvement or onset/relapse of eating disorders. Studies conducted have emphasized that, in addition to classical eating disorders (anorexia nervosa and bulimia nervosa), new types (e.g., orthorexia nervosa) and subclinical disorders are also seen in pregnant women. Based on this information, this is a descriptive study that was carried out to determine the relationship between the risk of orthorexia in pregnant women and body image.

Material-method: The study included pregnant women receiving prenatal care at the obstetrics polyclinics of a state hospital in a province (n=175). After applying the first test on the pregnant women (in their first trimester), the posttests were carried out after the 30th week covering the third trimester of pregnancy. ORTO-11 scale, the Eating Attitude Test (EAT-40), and the Pregnancy Self-Perception Scale were used in data collection.

Results: The mean age of the pregnant women who participated in the study was 27.02±5.02. The mean first-test ORTO-11 score of the participants was 29.29±3.77, and their mean post-test ORTO-11 score was 26.58±4.08, while the difference was statistically significant, and the concerns of the pregnant women in their final trimester regarding eating healthy were higher than those when they first learned about their pregnancy. Among the pregnant women in their final trimester, the mean EAT-40 score was 19.64±8.66, the mean pregnancy motherhood perception dimension score was 25.30±2.97, and the mean pregnancy body perception dimension score was 15.39±4.00.

Conclusion: Based on the data of the study, it may be stated that the pregnant women in their final trimester had obsessions about healthy eating, and they had a negative perception of the changes in their bodies. Disorders in eating attitudes in pregnancy may significantly affect the outcomes of pregnancy and newborn health.

Background: Since December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in China, and quickly spread worldwide. To date, SARS-CoV-2 infection has become a global concern and health problem.

Method: In this study, we evaluated the co-infection of SARS-CoV-2 and Influenza viruses in confirmed COVID-19 patients in Abadan, Iran. They referred to the centers for COVID-19 detection at Abadan University of Medical Sciences in Southwest Iran. Nasopharyngeal and oropharyngeal throat swabs were collected from each person and tested for Influenza A using a multiplex Real Time-Polymerase Chain Reaction.

Results: In this study, among 40 SARS-CoV-2-positive cases, 2 patients (5%) were co-infected with influenza A virus.

Conclusion: The low frequency of influenza in our study could be due to the small sample size, which is one of the main limitations of our study Also, other respiratory tract infections were not investigated in this study.

Aim: To investigate the prognostic significance of delta-neutrophil index (DNI) and neutrophil/lymphocyte ratio (NLR) in women with intrauterine growth retardation (IUGR) and normal pregnant women.

Methods: Normal pregnant women who delivered at Health Sciences University Etlik Zübeyde Hanim Women's Health Training and Research Hospital between January 2015 and July 2020 and pregnant women with IUGR were included in the study. 486 pregnant women and 400 normally pregnant women diagnosed with IUGR according to Delphi criteria were included in the analysis. Data available at presentation for delivery or within four weeks before delivery were used for analysis of DNI and other laboratory values in both the patient and control groups.

Results: The mean age of study group was 28.3±4.6 and control group was 27.2±5.6 years. There were significant differences between the study and control groups regarding maternal age, prepregnancy BMI, BMI at delivery and gestational age at admission and delivery, hemoglobin(Hb) levels, hematocrit (Hct) values, WBC values, lymphocyte, monocyte, neutrophile, thrombocyte counts, NLRs, DNI values, between the two groups. The median NLRs were 4.6 (range, 1.54±44.29), the mean DNI value of IUGR was --0.26±3.4 and the mean DNI value of control group was -3.7±5.8 (p<0.001, p<0.001, respectively). The NLR and DNI levels are significantly higher in the IUGR group. The optimal cut-off value for NLR was 3.84, with a sensitivity of 70.6% a specificity of 70.5%, and an area under the receiver operating characteristic curve of 0.780. The optimal cutoff value for DNI was -1.18, with a sensitivity of 53.9%, a specificity of 52%, and an area under the ROC curve of 0.692. The Odds Ratio of the DNI was 1.2, and NLR was 5.7.

Conclusion: Considering its sensitivity and specificity, the NLR value shows that inflammatory events are much more effective in pregnant women with IUGR than we thought.

Introduction: Malawi has a high and rising incidence of musculoskeletal injuries and inadequate orthopaedic trauma care capacity, which must be urgently addressed.

Methods: We performed a scoping literature review to define essential goals and challenges to musculoskeletal trauma care delivery in Malawi pertaining to the following domains: injury prevention, prehospital care, rural health centres, district hospitals, and central hospitals. For each domain, essential goals were ratified and challenges were prioritized by a panel of experts on Malawian orthopaedic trauma care.

Results: The five highest priorities pertained to injury prevention (2), central hospital-level definitive treatment (2), and district hospital-level initial fracture management (1). We believe the next steps are to use the prioritized list of challenges to form working groups with the goal of examining and developing strategies to address each challenge. For the top priority challenges in each domain, we recommend the following: 1) Prevent road injuries by law enforcement, children's education, civic engagement, and road infrastructure development; 2) Improve pre-hospital transportation by scaling up emergency dispatch systems, fixing broken ambulances, and training public transportation workers in basic first aid; 3) Provide health workers in Rural Health Centres with basic training in musculoskeletal injury management and triage; 4) Improve diagnostic x-ray capacity at District Hospitals by fixing/replacing broken machinery and ensuring stable power supply; 5) Improve operative capacity at Central Hospitals by increasing operating theatre availability, efficiency, and utilization, and supporting specialist surgical training programmes.

Discussion: We hope that this manuscript will serve as a practical, actionable guide for policymakers, donors, health system leaders, educators and orthopaedic trauma care providers. Through this process, we also hope to create a replicable methodology and framework that can be applied to other clinical departments in Malawi, and for similar work in other low- and middle-income countries.

Background: Intuitive eating may predict better psychological and behavioral health. Intuitive eating, hedonic hunger, and diet quality may affect individuals' mental health and sleep quality.

Methods: Descriptive cross-sectional study developed with an online questionnaire for randomly selected volunteers (n=351) aged 19-64 years. Hedonic hunger status was evaluated by Power of Food Scale (PFS), intuitive eating by Intuitive Eating Scale-2 (IES-2), mental health status by Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and sleep quality by Pittsburgh Sleep Quality Index (PSQI). Food consumption records were taken to evaluate individuals' dietary quality, using Healthy Eating Index (HEI)-2015.

Results: It was found that 50.7% of the participants exhibited intuitive eating behavior, while 65.0% experienced hedonic hunger. When the diet quality was examined, it was found that 65.2% of the participants had poor diet quality, while 33.6% needed to improve their diet quality. Sleep quality and mental health status of individuals exhibiting intuitive eating behavior were significantly better (p<0.05). Diet quality was not associated with mental health, intuitive eating, hedonic hunger and sleep quality scores (p>0.05). While there was a weak negative correlation between intuitive eating and PSQI score (r=-0.160, p<0.05), while a positive correlation was found between hedonic hunger and PSQI score (r=0.286, p<0.05). Intuitive eating was associated with better sleep quality, as lower PSQI scores indicate better sleep quality. Intuitive eating was also associated with better mental health (r=0.339, p<0.05).

Conclusion: This study reveals that intuitive eating behavior is associated with better sleep quality and mental health, while hedonic hunger behavior is associated with poor sleep quality.

Background: The descending aorta velocity is important predictor of aortic disease in children and can be very helpful in some clinical and surgical decision making.

Aim: The purpose of this study is to assess the normative values of descending aorta velocity among children from South-East Nigeria. It also aimed to assess the correlation between age, body surface area and mean velocity across the descending aorta.

Methods: This is a cross-sectional study where the descending aorta velocity of one hundred and eleven children were enrolled consecutively using digitized two-dimensional and Doppler echocardiography.

Results: A total of 111 children had echocardiography to study their cardiac structures and compute their mean scores of their descending aorta velocity. The mean velocity across the descending aorta was 1.3±0.2m/s with maximum and minimum velocities of 2.06 and 0.84cm respectively. The mean descending aorta velocity in males (1.37±0.24 m/s) was significantly higher than that in females (1.24±0.18); (Student T test 3.09, p = 0.03). There was no correlation between age and mean velocity across the descending aorta (Pearson correlation coefficient; -0.03, p = 0.7) nor between body surface area and descending aorta velocity (correlation coefficient 0.01, p= 0.8).

Conclusions: The presented normalized values of the descending aorta velocity using a digitized two-dimensional and Doppler echocardiography among healthy children will serve as a reference values for further studies and can be applied for clinical and surgical use in children with various cardiac anomalies.

Acute respiratory failure is an important reason for pediatric intensive care admissions. Lung parenchymal disease, airway obstruction, or neuromuscular dysfunction are the most common causes. Negative pressure pulmonary edema, characterized by pulmonary edema associated with upper airway obstruction, can rarely cause sudden onset respiratory failure. Herein, we describe an infant who suffered sudden onset respiratory failure and pulmonary hemorrhage while being held facedown for a bath, was admitted to the pediatric intensive care unit, intubated and mechanically ventilated for three days, and was diagnosed with negative pressure pulmonary edema, and discharged without any sequelae. Negative pressure pulmonary edema is a rare entity. Its true frequency is not known due to the lack of awareness. This report aimed to increase clinician familiarity with negative pressure pulmonary edema in patients with sudden onset respiratory failure and/or pulmonary hemorrhage.

Various infective complications can be seen after a dental procedure. They are rarely resistant to standard therapy. In the case we present, a case of preseptal cellulitis caused by pseudomonas oryzihabitans after tooth extraction in a male patient who did not have any underlying cause. As in our case, evaluation of the cases resistant to standard treatment in terms of drainage and multidisciplinary management of culture results together with infectious diseases will increase the treatment success rate.