Malawi Medical Journal最新文献

Objective: To determine the incidence, indications, the risk factors, complications, maternal morbidity and mortality of emergency peripartum hysterectomy (EPH), and perinatal outcomes at a tertiary hospital, Turkey.

Methods: We analyzed 71 cases of EPH from 2012 to 2019 at a tertiary hospital in a retrospective study. There were 142 control patients.

Results: There were 71 EPH out of 69,504 deliveries, for an overall incidence of 1.02 per 1000 births. The main indication for peripartum hysterectomy was abnormal placentation (67.6%), followed by uterine atony (28.1%), and uterine rupture (4.2%). Cesarean section (CS) and previous CS are major risk indicators for EPH. Other risk indicators are advanced maternal age (≥ 35 years) and multiparity. All patients with abnormal placentation had a previous CS. 93% of EPH were performed during and/or after CS, and 7% after vaginal delivery. 69% of EPH were made in total and 31% were subtotal. The three most common maternal morbidity included: wound infection and febrile morbidity (26.7%), bladder injury (16.9%), and disseminated intravascular coagulopathy (11.2%). There were no maternal deaths but perinatal mortality was 4%.

Conclusion: The most common indication for EPH was abnormal placentation. Also, CS and previous CS are major risk factors of EPH. Other risk factors for EPH are advanced maternal age (≥ 35 years) and multiparity. Moreover, all unnecessary CS should be avoided.

Background: Falls are a serious problem and are among the leading causes of morbidity, functional dependency, and death in older adults. Falls have become a social and global public health concern due to the current aging population in Africa and across the globe. However, their prevalence and risk factors have received little attention in Africa.

Purpose: Thus, this study aimed to provide a baseline survey to determine the prevalence and associated risk factors for falls among older adults attending a primary care facility in Cape Coast, Ghana.

Results: Participants (n = 244) were patients aged 60 years and older who visited the University of Cape Coast Hospital. The prevalence of falls identified in this hospital-based study was 40.2%. The following independent variables were found to be statistically significant predictors of risk of falls among the participants when compared with their respective reference categories; age 80 years and above [OR = 3.707, 95% CI = 1.738 - 7.907, p = 0.001], participants who had a history of falls [OR = 2.234, 95% CI = 1.326 - 3.765, p = 0.003], participants with three or more co-morbidities [OR = 16.456, 95% CI = 2.099 - 129.020, p = 0.008] and obesity [OR = 2.211, 95% CI = 1.151 - 4.250, p = 0.017].

Conclusion: The prevalence of falls among older adults is high. Thus, clinicians in the primary care setting should screen for, give fall prevention education, and prescribe appropriate interventions to at-risk patients.

Background: The high prevalence of the risk factors of head and neck cancer (HNC) amongst senior secondary (high) school students in Nigeria is an issue of serious public health concern. Therefore, this study aimed to assess the knowledge of HNC among them.

Methods: This cross-sectional study surveyed 2,530 senior secondary school students in Nigeria, assessed their knowledge of HNC, using a self-administered questionnaire. Data collected were analyzed using the SPSS version 25 software.

Results: The mean (±SD) age of the respondents was 16.34 (±2.0) years. More than half (1418; 56.6%) of them were males, 530 (20.9%) were schooling in the north-central geopolitical zone of Nigeria, 1,860 (73.5%) were in public schools, 554 (21.9%) were boarding students, and 817 (33.5%) were in Senior Secondary (SS) 3 class. Only 789 (31.2%) respondents were aware of HNC, out of which: 69.2% of them had below-average scores in their overall assessment on HNC; 256 (32.4%) had ever received education on HNC and 81.2% indicated a positive interest in knowing more about HNC. The factors predicting above-average score on knowledge about HNC among the respondents were: being in SS3 class (OR=1.73; 95% CI=1.17 - 2.56), having been educated about HNC (OR=1.69; 95%CI=1.21 - 2.35) and having the interest to know more about HNC (OR=1.88; 95%CI=1.21 - 2.92). Bivariate analysis showed that these factors had statistically significant association (or relationship) with above-average score on knowledge about HNC (pvalues<0.05).

Conclusion: Majority of the surveyed students were willing to know more about HNC. The use of a properly planned massive school-based HNC education programs may go a long way in educating this population group on HNC.

Background: There are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi.

Methods: In a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities.

Results: A total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5-70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodeling. Most patients were on at least a single neurohormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively.

Conclusions: Hypertension is the commonest comorbidity in patients with heart failure, who are mostly females with NYHA class I or II symptoms. Most had LV remodeling changes and are on at least one neurohormonal antagonist but most remain sub optimally treated.

Background: Use of performance enhancing substances (PES) is common among athletes with a worldwide prevalence ranging from 5% to 31%. There has been little knowledge of PES use in African athletes with no available data for Malawian football players. This study aimed to determine the prevalence of PESs use among elite football players in two super league teams in Blantyre, Malawi.

Methods: This was a cross-sectional study conducted in two super league football teams in Blantyre, Malawi. A modified standard questionnaire obtained from the World Anti-Doping Agency (WADA) Social science research package was administered to collect data from a convenient sample of 43 elite football players on the characteristics of participants, prevalence of PESs use and reasons for using PES. Data were analysed using descriptive statistics and Chi-square test.

Results: Out of 86 eligible football players, 43 with a mean age of 24 ± 4 years participated in the study. Many players (60%) had secondary education as their highest level of education and most players (86%) had played football for more than five years. Out of 43 participants, 39 (91%) had been using PESs while four (9%) had never used PESs. Out of 13 substances, caffeine (77%), herbal products (40%), and energy bars (40%) were the commonly used PESs while cocaine (2%) was the least used substance among the players. Improving performance was the most common reason (81%) why participants were using PESs followed by increase in lean body mass (35%).

Conclusion: The prevalence of PESs use among elite football players in two super league teams in Blantyre, Malawi is high. The most used PES are caffeine, herbal products and energy bars. Participants mainly use PESs for improved performance in football. Therefore, awareness among elite football athletes and stakeholders on adverse health effects of PES use should be promoted.

Introduction: In Malawi, Primary Caregivers (PCGs) of children living with Cerebral Palsy report challenges such as physical strain and lack of resources that affect care giving. Although such experiences affect the PCGs' Quality of Life (QoL), there is paucity of data for Malawi. Understanding their QoL would inform establishment of holistic intervention(s) tailored to meet their needs. Therefore, the purposes of this study were to determine QoL of PCGs of the children who were receiving rehabilitation at Queen Elizabeth Central Hospital (QECH) and Feed the Children (FtC), to identify PCG's and children's socio-demographic factors that may attribute to the perceived QoL, and to compare the PCGs' QoL between the sites.

Methods: A cross-sectional study was conducted from January to April 2019 on 142 PCGs of children aged between 2 and 18 years of age. All PCGs who were employed for the child-care, or had a chronic sickness were excluded. QoL was assessed using the World Health Organization Brief questionnaire, with a cut-off point of <60% for poor QoL. The severity of children's impairments was assessed using Gross Motor Function Classification System. Descriptive and inferential statistics were conducted to analyze the data. The PCGs' age, sex, marital status and level of education, and child's severity of impairment were compared with QoL.

Results: The majority of PCGs (61.30%) had poor QoL, and there was no significant difference in overall QoL of the PCGs between the sites (p<0.31). The PCGs at QECH had significantly higher physical domain mean scores than at FtC (U=1906, p<0.01). The overall QoL differed significantly across the marital statuses of the PCGs (p<0.03).

Conclusion: The study has established that most PCGs at both sites possess poor QoL. However, there is need to investigate how the rehabilitation institutions and workers influence the QoL of the PCGs within and between the facilities.

Background: Isoniazid preventive therapy is recommended as part of a comprehensive HIV and AIDS care strategy. IPT is used as prophylaxis to reduce the incidence of TB in HIV-infected persons. However, its implementation has been very slow and has been influenced by several factors. This study assessed health workers' knowledge and adherence to Isoniazid Preventive Therapy guidelines.

Methods: This was a cross-sectional study in six health facilities providing HIV care in Ebonyi State using a semi-structured, self-administered questionnaire. Data were collected from 85 health workers working in the HIV clinics. Data were also extracted from 200 patient treatment cards. Data analysis was carried out using SPSS version 20 software. Chi-square statistics and logistic regression were carried out to determine the association between socio-demographic characteristics and knowledge as well as self-reported practice of the guideline.

Result: Slightly over half of the respondents (58.8%) had good knowledge of the guideline, and the majority (75.3%) self-reported that they practiced the guideline. Only 17% of the treatment cards had isoniazid prescribed and only 11% of these had patient adherence assessed. The most common challenges to implementation of the guideline cited by health workers were unavailability of isoniazid, poor awareness, patient non-adherence, poor resources, high pill burden, and lack of training. Being a doctor and more than 3 years duration of work in the clinic were predictors of good knowledge. There was no predictor of practice.

Conclusion: There was good knowledge and practice of the guideline from health worker self-reports, however, review of treatment card showed prescription was low. Further studies to explore and understand why there is such low prescription of INH/IPT to HIV patients despite good knowledge of healthcare professionals are recommended.

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.