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- ItemRestrictedAssessing diabetic lifestyle knowledge, attitude and practice and their associated factors in type II diabetic patients attending medical clinic at Nkhoma Mission Hospital(Kamuzu University of Health Sciences, 2020-09-16) Chisepo, PatrickThe problem: Lifestyle Modification involves altering long-term habits, typically of eating and physical activity and maintaining the new behaviour for months or years.(3) Lifestyle Modification is known to treat or reverse a number of Non-communicable diseases(NCD) and plays an important role in the management of diabetes toward achieving good glycaemic control, as well as preventing or delaying micro-vascular complications in patients with type II diabetes. Though we give patient education and counselling at Nkhoma medical clinic regarding Lifestyle Modification, little is known about patients’ intention, attitude, and actual practice of these activities. This study will help us to identify patients’ stated intentions and attitude factors that relate to lifestyle behaviors. Understanding these motivating thought processes will help us better relate to counseling individual patients, as well as improve diabetes education and empowerment programs. 7.2 Study design: We will carry out a descriptive quantitative cross-section study 7.3 Objective: The study aims to assess patients’ intention, attitude and behaviour towards Lifestyle Modification among patients with type II diabetes. Specifically will assess level of the patients’ intentions to engage in Lifestyle Modification, factors that are associated with Intentions to engage in Lifestyle Modification and factors predictive of Lifestyle Modification. 7.4 Methodology: This will be a descriptive cross-section study of diabetic patients attending outpatient medical clinic. It will use Diabetes Intention, Attitude and Behaviour questionnaire (DIAB-Q) to measure diabetes-related cognitions and behaviours for engaging in health lifestyle. A sample of 50 patients with type II diabetes will be enrolled using convenience sampling during the study period of two months; since the medical clinic at Nkhoma is done once a week on Tuesdays, it will mean the data collection will be done in 8 days over the 2 month period. The study will include type II patients 18 years and above who consent and have been known to have diabetes for at least 1 week. It will exclude those who are below 18 years and those who have had diabetes for less than 1 week.
- ItemRestrictedAssessing factors that influence participation of caregivers in the treatment of preterm neonates on bubble Continuous Positive Airway Pressure at Mangochi District Hospital(Kamuzu University of Health Sciences, 2021-12-16) Chisope, Evetta Kuwala;Title of study; Assessing factors influencing participation of caregivers in the treatment of preterm neonates on bubble Continuous Positive Airway Pressure at Mangochi District Hospital. Study problem; Global mortality of preterm babies remains high at 35% with many survivors suffering lifetime disabilities such as learning disabilities, visual and hearing problems. The leading cause of mortality among preterm neonates is Respiratory Distress Syndrome (RDS), a condition that is effectively treated with the use of bubble Continuous Positive Airway Pressure (CPAP) therapy. In addition, good neonatal outcomes are achieved when caregivers of preterm neonates are incorporated in planning, delivery and evaluation of healthcare. However, implementing the aspect of engaging caregivers in healthcare delivery face challenges as conflict emerges between nurses and caregivers as nurses want to retain their role as primary caregivers though it shifts to being mentors. Again, the aspect is not valued nor encouraged especially in low- and middle-income countries. Study objectives; the aim of the study is to assess factors that influence participation of caregivers in the treatment of preterm neonates on bubble Continuous Positive Airway Pressure at Mangochi District Hospital. The investigator will explore caregivers’ knowledge on their role in provision of care, the barriers and enablers of their participation in care and the strategies for improving caregiver participation in treatment of preterm neonates receiving bubble CPAP. Methodology; This is a qualitative study employing in-depth interviews, focus group discussions and observations. The study will take place at Mangochi District Hospital. Participants will be caregivers for preterm babies who have been on bubble CPAP for at least 24 hours and they will be recruited purposively. Data will be collected by conducting interviews, focus group discussions and observations to achieve objectives of the study. Ethical approval of the study will be obtained from COMREC and individual participants in the study will give informed consent to participate. Participants identification will be protected by using identity codes and not their names and all study documents will be kept in a lockable cabinet which will be accessed by study team only. Expected findings and their dissemination; the study will inform factors that influence the utilization of a simple but effective strategy in reducing neonatal mortality, thus, engaging caregivers in care provision to preterm babies, from caregiver perspective. Results will be disseminated through a written report to KUHES library, COMREC secretariat and Mangochi District Health Office. Furthermore, results will be presented at a research conference organized by KUHES and will be published in a peer review journal.
- ItemRestrictedAssessing immunosuppressive status in HIV clients with cervical cancer at Queen Elizabeth Central Hospital, Gynaecology Unit(Kamuzu University of Health Sciences, 2022-04-11) Maluwa, Thokozani; Dinala, YusufType of study Retrospective folder review study. Problem Women living with HIV have increased risk of developing cervical cancer which is associated with an increase in mortality rate. Malawi being one of the countries with high HIV prevalence rate, this study wants to determine the immunosuppressive status of HIV positive women with cervical cancer. Broad objective • To assess immunosuppressive status in HIV clients with cervical cancer Specific Objectives • To determine the effect that cervical cancer has on HIV viral load status and CD4 count. • To explore association of viral load status in HIV patients with cervical cancer with age, cancer stage, socio-economic status and level of education. • To assess how ART adherence, affect HIV viral load status in HIV patients with cervical cancer. methodology This will be a retrospective folder review study. A total of 87 HIV clients with cervical cancer files will be obtained from QECH, gynecology department. A simple random sampling method will be used to sample the files. Variables such as age socio-economic status, level of education, stage of cancer, ART intake will be collected through a questionnaire. CD4 count and Viral load data between 2016-2021 will be collected from the files of the selected clients. Expected findings The viral load of HIV patients with cervical cancer will increase while CD4 will decrease. This is because HIV and AIDS patients have reduced immunity and the cancer lowers the immunity further hence the virus replicates rapidly. PowerPoint presentation will be done at Kamuzu College of Health Sciences (KUHeS) and at any designated Research Conferences. A final copy will be sent to the research supervisor(s), QECH, COMREC, Head of department and the Library. Manuscripts will also be prepared and be submitted at journal for publications. 11-Apr-2022 Assessing immunosuppressive status in HIV clients with cervical cancer at Gynecology unit, QECH, Blantyre; Malawi V2.0 21 March 2022
- ItemRestrictedAssessing prevalence of diabetes for patients who are on Hydrochlorothiazide and Propranolol in Blantyre(Kamuzu University of Health Sciences, 2021-03-17) Shaba, Alice; Harrison, ChikondiHypertension and diabetes are the most common co-morbidities which are increasingly becoming a great public health risk to most developing countries including Malawi. This is attributed to physical inactivity, urbanization, obesity and nutritional transitions. Hypertension is managed by different drug classes which include; diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and beta blockers. The use of diuretics and beta blockers has been associated with a new onset of diabetes. This quantitative cross sectional study aims at assessing the prevalence of diabetes for patients who are on hydrochlorothiazide (HCTZ) and propranolol in Blantyre. The objectives of the study include identifying hypertensive patients who are on HCTZ and propranolol; determining prevalence of diabetes in these patients; and lastly determining blood sugar control. This study will be conducted at Queen Elizabeth Central Hospital in Blantyre with 177 sample size. Study population will be both male and female hypertensive adults who have been on HCTZ and propranolol for a year. It is expected that there will be high prevalence of diabetes among hypertensive patients who are on HCTZ and propranolol. Also there will be high percentage of diabetes patients having their blood sugar not controlled. Results of the study will be presented to College of Medicine and possibly published in peer reviewed medical journal
- ItemRestrictedAssessing the acceptability of paclitaxel as treatment for Kaposi Sarcoma in patients and clinic providers in Mangochi(Kamuzu University of Health Sciences, 2022-07-11) Kachedwa, FrancisType of Study: This is a qualitative study that seeks to assess the acceptability of Paclitaxel as treatment for Kaposi Sarcoma in patients and clinic providers in Mangochi. Background of the problem: Kaposi Sarcoma patients in Malawi have long been treated with Vincristine either as a monotherapy or in combination with bleomycin. Given many reports of toxicity in vincristine patients at higher dosages albeit with little or no concomitant benefits of dosage increases, the government of Malawi revised the first line treatment for Kaposi Sarcoma. In this regard, the Malawi Ministry of Health (MOH), has embarked on rolling out Paclitaxel for Kaposi Sarcoma treatment to district hospitals, Mangochi inclusive, with only a few districts remaining. As this is a new intervention, there is a considerable knowledge gap as regards to patients’ and providers’ perceptions on Paclitaxel among other aspects. Such varying perceptions may have a significant bearing on the acceptability of Paclitaxel in the target population. Studies are therefore required especially in this preliminary stage of the intervention in order to unravel areas that require urgent addressing of quality issues among others. Therefore, in this regard, this study seeks to explore the acceptability of paclitaxel at the district hospital level of care. Objectives of the study: Broadly, the aim of the study is to assess the acceptability of paclitaxel as treatment for Kaposi Sarcoma (KS) among patients and providers in Mangochi district. The study seeks to specifically highlight perceptions of patients and providers on Paclitaxel usage and explore some pertinent barriers and enablers to acceptability of paclitaxel at a district hospital level of health care. Methodology: This is a qualitative study design that shall employ a phenomenological approach. The study will take place at Mangochi District Hospital in Mangochi District. The study population shall include of 32 participants comprising of 16 patients and 16 clinic providers selected through Non-probabilistic purposive sampling. Data will be collected through in-depth interviews using interview guides for both patients and providers. A focus group discussion will be conducted among providers for issues of maintaining patients privacy and confidentiality. The protocol shall be submitted for COMREC approval and approved written consents shall be administered or read to the participants to seek their consent. No names of participants shall be used in this study and the digital files and transcripts shall be stored under lock and key/ passwords with access limited to the research team. Data will be analysed manually using content analysis as guided by the Theoretical framework of acceptability. Dissemination of Expected findings: The study is expected to unravel any possible acceptability issues associated with Paclitaxel as treatment for Kaposi Sarcoma. The findings of this study will be shared to COMREC, COM library, Mangochi DHO, and at an annual dissemination conference organized by KUHeS, among other such conferences. A publishable manuscript will be submitted to relevant local and international journals. 11-Jul-2022 vii Study Protocol Version 1.3 15 th June 2022 Possible constraints Some study participants may refuse to be enrolled or withdraw for fear of delays to receive their treatment. The study conduct shall ensure that participants receive their treatment unhindered prior to commencement the in-depth interviews. There may be fears of interviews taking too long, effecting the participants time of getting home or conducting other planned activities hence leading to refusal of enrollment. The investigator shall make sure to use time management techniques to ensure that the interviews and discussions are completed by or before the allotted time as described in the informed consent.
- ItemRestrictedAssessing the burden of Diabetes Mellitus (DM) and risk factors among Blantyre city based Non-Governmental Organisation (NGO) drivers(Kamuzu University of Health Sciences, 2020-06-05) Mtila, YusufType of Study The study is a cross-sectional study that will adopt the World Health Organization (WHO) STEPS survey design for NCD risk factors assessment with particular interest on Diabetes. Problem The prevalence of Diabetes Mellitus (DM) in Malawi was determined at 5.6% among adults aged 25-64 years by national wide STEPS survey in 2009. Sedentary life style which is a characteristic of driving population has been associated with increasing prevalence of Diabetes Mellitus. Studies on determinants and distribution of DM among different groups of driving populations including taxi drivers, bus drivers and truck drivers have been conducted. The results from the studies have informed effective programming on DM response interventions amongst the target populations. Currently epidemiology of DM among Non-Governmental Organization drivers in particularly is not known and documented. Knowledge on prevalence of DM and their associated risk factors among NGO drivers in Blantyre city will inform evidence-based interventions that specifically respond to diabetes burden among them. Objectives The main objective of the study is to assess the prevalence and risk factors of Diabetes Mellitus among NGO drivers in Blantyre city. Specific objectives include: Assess prevalence of lifestyle and behavior risk factors, Medical/ physiological risk factors and prevalence of DM among NGO drivers. Methodology A sample of 91 NGO drivers from Blantyre city will be interviewed, assessed on behavior, physical and biomedical risk factors. Two enumerators and two certified providers will be temporally employed to facilitate data collection process. The enumerators will be interviewing NGO drivers on background information, behavior risk factors using a questionnaire. The interviewees together with their partly filled questionnaires will next be directed to providers (Nurse/Clinician) for presence of DM, physical and biomedical factors assessment. All interviews will be recorded, entered into STATA 16 and hard copies filed in a file cabinet. Data will be processed and analyzed using STATA. Expected Findings It is expected that there will be significant associations between behavior, physical, physiological risk factors to prevalence of DM in Blantyre city-based NGO drivers. Dissemination of Findings Findings from the study will be shared with relevant authorities in Blantyre city council, CONGOMA, Ministry of Health and COMREC to reflect on the recommendations of the study. It is expected that findings from the study will be used by Malawi government for reference on development of comprehensive national NCDI /Diabetes policy.
- ItemRestrictedAssessing the change in bleeding rates and related clinical outcomes in haemophilia patients before and after introducing Humanitarian Aid factor concentrates in Malawi(Kamuzu University of Health Sciences, 2022-08-05) Mkwenembere, FrancisType of study This study will be a retrospective cohort that will use existing de-identified data from the WBDR to be obtained from an observational study of a larger COMREC approved haemophilia cohort study titled “Health-related quality of life in haemophilia patients in Malawi” (P.02/19/2612) which is being conducted by the Society of Haemophilia and Allied Disorders (SHAD). Study problem There is data paucity on haemophilia in Malawi. Literature review showed that many research studies were done in high income countries that mostly focused on comparison of treatment modalities of prophylaxis and on demand. The Malawi NCDI Commission 2018 Report lacked representation of haemophilia disease suggesting limited data of haemophilia research in Malawi. Objectives This study aims at assessing the change in bleeding rates and related clinical outcomes in haemophilia patients before and after introducing clotting factor concentrates in Malawi. Specifically, it will assess the change of annual bleeding rates before and after clotting factor concentrates, compare the quality of life before and after exposure of factor clotting factor concentrates and estimate the difference regarding days lost to work or school before and after clotting concentrates Methodology Data will be analysed using Stata 15 and continuous variables will be summarised either using Mean/Standard deviation or median/interquartile range depending on the normality. Wilcoxon Rank Sum Test will be used for comparison with a p-value of <0.05 considered statistically significant. Expected findings The study is expected to reveal any difference in bleeding rates, quality of life and improved clinical outcomes between the time prior and after the introduction of use of factor concentrates in Malawi. Dissemination Results will be shared with COMREC, Kamuzu University of Health Sciences, WFH, SHAD, and Ministry of Health through the Department of Non-Communicable Diseases. The results will also be disseminated through various symposia and will be submitted for publication in peer-reviewed journals.
- ItemRestrictedAssessing the extent of hypertension screening and management among people living with HIV in selected antiretroviral therapy clinics in Blantyre(2022-05-12) Black, Myson; Khuluza, Chana; Banda, Mantz Antonio; Chitsakamile, MadalitsoHypertension is one of the non-communicable diseases causing significant morbidity and mortality all over the world. The factors leading to hypertension are numerous and one of the important predisposing factors includes advanced age. Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease (CVD). In developing countries like Malawi where HIV/AIDS related deaths have declined due to antiretroviral therapy, the prevalence of hypertension in people living with HIV has increased over the years prompting the health systems to respond by development of policies that addresses this trend. Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV care programs is recommended in Malawi, though, uptake has been limited. Screening PLHIV for HTN and retention and control of those diagnosed would facilitate leverage the successes of HIV programs. This study will be an analytical cross sectional study to assess the extent of hypertension screening and management in people living with HIV in selected ART clinics in Blantyre. Objectives The study objectives are to evaluate the proportion of people living with HIV on ART screened for hypertension in ART clinics; to identify the challenges associated with screening of HTN in ART patients Methodology The study will employ quantitative methods by collecting structured data using face to face interviews and a structured questionnaire. Both the ART providers as well as the clients will be interviewed. Expected findings We expect to find the challenges affecting the hypertension screening, the extent of screening for hypertension and evaluate the reasons for inadequate or lack of screening. Dissemination The study results will be disseminated to stakeholders such as individual health facilities using the DHSS. The University will be given a copy of the results for library use and one copy will be given to the department of Public health.12-May-2022 9 These findings will inform policy makers on the progress of the implementation of the hypertension screening policy for ART clients. It will show the need to practically conduct a comprehensive study to ascertain the operationalization of the guidelines stipulated in the 2016 guidelines for management of HIV in adults and children.
- ItemRestrictedAssessing the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital, Mzuzu(Kamuzu University of Health Sciences, 2020-09-02) Chikopa, FrynessThe topic of the study is to assess the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital. This will help health professionals to design interventions that will help to address the needs of the caregivers resulting into improved quality care to older clients. PROBLEM Currently, in Malawi there is scarcity of data on studies conducted on psychological, social and economic impact of caregiving on caregivers of mentally challenged patients who are also older persons above 60 years of age. A number of caregivers are affected psychologically, socially and economically due to their role of caregiving this affects quality of care and little is done in managing these effects. Hence the study will help to identify psychological, social and economic challenges that affect the care givers which can inform the development of appropriate strategies. OBJECTIVES The objectives will include; describing the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients, describing how the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients affects the quality of care of mentally challenged older patients and documenting recommendations to 02-Sep-2019 7 address psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients. TYPE OF STUDY This is a descriptive qualitative study design. METHODOLOGY The study will be conducted at St John of God Hospital in Mzuzu city. Purposive sampling will be used to select respondents. About 30 caregivers and 10 health care workers will be interviewed. However, the actual sample will depend on the saturation point: a point at which no new information is emerging from the data. The researcher will use in depth interviews. These will be administered to the caregiver and the health care workers who interact with caregivers of the older clients. The questionnaire/ topic guide will have three parts namely; demographic data of the care givers and questions assessing psychosocial and economic impact of caregiving on caregivers and how such impact affects the quality of care provided by caregivers. The other part of the topic guide will assess the health care workers perceptions of the psychosocial and economic impact of caregiving on caregivers. All interviews will be audio recorded. Study population will consists of two groups. First are caregivers of the patients who are aged 60 years and above. The second group will be health care workers who interact with the caregivers in order to assess the health workers perceptions of the psycho-social and economic impact of caregiving on the caregivers. Thematic data analysis will be used. The data will be analysed aided by a computer package called NVIVO 12. Descriptive statistics will be computed and reported for social demographic data. 02-Sep-2019 8 The study limitations will include bias as the study will be conducted at a hospital setting and therefore some participants may not be free to express themselves. Some caregivers may also feel coerced to participate. EXPECTED FINDINGS There will be psychosocial and economic impact of caregiving on caregivers of a mentally challenged older patients accessing services at St John of God hospital. DISSEMINATION Findings of the study will be shared during journal club meetings at St John of God and research conferences. The results will also be shared to COMREC. An article based on the findings will also be published in a peer –reviewed journal.
- ItemRestrictedAssessing Women’s Perception towards Cervical Cancer Screening at Mponela Rural Hospital, Dowa(2023-01-11) Kawale Chiphangwi, FlorenceSTUDY DESIGN: This will be descriptive qualitative research study, assessing women’s perception towards cervical cancer screening at Mponela rural hospital. INTRODUCTION/BACKGROUND: Cervical cancer is listed among the top gynaecologic cancers worldwide. It is ranked fourteenth among all cancers and fourth-ranked cancer among women worldwide. It is estimated that 85% of all cervical cancer deaths occur in developing countries. Malawi has the highest cervical cancer mortality rate in the world with 51.5 death per 100. 000 deaths per year. This is seven times the global rate, and double the rate in Eastern Africa. A call for cervical cancer elimination has been made and Malawi has adopted cervical cancer elimination strategies, which among them is cervical cancer screening. PROBLEM STATEMENT: Despite the available cervical cancer screening strategies that have been put in place in Malawi, and specifically Mponela Rural Hospital, cervical cancer screening rate still remains low. Currently only 4% of women in Mponela have accessed cervical cancer screening, against the 80% national target for cervical cancer screening. No studies have been done to establish the communities’ perceptions of cervical cancer and cervical cancer screening at Mponela Rural Hospital. Therefore the aim of this study is to assess the women’s perceptions towards cervical cancer screening STUDY OBJECTIVES: This study aims at assessing the women’s perceptions towards cervical cancer screening at Mponela Rural Hospital. SPECIFIC OBECTIVES 1. To assess women’s knowledge on cervical cancer 2. To explore women’s belief towards cervical cancer screening 3. To assess the barriers and facilitators to cervical cancer screening 4. To identify strategies that can promote cervical cancer screening METHODOLOGY: A descriptive qualitative research design using in-depth interviews to 30 women aged between 25 and 64 years of age who have never undergone cervical cancer screening at Mponela Rural Hospital. Eligible women waiting for other services, and have never had cervical cancer screening will be selected purposefully. In-depth interview will be done using a semi structured thematic interview guide to deeply explore women’s perceptions on cervical cancer screening. The instrument will be tested at Mtengowanthenga Mission Hospital, and trustworthiness of the instrument will be determined. EXPECTED FINDINGS: It is expected that women’s perceptions on cervical cancer screening at Mponela Rural Hospital will be identified. This will help in establishing policies and strategies that can help in increasing the uptake of cervical cancer screening. ETHICAL CONSIDERATION: Prior to starting the study, approval of the study will be sought from College of Medicine Research and Ethics Committee and permission will be obtained from Dowa District Health Office research committee. Explanation about the search study will be explained to the eligible women, and informed consent will be sought. DATA ANALYSIS: Thematic data analysis will be used to describe and interpret the data, as well as to select code and construct themes. DISSEMINATION OF THE RESULTS: The results will be disseminated to College of Medicine Research and Ethics Committee, Kamuzu University for Health Sciences, Dowa District Health research committee as well as publishing in a nursing journal
- ItemRestrictedAssessment of lipid profile patterns of diabetic patients at Kamuzu Central Hospital(Kamuzu University of Health Sciences, 2021-03-04) Filisa, Florence AnnaStudy type: This is a descriptive cross-sectional study assessing lipid profile patterns of diabetic patients at Kamuzu Central Hospital. The problem: The burden of diabetes continues to increase globally and in Malawi with a prevalence of 9.3 and 5.6% respectively. Diabetes is a known high risk factor for Atherosclerotic cardiovascular disease ASCVD. The elevated risk of ASCVD in diabetic patients is a product of lipid abnormalities (dyslipidaemias) typical in people with diabetes. Insulin resistance in diabetes has been shown to contribute to the pathophysiology of dyslipidaemia in diabetes. Dyslipidaemia is a modifiable risk factor for ASCVD and can be managed by lowering the lipid blood levels through low lipid diet, exercises and statin therapy, thereby reducing the risk for developing adverse complications such as stroke in diabetics. The screening and monitoring of dyslipidaemia is recommended for people with diabetes to assess the risk and manage the condition effectively. Assessment of lipid profile patterns and its relationship to other risk factors to ASCVD can help suggest individual specific management of diabetic dyslipidaemia. The individualised patient management approach ensures success in patient lipid control. This would in turn reduce the ASCV-related morbidity and mortality in diabetic patients. Despite the recommendations, Malawi is still lagging behind in lipid profile screening and monitoring for diabetic patients. This may be due to various health system challenges that hinder availability and consistent provision of this essential service. Current clinical practice at Kamuzu Central hospital includes a 10mg/day prescription of statin to all diabetes patients. This is done without a lipid test, despite the facility having these tests available. Underutilization of these relevant tests by the diabetic clinic requires further investigation. Furthermore, due to the limited lipid profile data in Malawi, the study aims to assess the lipid patterns and related risk factors associated with dyslipidaemia among patients being treated for diabetes at Kamuzu Central Hospital. Study objectives: The main aim of the study is to describe the prevalence, biochemical characteristic and risk factors associated with dyslipidemia in diabetic patients aged 18-72 years attending the diabetic clinic at KCH. The specific objectives are to 1. Determine lipid profiles of the adult diabetic participants attending the diabetic clinic. 2. Calculate the prevalence of dyslipidemia in the study participants using HbA1c. 3. Determine blood HbA1c levels of study participants. 4. Determine the relationship between dyslipidemia and other variables such as age, sex, body mass index and HbA1c. Methodology: This will be a descriptive cross-sectional quantitative study. The study population will be diabetic patients aged 18-72years attending the KCH diabetic clinic. The sample size will be 388 participants. The sample size was calculated using the Conchran formula, based on an expected prevalence of dyslipidaemia of 40% in this patient population, with a power of 80% and 5% standard error and 5% attrition). A self-developed data collection tool (attached in Appedix) will be used to collect participant information including socio-demographic data (age and sex), information on cardiovascular risk factor such as smoking and alcohol consumption, and medication history will also be collected. We will perform anthropometric measures and collect vital signs. Weight and height scales will be used to obtain participants weight (kg) and height (m) readings. These readings will be documented on the same self-developed data collection too. BMI will be calculated using the weight and height readings using the formula: weight divide by square root of the height. Two blood samples will be collected, one in EDTA tube for HBA1c tests and another in red topped plane tubes for biochemical lipid profile testing. Whole blood will be used to measure HBA1c using the NycoCard. Serum will be used to measure lipid levels. Results will be captured in the data tool developed as well. Data will then be entered in Microsoft Excel sheet. SPSS and Stata will be used for data analysis. Descriptive statistics will be presented in a table to describe the general characteristics of the participants. Chi square test and Fischers test will be used analyse categorical and independent variables respectively. Stratification of data will be applied to handle confounders such as smoking and age. The t-test will be used to test the differences between two means. Correlations between the variables will be tested using Pearson‟s Product or Spearman‟s test of correlation depending on data normality. In all cases, a pvalue ≤0.05 will be considered significant. Possible Constraints A possible constraint to this study could be Covid-19 pandemic. Due to the special risk this pandemic has on individuals with diabetes, we assumed patient turnout at the clinics would decline. However, at KCH, the patient turnout at the clinic has not been significantly affected. So, we envisage that enrolling patients in the study will not be affected. During the study activities, we will ensure that all Covd-19 preventive measures are strictly adhered to throughout the course of the study. Clinic staff will monitor and ensure social distancing, wearing of masks as well as hand washing for clinic staff and patients. Nurses will hand sanitize before and after attending to each patient to ensure a Covid-19 safety for our clinic patients. Expected Findings and Dissemination: The results will aid in providing information on whether maintenance of the 10mg/day statin therapy for all diabetics being practiced at KCH is justifiable and adequate or there should be adjusted based on individual patient lipid results and additional risk factors. The results once analysed will subsequently be published in an international scientific journal and copies will be presented to the following: The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, The Health Sciences Research Committee (through the COMREC Secretariat), The University Research and Publication Committee (URPC) (through the COMREC Secretariat). Results will also be presented to KCH during monthly ground rounds. A copy will also be shared with the Malawi Ministry of Health NCD commission.
- ItemRestrictedAssessment of prevalence and predictive factors of perceived Stigma among clients with mental illness attending mental health clinics in Lilongwe district(Kamuzu University of Health Sciences, 2022-08-17) Angasi, EmmaThis study will be a cross-sectional, quantitative and descriptive design that will assess the prevalence and predictive factors of perceived stigma among clients with mental illness attending mental health clinics in Lilongwe district. Problem Statement Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves (Tesfaw et al., 2020). This can be manifested by decreased self-esteem and increased depression and a person with internalized stigma may feel shame and embarrassment about having mental illness (Latalova et al., 2014). This can impact on how mental health service users utilize mental health service (Mascayano et al., 2020). However, the magnitude of perceived stigma among clients who attend outreach mental health services in Lilongwe is not known. Intervention of perceived stigma among mental health service users can be possible and meaningful when factors that contribute to the perceived stigma are known. In the case of Lilongwe health office, it is not known which factors are associated with perceived stigma among mental health service users. Studies done in Africa, such as Ethiopia have explored the prevalence of perceived stigma but factors such as medical or clinical have not been explored. Furthermore, more studies have been conducted on different population rather than clients themselves to explore the magnitude of perceived stigma (Bifftu & Dachew, 2014). This study therefore assesses the prevalence and predictive factors of perceived stigma among clients with mental illness accessing mental health services at mental health clinics in Lilongwe. Objectives of the study Broad objectives of the study The broad objective of this study is to assess the prevalence and predictive factors of perceived stigma among clients with mental illness attending mental health clinics, Lilongwe district. Specific objectives of the study The specific objectives of the study are to; 1. Measure the prevalence of perceived stigma among clients with mental illness in Mental health clinics in Lilongwe 2. Determine social factors associated with perceived stigma among illness in mental health clinics in Lilongwe 3. Determine clinical/medical factors associated with perceived stigma among clients with mental illness in Mental health clinics in Lilongwe Methodology This study will use mental health clinics which are, facility based (1) and mobile outreach clinics (5), quantitative cross-sectional study using systematic random sampling technique in assessing the prevalence and predictive factors of perceived stigma. Data collection will be conducted for two months with a sample size of two hundred and sixty-one (261). Data will be collected by the Principal Investigator and the research assistants with the use of adopted data collection questionnaire developed in English version and translated into Chichewa version. Data will be analyzed by use of statistical package of social sciences version 22. Expected Findings The study will document the prevalence of perceived stigma and predictive social, clinical/medical factors associated with perceived stigma. Dissemination of Findings The report of this study will be submitted to Lilongwe District Health Office, Kamuzu University of Health Sciences (KUHeS), College of Medicine Research and Ethics Committee (COMREC), Ministry of Health, Non-Communicable Diseases and Mental Health department. The findings will be published in reputable peer reviewed journals and presented at conferences
- ItemRestrictedAssessment of quality of life among patients with type II diabetes mellitus at Kamuzu Central Hospital in Lilongwe, Malawi(Kamuzu University of Health Sciences, 2021-01-13) Chisalunda, Alinafe VenancioStudy type This is a convergent mixed methods study with both quantitative and qualitative methods. Quantitatively, a cross section descriptive study design will be employed. For qualitative data, a phenomenological approach will be used The Problem to be studied Diabetes mellitus is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Unfortunately, Majority of guidelines on diabetes care focus on the medical aspects of initial management without addressing other needs e.g. psychological well-being. This results in poor outcomes in diabetes patient management and hence poor quality of life. Current studies have found that health related quality of life is instrumental to the delivery of care and it is recognized as being an inclusive term that assesses both self-reported mental and physical functioning of an individual. However health related quality of life assessment is not incorporated in diabetes management in Malawi. Furthermore, no study on assessment of quality of life among type II diabetes mellitus patients has been conducted in Malawi. Objectives The main objective of this study is to assess the quality of life among patients with type II diabetes mellitus receiving treatment at Kamuzu Central Hospital in Lilongwe, Malawi. The specific objectives are to describe physical, psychological and social challenges faced by patients with type II diabetes mellitus and to determine ways of addressing the challenges to improve quality of life. Methodology This will be a convergent mixed methods study in which both qualitative and quantitative data will be collected. Quantitatively, cross section design will be employed and data will be collected using the Modified Diabetes Quality of Life (MDQoL) -17 questionnaire. Phenomenological approach will be used for qualitative data and will be collected through in-depth interviews with patients and guardians using an interview guide. The interviews will be tape recorded. Diary method and emotional mapping will also be used to capture qualitative data. Demographic characteristics for example age and gender will be collected as well as duration of diabetes history, body weight and presence or absence of complications. The common diabetes complications are; nephropathy, retinopathy, erectile dysfunction, peripheral neuropathy, heart problems for example coronary artery disease, myocardial infarction, congestive heart failure and peripheral vascular disease. These variables will be collected using a demographic data form. Quality of life values as given by the MDQoL-17 questionnaire will also be collected. This questionnaire has 17 diabetic specific questions that are classified into 8 concepts. These concepts are; physical, social functioning, role limitations due to personal and emotional problems, psychological impact, energy/fatigue, bodily pain and general health perceptions. After data collection, STATA software will be used for analysis. Furthermore, multiple regression model will be employed to draw conclusions from the quantitative data. Analysis for qualitative data will be done manually using thematic content analysis. Expected findings and dissemination It is expected that the results of this study will reveal: physical, psychological and social challenges that diabetes patients encounter. It will further identify precipitating factors to these problems and come up with evidence-based policies to help solve the problems. Furthermore, the results will act as an eye opener to incorporate health related quality of life assessment in diabetes management. Results from this study will be disseminated at College of Medicine Research Ethics Committee (COMREC), at the students’ research dissemination conference in the health systems and policy department at College of Medicine, College of Medicine Research Dissemination Conference, and Kamuzu Central hospital as well as published in the Malawi Medical Journal (MMJ). A copy of the dissertation will also be submitted to College of Medicine’s Library.
- ItemRestrictedAssociation between knowledge and adoption of healthy living practices among hypertensive patients at Queen Elizabeth Central Hospital(Kamuzu University of Health Sciences, 2020-11-11) Kakowa, Zinenani; Matsimbe, Thokozani; Kankhuni, MaranathaHypertension remains the most rapidly rising cardiovascular disease in Africa. It is a highly prevalent Non-Communicable Disease (NCD) in Malawi with nearly a third of 25-to-64-year-olds having raised blood pressure or taking antihypertensive medication. Lifestyle modification is the first step in hypertension management. The high prevalence of hypertension calls for implementation of healthy living practices. In Malawi there is limited or no data on the knowledge and practice of healthy living practices among hypertensive patients hence this study. Therefore, this study will focus on the association between knowledge and adoption of healthy living practices among hypertensive patients at QECH. The chief objective is to assess the association between knowledge and adoption of healthy living practices amongst hypertensive patients. This study is necessary because it will enlighten the Ministry of Health on how many hypertensive patients are aware and adopt healthy living practices. Depending on the percentage of those who are aware and those who are not, the Ministry will be able to put in place interventions that will educate people on the healthy living practices hence managing and preventing hypertension. This will be a cross sectional descriptive study and will use mixed methods, both quantitative and qualitative. The study will be conducted at QECH in Blantyre, Malawi as captioned in the title. The study participants will be any patient within the age range of 25 to 64 years old admitted in the medical ward but has hypertension and those hypertensive patients coming to the general clinic. Convenience sampling method will be used to identify possible study participants and 126 participants are expected to be enrolled. The study participants will be only those hypertensive patients that are found at the hospital at that particular time. Data will be collected by doing indepth interviews with the study participants using an interview guide and the data will be analyzed using Epi-info. It is expected that not all the hypertensive patients that are aware of the healthy living practices adopt them, some are aware and adopt the healthy living practices and some who are not aware at all. All ethical regulations will be followed to ensure that the information assembled in this study is acceptable and probable limitations of this study will be managed to ensure that the data is precise. Finally, the data collected from this study will be presented at the CoMREC research dissemination.
- ItemRestrictedBarriers and facilitators for screening for anxiety and depression among children and young people attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital, Malawi(Kamuzu University of Health Sciences, 2022-05-12) Makiyi, PreciousType of Study: A qualitative study Problem: Despite the high prevalence of depression and anxiety among children and young people with epilepsy, screening for these mental disorders in CYP with epilepsy is not routinely done in most health facilities in Malawi. Objectives: Broad objective The broad objective of the study is to assess the barriers and facilitators for implementation of routine and universal screening for anxiety and depression among children and young people (CYP) attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital. Specific objectives The specific objectives of the study are: 1. To assess the acceptability of screening for depression and anxiety among CYP with epilepsy and their guardians. 2. To explore the individual and institutional barriers and facilitators for screening for depression and anxiety among CYP with epilepsy. 3. To explore the views of patients and their carers, and clinical staff (including doctors, nurses and counsellors working in the epilepsy clinic) regarding the following commonly used and free-of-cost screening instruments for anxiety and depression in CYP: Revised Child Anxiety and Depression Scale (RCADS) (8-18 years), Short Mood and Feelings Questionnaire (SMFQ) (8-18 years), Hospital Anxiety and Depression Scale (HADS) (from 12 years), Beck Depression Inventory (from 14 year), Beck Anxiety Inventory (from 14 years), and Patient Health Questionnaire (PHQ-9) (from 13 years). In addition, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) would be discussed with participants. Although the NDDI-E) has only been validated in adults, we will consider its potential utility because it is specific for patients with epilepsy, short, and free of charge. Methodology: This study shall adopt qualitative research design involving Focus Group Discussions as well as In-depth Interviews with key stakeholders including CYP with epilepsy and their guardians, epilepsy and psychiatric nurses, a pediatrician, a psychiatrist, a hospital administrator, and staff of the Ministry of Health (director of non-communicable diseases (NCD) or his/her representative”). Expected Findings: Based on previous studies of barriers and facilitators of screening for mental health conditions in other Low and Middle Income Countries (LMICs), we hypothesize that the barriers may include mental health stigma, lack of appropriate culturally adapted screening instruments, limited training for clinicians about screening, limited time available for clinicians to conduct the screening in addition to their existing workload, and limited opportunity for subsequent mental health assessment and treatment for the CYP identified from the screening 12-May-2022 19 | P a g e Makiyi, Ani, Udedi, and Matanje; Barriers and Facilitators for depression screening among CYP with epilepsy. Protocol version 3- May, 2022 as requiring further support. We hypothesize that facilitators may include strong institutional support for screening. Dissemination of results plan: The findings will be shared with the COMREC, SHARP Program Coordinator, QECH, Ministry of Health, all participants, presented as relevant academic conferences, and published in peer reviewed journals.
- ItemRestrictedBurden of chronic disease comorbidities among cancer patients attending oncology services at Queen Elizabeth and Kamuzu Central hospitals in Malawi(Kamuzu University of Health Sciences, 2020-10-16) Chiwanda, JonathanProblem to be studied: This doctoral study is focusing on estimating burden of chronic diseases among cancer patients. In Malawi, cancers are increasingly contributing to high burden of diseases. There is also high burden of other chronic diseases, however, there is no available data on prevalence of specific comorbidities among cancer patients. Therefore, understanding the prevalence of chronic disease comorbidities among cancer patients will help in developing appropriate interventions for prevention, management and treatment of comorbidities with the aim of improving quality of life and survival. Type of study: The project has two study designs; cross-sectional and Randomized Control Trial (RCT) components at different phases. Broad objective/ aim: 1. Explore common chronic comorbid conditions among cancer patients at two main referral hospitals of Queen Elizabeth and Kamuzu Central. Objectives Phase one 1. To estimate prevalence of chronic disease comorbidities among cancer patients. 2. To compare prevalence of comorbidities across gender, age and urban versus rural settings among cancer patients. 3. To identify factors associated with disease comorbidities among cancer patients 4. To compare quality of life among cancer patients with chronic disease comorbidities to those without comorbidities. Phase two 5. To compare quality of life among cancer patients with chronic disease comorbidities between the intervention and control groups. 6. To estimate survival among cancer patients with comorbidities Methodology: The study has two phases. The initial phase which is formative will use a crosssectional study design to estimate the prevalence of comorbidities among cancer patients presenting at Queen Elizabeth and Kamuzu Central Hospitals. The sample size will be a minimum of one hundred and ten. This will be followed by a single-blinded randomized control trial involving delivery of SMS alerts delivery to participants. The study will have two arms namely; intervention and control. Individual participants from the intervention arm will know about their receiving of SMS alerts but they will not be given information about whether everyone is getting similar messages. The end line will measure the effectiveness of the intervention (use of SMS alerts) in terms of improving quality of life and estimate survival. Ethical Consideration: The permission to conduct the study will be sought from Kamuzu Central Hospital (KCH) and Queen Elizabeth Central Hospital (QECH). Ethics approval will be sought from the College of Medicine Research Ethics Committee (COMREC). Expected findings: We expect to have high burden of chronic diseases among cancer patients due to direct proportionality of high burden of cancers and other chronic diseases in Malawi. Results dissemination: All results will be disseminated through research dissemination conferences both at College of Medicine and other available international symposia. Copies of the findings will be shared with COMREC, QECH, KCH and Ministry of Health Headquarters.
- ItemRestrictedClinical qharacteristics, quality of care and outcomes of patients presenting with diabetes ketoacidosis at Kamuzu Central Hospital(Kamuzu University of Health Sciences, 2021-11-11) Mwabutwa, EmmanuelType of Research This will be a cross-sectional study. Problem Diabetes Ketoacidosis is a serious and life threatening complication of diabetes. There is need to understand the clinical characteristics, in-hospital management quality and patient outcomes in view of the increasing numbers of patients being diagnosed and admitted with diabetes at Kamuzu Central Hospital. Study Objectives Broad objectives The primary objective of this study is to describe the clinical characteristics, precipitating factors, management and outcomes of patients with diabetes ketoacidosis at Kamuzu Central Hospital. Specific objectives To describe the proportion of patients with of suboptimal insulin therapy (poor insulin compliance /storage/technique of injection) as a precipitant to DKA To establish clinical characteristics of patients presenting with DKA To analyze point of care on patients with DKA determine time to resolution of DKA, quality of care and outcomes of patients with DKA Data Collection, management and analysis Patients will be recruited from adult medical wards at Kamuzu Central Hospital. A standard questionnaire will be used to collect data. Health passports, patient case files will be reviewed to gather information on patients’ comorbidities and drugs. Collected data will be entered into an electronic database and statistical analysis will be performed using STATA 15.1 software. Descriptive statistics will be used to summarize frequencies and proportions. Chi squared testing will be used to compare categorical variables and t-testing will be used for continuous variables. Research Ethics A written informed consent will be sought from all study participants and confidentiality will be ensured by the study team by following good clinical practice guidelines. Research ethics approval will be sought from the College of Medicine’s research and ethics committee. Expected findings and dissemination We expect to highlight the common clinical characteristics, quality of in-hospital management and outcomes of patients admitted with diabetes ketoacidosis at Kamuzu Central Hospital.
- ItemRestrictedComorbidity of depression with diabetes in noncommunicable diseases clinics in southern Malawi(Kamuzu University of Health Sciences, 2021-03-17) Udedi, Micheal MphatsoType of study: Cross-sectional study design will be used in this project. Problem: This research project will focus on prevalence and detection of depression in the context of non-communicable diseases. Malawi, like many low- and middle income countries, is faced with the growing challenge of non-communicable diseases (NCDs). Depression is one of the shared risk factors for physical NCDs however there is currently no routine practice to identify and manage mental illnesses in the physical NCDs clinics in Malawi. Broad Objective: We aim at estimating the prevalence of depression among patients with type 2 diabetes mellitus attending to NCDs clinics in the two districts of southern Malawi. Methodology: The project will be a cross sectional study and will involve validated Chichewa version of the PHQ-9. A minimum calculated sample size of 323 participants will be recruited consecutively at the NCDs clinics of Mwanza and Blantyre districts. The permission to conduct the study has been sought from the heads of the facilities where the study will be conducted. The ethical approval will be sought from the College of Medicine Review and Ethics Committee (COMREC) and informed consent will be sought from the study participants before administering the questionnaire. All filled questionnaires will be handled by the research assistants and the PI and will be kept in a safe place before and after data entry. The computers for data entry will be protected by passwords. Data will be analyzed statistically using a statistical package for social sciences. Patients’ characteristics by age, sex and condition will be described using frequency tables. Expected findings: This study might uncover the prevalence and detection of depression in NCDs clinics in the district of southern Malawi. The findings of this study therefore may be relevant in advocating for the integration of depression management into NCDs clinics in Malawi. Dissemination: The findings from this research project will be accessible by academicians and researchers through the College of Medicine library. Furthermore, the findings will be submitted to the COMREC secretariat, the University Research and Publication Committee (URPC) through COMREC secretariat and the National Health Sciences Research Committee (NHSRC). The results will be shared through presentations at national and international research or policy conferences as well as submission to peer reviewed publications. The results will be shared with the participating health facilities and furthermore the results will also be shared with policy makers and other local stakeholders in form of policy briefs as part of evidence on prevalence and detection of depression in NCD clinics in Malawi.
- ItemRestrictedComprehensive analysis of pathogens, resistomes, and inflammatorymarkers in the cornea(Kamuzu University of Health Sciences, 2022-09-08) Kalua, Khumbo; Misanjo, EstherType of research study This will be a hospital-based, prospective, cross-sectional study which will be conducted at Lions Sight First Eye Hospital, as part of the global collaborative network. Problem to be studied A descriptive study on Pathogens, Resistomes, and Inflammatory-markers in the cornea at Lions sight first eye hospital (LSFEH) in Malawi. Objectives Main objective To identify etiology, antimicrobial resistance (AMR) and local host immune response, and correlate with presentation and outcome. Specific Objectives 1. To identify pathogens causing infectious keratitis in an unbiased manner. 2. To determine the optimal diagnostic technique (stains, cultures, MDS) for corneal ulcers. 3. To determine the effect of seasonality on pathogen profile and visual outcomes. 4. To determine the frequency and richness of AMR in pathogens causing keratitis. 5. To determine AMR genotype and phenotype correlation with clinical outcomes. 6. To determine the host transcriptional signatures for pathogen types. 7. To determine the host transcriptional signatures for clinical outcomes. Methodology The study will enroll all patients aged 1 month and above who will present at LSFEH with a corneal ulcer during the study period. A minimum sample size of 100 patients will be recruited in this study. All patients that will meet inclusion criteria will be administered a questionnaire. They will also undergo comprehensive anterior ocular examination. Ocular tissues sample will be collected from both eyes and will be used for high-throughput sequencing (conjunctival swabs, corneal swabs). High through put sequencing, in theory, should allow for the unbiased detection of any pathogen and biomarkers in a clinical sample. The sample will be stored in a minus 20 freezer up until the analysis is done. Expected findings This is a multicenter study, led by University of California San Francisco UCSFA (USA). It is expected that the spectrum of etiology will vary significantly with geographic location. In addition, seasonality will affect pathogen profile and disease outcomes. It is also expected that AMR will differ by global location and predict clinical outcome. Finally, it is hypothesized that immune signatures can predict pathogen types and clinical outcome. Dissemination The results will be disseminated at College of Medicine Research Ethics Committee (COMREC), hospital director for Queen Elizabeth central hospital (QECH), Malawi National Prevention of Blindness Committee, Ministry of Health (MOH) and brief presentation to clinical and nursing staff of Lions sight first eye hospital (LSFEH).
- ItemRestrictedcritical analysis of hypertension care delivered in Balaka, Machinga, Mchinji and Rumphi Health Care facilities(Kamuzu University of Health Sciences, 2020-11-11) Mbulanje, LuciaProblem: Quality care services play an important role in the prevention, management and control of diseases as far as health promotion is concerned. Availability of resources and guidelines are among other things that contribute to achieve quality. However, despite adopting guidelines that promotes quality and universal access for hypertension care in Malawi, the intervention has not been formally assessed in these districts. Objectives: To explore whether and in what ways is hypertension care delivered in health care facilities consistent with WHO and Malawi guidelines for hypertension management. Specifically, this secondary review will assess health care provider’s qualification and expertise in delivering hypertension care, explore availability of guidelines for the management of hypertension at health facilities, explore the availability of the infrastructure and equipment essential for diagnosing and managing hypertension, explore the availability of drugs for the treatment of hypertension and compare the service delivered with what is stipulated in the guidelines. Methodology: This is a cross sectional study utilizing data from the Malawi Longitudinal Study for Families and Health (MLSFH). This secondary review will look into MLSFH data from 4 districts namely Machinga, Balaka, Mchinji and Rumphi. Data was collected from Health Facility managers of the facilities using interviews guided by a structured questionnaire. Data will be analyzed using STATA version 14 and descriptive statistics will be applied to summarize frequencies and proportions. Expected findings: The study will provide information on the extent the health care system is responding to hypertension management in Malawi. Dissemination: Research findings will be disseminated to COMREC, Rumphi, Mchinji and Balaka district health offices. Further manuscripts will be prepared for submission to appropriate journals.
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