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- ItemRestrictedContinuity of Essential Health Services (CES) study - Exploring effect of COVID-19 on demand for maternal, newborn and child health services in selected districts in Malawi by William Stones(Kamuzu University of Health Sciences, 4-06-21) Stones, WilliamType of Study This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. BACKGROUND RATIONALE Malawi registered its first Covid-19 cases in March 2020. A Presidential Taskforce on Covid -19 was immediately set up and Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. OBJECTIVES The overall study objective is: • To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services. 2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. METHODS The methodology will include focus group discussions (FGDs) and key informant interviews (KIIs), followed by in-depth interviews (IDIs) to capture respondents of vulnerable groups. The data will be collected from Mchinji and Blantyre Districts (indicative locations to be confirmed following consultation) and the study population will include adult pregnant/breastfeeding women, parents/caretakers of children under five years of age, adolescents (15 to 19 years of age, 7 companions/partners of pregnant/breastfeeding women and pregnant/breastfeeding adolescents, community-based health workers, health workers and facility based managers. DATA MANAGEMENT AND ANALYSIS All audio and handwritten data collected from the FGDs and interviews will be stored securely. Electronic notes, transcripts and translations will be stored electronically and protected by a password. Only members of the research team will have access to these documents. As soon as the audio-recordings have been transcribed and verified, they will be destroyed by erasing the voice recordings. Framework analysis will be used for cross-sectional analysis of data from FGDs, IDIs and KIIs. The focus will be on understanding the demand and supply-side barriers to seeking routine and emergency health care services, the extent to which the pandemic has impacted people’s willingness and ability to access MNCH services and how service readiness and provision has changed as a result of COVID- 19 and its effects. A combination of deductive and inductive themes will be included. POSSIBLE CONSTRAINTS COVID-19 situation might require adaptation of study methods using more or only virtual methods for interviews and FDGs; virtual FDGs might be not ideal given that moderators should be physically present to be able to catch the dynamics in the groups and to be able to guide and facilitate appropriately. However, the research teams will only do virtual FDGs in case there is no alternative. RESULTS PRESENTATION Key findings will be presented during a webinar with a UN, participating districts and MoH audience. All data collected, analytical memos and framework analysis files will be de-identified and shared with UNICEF alongside draft reports. The report will also be shared with COMREC. IMPLICATIONS OF THIS STUDY We anticipate that findings from this study will highlight the impact of Covid-19 on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. 1. Background In Malawi, since March 2020 when the first COVID-19 cases were reported, a Presidential Taskforce on Covid -19 was set up with a mixed membership of Public Health Experts, technocrats and members of the Cabinet. Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. In addition, number of passengers in public vehicles were also limited to 2 people per seat only. Between September and December, 2020, the number of COVID-19 cases reduced which may have fuelled non-adherence to COVID prevention measures. Since January, 2021, Malawi has been hit hard by the second wave of COVID-19 which has caused a sharp rise in the numbers of cases and increase in COVID-19 related deaths. The country has been declared a State of Disaster. The Vice President of Malawi has since led the team to develop new guidelines on COVID response and management. Further restrictions have been made to public gatherings now at 50 people only, the wearing of masks has become mandatory in all public places including markets, shops etc. Restrictions have also been made to trading hours in bars and markets. Since the second wave of COVID-19, more people have tested and hospitalized leading to an overburdened health care system. Government has embarked on efforts to increase the number of health care staff, increase treatment centres and lobby for resources (equipment and supplies) especially oxygen cylinders and accessories and COVID-19 testing kits which are in limited supply. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. Given relatively limited health care capacity, particularly for critical care, a “bend the curve” paradigm may be less salient in the region and governments need to balance the threat of COVID-19-specific mortality with the potential secondary impacts of mitigation measures, which may also result in excess mortality. The West Africa Ebola epidemic (2014-16) is instructive as it demonstrated that indirect mortality can exceed the direct mortality of the health emergency. Scenario-based modelling of excess maternal and child mortality due to reduced coverage of essential health and nutrition services suggests that the indirect impact of COVID-19 mitigation measures could result in an increase of 9·8% to 44·7% in under-5 child deaths per month, and an 8·3% to 38·6% increase in maternal deaths per month, across 118 countries1. COVID-19 projections estimate that 15 million additional unintended pregnancies could occur over one year if COVID-related service disruptions affected 10% of women in need of sexual and reproductive health (SRH) services in low- and middle-income countries2. Anecdotal evidence from Kenya, Malawi and Mozambique indicates an increase in adolescent pregnancies since the closure of schools due to COVID-19. Within schools, Malawian adolescents have some access to reproductive health information and counselling, presence of mother-groups to support girls in need of services, peer to peer support. The impact of COVID-19 on the availability and quality of MNCH services and social-economic disruption on access to these services requires investigation. The Pulse survey by WHO in 105 responding countries on continuity of essential health services during the COVID-19 pandemic showed disruptions of essential health services reported by nearly all countries, and more so in lower- 1 Timothy Roberton, DrPH. Emily D Carter, PhD. Victoria B Chou, PhD. Angela R Stegmuller, BS. Bianca D Jackson, MSPH. Yvonne Tam, MHS. et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Articles; Volume 8, ISSUE 7, E901-E908, July 01, 2020 2 Riley T, Sully E, Ahmed Z, Biddlecom A. Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries. Int Perspect Sex Reprod Health. 2020;46:73–6 income than higher-income countries. The majority of service disruptions were partial defined as a change of 5–50% in service provision or use. All services were affected, including essential services for communicable diseases, non-communicable diseases, mental health, reproductive, maternal, newborn, child and adolescent health, and nutrition services. Emergency services were the least disrupted, although 16 countries reported disruptions across all emergency services. The most severely affected service delivery platforms were mobile services, often suspended by government, and campaigns, for example as used for malaria prevention or immunization. The causes of the disruptions were a mix of demand and supply factors. On the demand side, 76% of countries reported reductions in outpatient care attendance. Other factors, such as lockdowns hindering access and financial difficulties during lockdown were also mentioned. On the supply side, the most commonly reported factor was cancellation of elective services (66%). Other factors mentioned included staff redeployment to provide COVID-19 relief, unavailability of services owing to closures of health facilities or health services, and supply-chain difficulties. 2. RATIONALE While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. During 2020, Malawi experienced that health services were downsized or closed to limit the risk of transmission. Shortage of staff was accelerated as frontline healthcare workers fell sick or died in places where there were already too few to provide essential services. Keeping essential health services available and accessible is vital to prevent losing even more lives, whether from malaria, measles, malnutrition or complicated pregnancies. This study study on Continuity of Essential Health Services (CES) aims at contributing to fill the knowledge gap on the demand and supply-side factors exploring barriers to seeking routine and emergency MNCH services. The immediate target groups include pregnant women, women of reproductive age with newborns and children under five years of age including breast-feeding women and adolescent women. In addition, health personnel, both clinical and management, as well as relevant community members will be included in the study. There is a need to understand the extent to which the pandemic has impacted people’s willingness and ability to access (i.e. availability, accessibility, affordability and acceptability) essential MNCH services and experiences of care during the pandemic. Furthermore, this study will also explore the supply side of health service delivery including the perception of health programme managers and health staff on resiliency of the health system and their view on why people are or are not coming in for care and the impact that the pandemic has on quality and the continuation of routine services delivery. The study will have a specific focus on vulnerable populations groups of women of reproductive age, including those living with HIV/AIDS and adolescents, as well as children under five. 3. Objectives of the study The overall study objective is: To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services.2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. Specific research questions: The two main research questions are: (A) What is the influence of demand side factors (intention action/gap drivers, reaching care, and receiving care); (B) what is the influence of supply side factors (providing care). These are further elaborated as below. A. Maternal, newborn and child health: Demand side factors Intention action/gap drivers a. Did the target groups of primary interest (as defined above) during COVID-19 pandemic use essential MNCH services (essential as defined in the national packages of care and provided by skilled personnel) to the same extent (frequency, based on needs/demands) as during non-COVID times? b. What were the main factors / reasons that affected the use of essential MNCH services by the primary target groups during COVID-19 pandemic? What was different to non-COVID times in regard to the topics below? Reaching essential MNCH services a. To what extent and how were the primary target groups able to reach to a health facility / seek essential MNCH services during COVID-19 pandemic compared to non-COVID times? b. What were the main factors/reasons that stopped or made it difficult for the primary target groups to reach essential MNCH care during COVID-19 pandemic compared to non-COVID times? Receiving essential MNCH services when the health facility is reached c. To what extent and why were essential MNCH services not available to the primary target groups when reached? d. What kind of changes were observed or experienced by the primary target groups with regard to the quality of MNCH services provided during COVID-19 pandemic compared to non-COVID times? B. Maternal, newborn and child health: Supply side factors Providing adequate care to the primary target groups according to demand and needs a. To what extent did essential MNCH services become disrupted and/or unavailable during COVD-19? How was the readiness of essential MNCH - to serve the primary target population as needed - affected? b. Which MNCH services were most affected and why? Lessons learned- demand and supply-side The study teams will elaborate based on above raised questions on what were the main lessons learned from the COVID-19 pandemic in regard to demand for, access to and readiness of MNCH services. In addition, the interviews will include a question on what the lessons learned were 11 Health services Health care providers Health care users Community-based health service delivery Referral pathways/linkages between community systems and health systems, and other. 4.3 Target groups of the study The target groups will include specifically: (1) Adult pregnant/breastfeeding women (20 to 49 years) (2) Adolescent pregnant/breastfeeding women (15-19 years) (3) Pregnant/breastfeeding women (15 – 49 years) living with HIV/AIDS (4) Parents/caretakers of children under five years of age including adolescent mothers and fathers (5) Facility based health care workers and health facility managers (6) Community health workers/volunteers and other community-based health agents such as peer mother supporters etc. (7) Sub-national health care managers (district/subcounty, region/county/province) 4. STUDY DESIGN This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. Conceptual Framework The “Governance and Capacity to Manage Resilience of Health Systems” conceptual framework postulates that health systems have three levels of resilience: absorptive capacity, adaptivecapacity and transformative capacity3. This framework is considered relevant as it arose from African experience of the Ebola outbreaks, that presented certain similar challenges to health systems. The absorptive capacity relates to the capacity of a health system to continue to deliver the same level (quantity, quality and equity) of basic healthcare services and protection to populations despite the shock (in this instance the Covid-19 pandemic) using the same level of resources and capacities. Adaptive capacity is the capacity of the health system actors (such as health workers) to deliver the same level of healthcare services with fewer and/ or different resources, which requires making organisational adaptations. Finally, the transformative capacity describes the ability of health system actors to transform the functions and structure of the health system to respond to a changing environment such as adaptations to Covid-19 guidelines and provision of Covid-19 care without compromising other services.
- ItemRestrictedCultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Zomba, Malawi(Kamuzu University of Health Sciencies, 7-07-21) Kip, Esther C.Executive Summary D. Title of the study: Cultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Malawi Problem Statement: In Malawi, a study on depression among adolescents living with HIV (ALHIV) revealed a prevalence rate of 18.9%3. Despite the high prevalence and impact of depression on ALHIV health outcomes, lack of awareness and stigma around mental health services leave ALHIV with depression undetected and there are few culturally, sensitive, standardized, and validated instruments available for depression screening in the African region1,6. The Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) psychosocial screening tool, is an efficacious evidence-based intervention (EBI)8-10 to improve identification of psychosocial issues, such as depression screening and risky behavior. This tool was recommended for use in the adolescent antiretroviral therapy (ART) program called Teen Club (TC) in Malawi in an attempt to identify the above-mentioned challenges. However, its introduction has had poor uptake. Our previous formative study on “Implementation barriers of the HEADSS screening tool in Teen Club Program in two districts in Malawi” found that HEADSS was too long, time consuming and not culturally appropriate to the Malawi setting and some of the suggestions included modification of this tool in order to be culturally acceptable for use in Malawi. Therefore, this current study builds upon our previous findings. Main objective of the study: The long-term goal of this study is to culturally adapt the HEADSS psychosocial screening tool based on our formative work, identify the barriers and facilitators to implementing the modified HEADSS, and identify implementation strategies to address identified barriers to improve the mental health outcomes among ALHIV in Malawi. Specific Objectives are to: 1) Review prior formative study findings and conduct systematic modifications process of the existing HEADSS psychosocial screening tool. 2) Identify the barriers and facilitators to the implementation of the adapted HEADSS among the HCPs in Teen Club program and ALHIV in order to understand the usability and acceptability of the adapted HEADSS screening tool. 3) Based on the findings in objective 2, identify implementation strategies to address the identified barriers to improve the mental health outcomes among ALHIV in Malawi. Methodology: This will be a cross-sectional descriptive qualitative study design and it will take place in Zomba district (Zomba Central Hospital and 1 health center). A purposive sampling approach will be used to select the participants. In-depth interviews (IDIs) using a semi-structured questionnaire will be conducted with key informants (KIs) and health care providers (HCPs) then FGDs with adolescents living with HIV (ALHIV) between 12 and 18 years old. The sample will comprise of 1 clinical psychologist, 1 psychosocial counsellor, 1 Adolescent Coordinators from the NGOs, 1 District Nursing Officer as key informants and 4 HCPs from the Health center and 2 from Zomba Central Hospital Teen Club Program (Lighthouse). A similar proportion of male and female ALHIV will be included in the FGDs from each site, totalling to 20 ALHIV in the 2 sites. An estimated total of 30 research participants will be included in this study. Potential constraints: Not many ALHIV might feel comfortable to speak up, however, our formative study showed that the ALHIV were open and expressed themselves without any problem. The training will be provided to the Research Assistant prior to commencement of data collection, and this will deliver specialized communication skills to enable ALHIV to feel free and speak out on their experiences. Support will be provided to those ALHIV who need to be referred to specialized mental health services and the research team will be trained to ensure that a correct support and referral system is in place before the start of data collection. Some participants may also experience discomfort to respond to the questions, however, they will be informed during the consenting process that they have the right to refuse to answer any question that makes them uncomfortable and to stop the interview at any time. In addition, while the research is aiming to reach an equal number of females and males, it may not be possible be get a gender balanced participation. However, we will communicate these limitations clearly during feedback, recommendation and dissemination activities. Additionally, due to the Covid pandemic, it might be a challenge to get the number of ALHIV on the appointed date as there is limited number of staff and ALHIV assigned for each day. We might even have to do face-to face interviews instead of FGDs depending on how the situation will be during
- ItemRestricted“Factors associated with antiretroviral therapy defaulting among HIV positive youth in Mzimba south, Malawi”. by Isaac Paul Kasalu(Kamuzu University of Health Sciences, 8-10-21) Kasalu, Isaac PaulThetype of research study:The researcher proposes to conduct a case control studyto identify factors associated withAnti-retroviraltherapy(ART)defaulting among the Human ImmunodeficiencyVirus (HIV)positiveyouthsaccessing HIV carein MzimbaSouth Districtof Malawi. The problem:There is evidence thatART defaulting is highest amongHIV positiveyouth in Malawi. Studies conducted in someparts ofMalawiindicatethatbetween 11 and 30 per 100HIV positiveyouthsdefault ART. ART defaulting has been associated with development ofdrug resistance in individuals enrolled onART. This could lead to increased morbidity and mortality of HIV positive clients due toresurgence ofopportunistic infections. In addition,an ARTresistant strain of HIVcan be transmitted from one patient taking ARVs to anotherthrough unprotected sexual intercourse.Evidencesuggeststhat physical, psychological,socialeconomic,demographic and health facilityfactors can contribute to ART defaulting.Nevertheless,there is scarcity of reportedevidence regarding specific factorsthat contribute to ART defaulting among the youth in Mzimba.Thisstudy therefore,aims atassessingfactorsinfluencingARTdefaulting in HIV positive youth enrolled onARTinMzimba. Objectives:The main objective of this study is to determine factors contributing to defaulting amongHIV positive youth enrolled on antiretroviral therapy in Mzimba South District.Specific objectives are:to determine prevalence of ART defaulting among the youth living with HIV in Mzimba South district;to assess patient (physical, psychological) related factors influencing ART defaulting among the youth in Mzimba South;to assess availability of communitysocial support initiativesfor youth on ART program;to identify healthfacilityinitiativesfor youths accessing HIV care in Mzimba Southand to identify risk factors for ART defaulting among the youth accessing HIV carein Mzimba South District. Methodology:Thisstudy will utilizeaquantitative,case control design.A sample population of 411HIV positive youth(137cases and274controls) attendingan HIV careclinic will be recruited. BothART defaulters and non-defaulterswill beenrolledinthis studyusing stratified random sampling technique.Data will be collected using astructured questionnaire.Datawill be analyzed using the Statistical Package for Social Scientists (SPSS)version 20.0.Chi-squareandbinary logistic regression will be carried out to establish relationship between ART defaulting and the independent variables. Expected findings anddissemination:It is expected thatthis study will identify specific factors that contribute to defaulting of treatment among the youth livingwith HIVandAIDSin Mzimba South.Findingsfrom this studywill be disseminated to the health facility management and care providers in respective facilities where the study will be conducted.Furthermore, resultswill be shared to the District ExecutiveCommittee (DEC)for M’mbelwa council, Kamuzu College of Nursing,College of medicine research and ethics committee (COMREC)and other research seminars. The manuscripts shall also be prepared for publication.
- ItemRestrictedPrevalence of asymptomatic SARS-CoV-2 infection among returnees from South Africa at Mwanza Border(Kamuzu University of Health Sciences, 10-03-22) Kenneth, Owen Ajassie ZacchaeusSARS-CoV-2 which has spread rapidly throughout the world can present as symptomatic or asymptomatic infection. Literature shows that asymptomatic individuals play a significant role in the ongoing pandemic, but their relative number and effect have been uncertain. In Malawi, there are no reliable estimates of the true burden of imported asymptomatic SARS-CoV-2 cases published. Malawi’s mainland testing algorithm for MoH priotises those with symptoms, thereby maximizing the risk for silent spread by asymptomatic persons. It is thus imperative that testing programs include those without symptoms. Under travel restrictions, Mwanza border, the main border for most returnees from SA (a high risk nation), remained the only border which was open during the partial border lockdown and SARS-CoV-2 testing was conducted in all the returnees irrespective of symptoms. With the information above, a retrospective study will be conducted to estimate the burden of asymptomatic SARS-CoV-2 infection where 350 cases will be employed as participants. Stratified sampling will be used to recruit the participants. The design has both quantitative and qualitative aspects The quantitative aspect will involve reviewing existing case-based records of returnees who presented at Mwanza border The qualitative aspect will involve administering of questionnaires to health-care workers at the border to find out how they managed the cases. No patient names will be mentioned in any of our data collection tools for complete privacy. Data analysis will be done both manually and electronically using SPSS. The aim of the study is to review and provide the available evidence on asymptomatic SARS-CoV-2 infection among returnees from SA at Mwanza Border. In this study we are going assess the prevalence of SARS-CoV-2 infection among the returnees at Mwanza border as our main objective and specific objectives as follows: to assess clinical and demographic characteristics of the returnees with asymptomatic SARS-CoV-2 infection, to develop an understanding on how returnees with SARS-CoV-2 were managed according to the standard management protocol, to compare the proportion of asymptomatic cases to symptomatic cases and to assess the association between demographic characteristics and SARS-CoV-2 status stratified by symptom status. We expect to find a high prevalence of asymptomatic SARS-CoV-2 infection among the returnees as testing was carried out on the returnees regardless of symptom presentation and the returnees were coming from a high risk nation. A report of the findings will be handed in to COMREC, Kuhes library and other relevant institutions. Findings from this study will have potential role to inform policy-makers and stake holders to devise, review and enforce measures and policies to effectively combat the pandemic, will help in laying a foundation for future studies, and the data collected will help us estimate the magnitude of the problem at Mwanza Border so that with our recommendations together, we can somehow help improve the quality of health-care services.
- ItemRestrictedThe effect of pulmonary rehabilitation on cardio-respiratory function of patients with chronic lung diseases identified during chest X-ray screening for pulmonary tuberculosis(Kamuzu University of Health Sciences, 11-03-22) Gwelama, PreciousType of Research Study This study will use an Experimental Study-it is a Randomized Controlled Trial (RCT) with 1:1 allocation to assess The Effect of Pulmonary Rehabilitation (PR) on Cardio-Respiratory Function of Patients with Pulmonary Tuberculosis in Blantyre. Problem to be studied The prevalence of Chronic Lung Diseases (CLDs) is high in patients undergoing Tuberculosis (TB) screening mostly due to previous pulmonary infections including pulmonary Tuberculosis (pTB). In order to prevent progressive loss of pulmonary function in these patients, interventions that prevent CLDs need to be employed. The National Tuberculosis Control Program (NTP) in Malawi does not have established guidelines in the management of pTB to prevent CLDs. Previous TB infection usually causes lung damage and post pTB survivors frequently present with persistent respiratory symptoms which clinically present as CLDs. Even though PR has shown to be effective in the management of CLDs by improving respiratory symptoms, physical function and health related quality of life (HRQoL), there is still limited evidence on the effect of PR during TB treatment. Furthermore the few studies performed so far with regard to PR in TB sequelae have confirmed the same positive results as those that are found with PR use in CLDs. Objectives Broad objective To compare the effect of PR (breathing exercises, strengthening and aerobic training PR techniques used in chronic lung diseases) at 6 weeks of treatment with no PR in the management of patients with TB. Specific objectives 1. To compare changes in spirometry Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) values in Litres (L) between participants receiving PR with those not receiving PR. 2. To assess the effect of PR on exercise tolerance in participants receiving PR in comparison to those not receiving PR. 3. To compare respiratory symptoms improvement of pTB between participants receiving PR with participants not receiving PR. Methodology This study will be conducted from 1st March to 31st May 2022 at the physiotherapy clinics based at Queen Elizabeth Central Hospital (QECH), Kamuzu University of Health Sciences (KUHES), and private practitioners in Blantyre. The study participants who will be selected will include a total of 240 participants. These participants will include pTB patients (≥18 years) who have initiated TB treatment with known HIV status from Blantyre District. Data on spirometry, physical function and HRQOL will be collected. Study Participants will then be randomly assigned to receive PR (the intervention) and no PR (control arm) using a sequence pre-generated by a statistician. The PR program will run for 6 weeks with a 90 min–120min supervised session at week one and week three. Continuous data will be analysed using a T test and Analysis of Variance (ANOVA) if normally distributed, and if skewed a Wilcoxon Rank Sum Test will be used. Furthermore, categorical variables will be analysed using a Fisher's exact test. Finally Logistic regression will be done to show differences between the intervention and control group. Expected findings and their dissemination It is expected that at the end of the study there will be evidence of clinically significant improvements in HRQoL, exercise tolerance, respiratory symptoms and lung function in patients receiving PR. These findings will be disseminated at District level, national conferences, the health facilities of the TB patients, College of Medicine Research and Ethics Committee (COMREC), Blantyre District Health Office (DHO), NTP and wider audiences through journal publications such as the Malawi Medical Journal.
- ItemRestrictedStrategies for linking HIV exposed infants to HIV care services at South Lunzu health centre by Rhoda Salome Kunje(Kamuzu University of Health Sciences, 12-05-21) Kunje, Rhoda SalomeBackground: HIV exposed infant care in Malawi is integrated with maternal ART follow-up to improve retention. Malawi National HIV Testing and Counselling (HTC) guide lines for HIV –exposed infants recommend a DNA PCR test done at 6 weeks, followed by 2 confirmatory rapid tests at 12 and 24 months to determine the HIV status of HIV exposed infants. Infants also receive 6 weeks of Nevirapine(NVP) starting at birth and early infant HIV DNA polymerase chain Reaction(PCR) diagnosis using dried blood spots after 6 weeks of age are done, Infants are clinically followed up until determination of final HIV infection status(1). Despite efforts to improve retention, lost to follow-up remains a challenge in the care of HIV exposed infants. Astudy done by Wingston F. Ng’ambi and others in Lilongwe Malawi showed that overall 48% of HIV-exposed infants were declared lost to follow-up due to a number of reasons (2). Available data at South Lunzu health facility in Blantyre Malawi, demonstrates that from 2018 to 2020, there has been increased numbers of children who have defaulted from HIV care services especially at 12 months and 24 months after being initiated in care.In 2018, out of the 213 HIV exposed infants that were enrolled at 2 months,96.6% were retained in care and 2.4% was the default rate.At 12 months 190 infants were enrolled in care and 70.4% was the retaintion rate and 9.6% was the default rate.At 24 months 176 infants were enrolled and there was 57.4% retaintion rate and 42.6% default rate.In 2019, 175 HIV exposed infants were enrolled and retention rate was at 97.6% and default rate was at 2.4%. At 12 months 162 HIV exposed infants were enrolled, 81.8% was the retention rate and 18.2% was the default rate. At 24 months, 146 infants were enrolled and retention rate was 61.1% and 38.4% was the default rate. This trend of defaulting from HIV care continued for the year 2020 especially as the children grew older. For this study, the researcher expects to find that there are no strategies or interventions at the health facility that are put in place to link back the HIV exposed infants who are lost to follow up for HIV health care services despite the increased default rates. PROBLEM STATEMENT Early Infant Diagnosis (EID) of HIV infection at the primary care level in Malawi is challenging. Many children are indeed tested for HIV and some are found to be HIV infected while others are HIV uninfected in the HIV diagnosis and treatment program and they are lost to follow-up at various stages. In Malawi’s option B+, loss to follow-up remains a great challenge in the care of HIV exposed infants, and although the Malawi government recommends HIV exposed infants receive Early Infant Diagnosis(EID) at under-five Paediatric clinics, most of these children are never enrolled. In 2014, less than 20% of HIV-exposed infants received early infant diagnosis test in the first 2 months of life, and only 30% of the HIV infected children were on antiretroviral therapy (13). Those children who are lost to follow are at higher risk of infection and opportunities to enter them into care are rare, consequently these children do not come back, if they come at all, its until they develop serious AIDS- defining illnesses, leading to death. OBJECTIVES: The aim of the study is to explore strategies for linking HIV- exposed infants who are lost to follow-up back into HIV care services at South Lunzu Health Centre in Blantyre,Malawi.Specifically, the study seeks to determine the proportion of HIV-exposed babies who tested positive to HIV and were lost to follow-up in relation to HIV care services,to describe the views of Health Care workers on effectiveness of the interventions currently in place for linking HIV exposed infants to HIV care services and to establish the remedies suggested by postpartum/breastfeeding mothers who are infected with HIV on minimizing lost to follow up cases amongst HIV positive infants at South Lunzu Health Centre. METHODOLOGY The research is a cross-sectional study using mixed methods (quantitative and qualitative) where data will be collected at the same time or approximately the same time period. Questionnaires and Focus Group Discussions will be used to collect the data at the same time period. The population of interest for this study will include ;HIV positive mothers who have exposed their infants to HIV but are lost to follow-up to HIV services and care, HIV exposed infants, and the health Care Workers at South Lunzu health facility (Nurse midwives, Health Surveillance Assistants, Clinicians, Expert clients).The sample size for the quantintative method will be 384 and participants will be randomly sampled from health records at the facility.The sample size for the qualitative method will be approximately 30, and participants will be purposefully selected.Data collection for the qualitative method will be done right at the health facility in quiet and private rooms through focus group discussions(FGDs).Abstrction sheet will be used to abstract data from health records. Data collected from participants will be securely stored in a computer data base that has a password and limited access will be provided to the study team. Data analysis will be done using deductive thematic content analysis. Informed consent will be obtained from each participant before being enrolled in the study. Confidentiality throughout study participation and therafter will be ensured. Ethical approval will be sought from College of Medicine and Ethics Committee(COMREC). DISSEMINATION OF EXPECTED FINDINGS The results of this study shall be disseminated in writing and presentations as feedback will be made to the: College of Medicine Research Ethics Committee(COMREC), investigators and study team, College of Medicine library, The University Research and Publication Committee(URPC)through the COMREC secretariat, All health workers at South Lunzu Health Centre, District Health Management Team (DHMT)for Blantyre including the Blantyre District PMTCT/EID Technical Working Group and to the wider scientific community through the COM Research and Dissemination Conference and preparation of a manuscript for submission to a peer-review journal.
- ItemRestrictedAssessing the association of COVI-19 with under-five children malnutrition in Namphungo and Chambe rural Health Centers of Mulanje District by Carolyn Kang’ombe(Kamuzu University of Health Sciencies, 13-07-21) Kang'ombe, CarolynXECUTIVE SUMMARY Background: Malnutrition contributes significantly to child morbidity and mortality. While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. In this study, we generate information about the burden of Covid-19 towards under-5 child nutrition resulting from the potential disruption of health systems, economic system and decreased access to food. Objectives: The broad objective of the study is to assess the association of covid-19 with underfive child malnutrition in rural health centers of Mulanje District.. To achieve the broad objective, the study will achieve the three specific objectives outlined; 1. To conduct a comparative description of accumulated cases of malnutrition in under-five children cases admitted on Outpatient Therapeutic Program and Supplementary Feeding Program during and before onset on COVID-19 pandemic. 2 To assess the food situation and income security in households of malnourished under five children during and before onset of COVID-19 pandemic. 3 To compare the health services delivery in under five clinics before and during the COVID-19 pandemic in the rural areas of Mulanje. Methods: The study will be conducted at Namphungo and Chambe Health centers. A mixed method design will be used where cross-sectional qualitative and quantitative study design will be employed. For quantitative data, secondary data will be used to address the first objective. Health center under-five clinic registration will be used to extract data. Participants will be care givers to the admitted under five children under Out-patient Therapeutic Program and Supplementary Feeding Program (n=71) that will be randomly sampled from the secondary data in the respective health centers registry. Qualitative data will be collected through in-depth interview with care takers (n=10) that have under-five children on out-patient therapeutic program and supplementary feeding program on food situation analysis. Key informants (n=4) at the respective health centers will be interviewed to understand the working modalities that were applied as COVID-19 response measure. Expected results and dissemination: This study expects to enlighten any association and impact on food production and access, provision of health services and changes in practices and behavior due to the COVID-19 and its contribution towards exacerbation of malnutrition among under five children in the communities. The results will assist in informing policy and advocacy which may 13-Jul-2021 Version 3, revised 22nd June,2021 2 | P a g e lead to the refinement and improvement of maternal and child nutrition preparedness in emergencies. The findings will be disseminated to COMREC, college of medicine school of public health and family medicine, Department of Nutrition, HIV and AIDS (DNHA), Mulanje District Health Office, Mulanje Agriculture Office as well as research dissemination conferences. Results will help to advocate for under-five nutrition measures that will assist in coping with the COVID- 19 pandemic and hence reducing under-five malnutrition.
- ItemRestrictedFactors affecting retention in care of patients initiated on antiretroviral treatment at Umodzi Art Clinic, Blantyre(Kamuzu University of Health Sciences, 16-03-22) Kaunda, Esther ShalomType of research study: The study is a cross-sectional analytical that will use mixed methods. Problem to be studied: The United Nations Programme on HIV/AIDS (UNAIDS) 95–95-95 target states that 95% of people living with HIV should know their status, 95% of people living with HIV who know their status should be on treatment, and 95% of people on treatment should be virally suppressed by 2025. Malawi strives to ensure that by the year 2030, she achieves this 95-95-95 target. However, only 69% of all people living with HIV were virally suppressed in Malawi in the year 2018, plus, available data at Umodzi clinic indicate that not all people that are initiated on ART are retained in care after 12 months which puts the 3rd 95 at a far to reach place. Broad Objective The study will investigate factors affecting retention in care of clients initiated on antiretroviral treatment at Umodzi ART clinic, Blantyre. Specifically, the study will: 1. Describe the social, economic and demographic profiles of both retainers and nonretainers, 2. Describe the factors affecting retention in care of patients on antiretroviral treatment, 3. Determine ways through which clients can be retained in care from their own perspective. Methodology: Study population will include all clients that were initiated on ART from January, 2017 to December, 2021 but did not retain in care. The sample size will be 172 and we will systematically enrol participants into the study. A checklist will be used to collect data from the files and an interviewer administered questionnaire will be used to have a deeper insight on the reasons for non-retention and ways that could help in improving retention of clients into care from their perspective. Collected data will be stored securely in computer data base that have a pass word and only limited access to key study team will be provided. Data analysis will be done using Stata software for quantitative data, and deductive analysis for the qualitative part. Informed consent will be obtained from each and every study participant before enrolment in the study and confidentiality will be ensured throughout the study period. Permission to undertake the study will be sought from QECH and ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC). Expected findings and their dissemination: We expect to describe the profile of those that retain and that do not retain in care, find factors that lead to no-retention and find ways that will improve retention among those initiated on ART. These expected results will be disseminated in writing and presentations as feedback made to Umodzi clinic, QECH and the District Health Management Team (DHMT) for Blantyre. Recommendations will be made to various levels of decision making including, Umodzi clinic, QECH, BDHO, MOH and other key implementing partners on improvements that need to be made to ensure that clients are retained in care in ART clinics.
- ItemRestrictedImpact of the coronavirus disease (COVID-19) pandemic on routine childhood immunization in Mwanza-Malawi, version 1.0(Kamuzu University of Health Sciences, 16-03-22) Kuchanje, Tamandani R. ReubenThe type of research study: Before and after study design using routine immunization data collected in all Mwanza health facilities. - The problem COVID-19 pandemic has created a number of global challenges which includes access to the general health care. Routine child immunization maybe part of the components affected by the COVID-19 pandemic as several studies done in different countries have shown reduction in vaccine coverage before and after or during COVID-19. The impact of COVID-19 in low income settings may be far more than what has been shown in studies conducted in other settings. Immunization has played a major role in reducing child mortality world-wide. Reduction in coverage may thus affect the fight in reducing global child mortality. Understanding the impact of COVID-19 on immunization may therefore help in putting up targeted intervention to improve immunization amidst the COVID-19 pandemic. - The broad objective To compare the vaccine coverage before and during (COVID-19) pandemic on routine childhood immunization among under-five children in Mwanza district - Specific objective 1. To equate coverage of three specific vaccines (DPT, PCV and Measles vaccine) received by under-five children between pre and post Covid-19 at Mwanza health facility 2. To balance vaccine coverage between male and female under-five children who got their immunization services from Mwanza health facilities between pre-pandemic period (January to December 2019) and during pandemic period (January to December 2021) 3. To assimilate vaccine coverage among under-five children who got their vaccines timely according to vaccine schedule based on age between pre-pandemic period (January to December 2019) and during pandemic period (January to December 2021) - Methodology A before and after study design will be used for this study. All the children who received vaccine before covid-19 and those who received vaccine during covid-19 will be included into the study until the sample size is reached, using routinely collected medical data dated 1st April to 31st July, 2019 and 1st April to 31st July, 2020.. This study will collect demographic data of children, Children vaccination data before Covid-19, and Children vaccination data during Covid-19 pandemic. Our Primary outcomes will be the percentage difference in the proportion of vaccinated and the secondary outcome is Vaccine preventable outbreak. Distributions of age, and sex will be compared between the 2019 pre-COVID-19 period and 2020 COVID-19 period. Trend analysis will be done to see the progress of vaccination. The percentage differences of routine vaccine doses administered during the pre-pandemic period (April to July 2019) and during the period of COVID-19 (April to July 2020) will be calculated and compared. The percentage difference of routine vaccine doses administered at each health facility before and during COVID-19 will be calculated and compared. The percentage difference of routine vaccine doses administered based on age eligibility will be calculated and compared. The difference-indifference (DID) analyses will be done to take care of any normal trends due to changes in the size of the population and vaccine acceptance. And Pearson Chi-square test will be used for statistical significance test. Complete vaccination coverage for all mentioned routinely-recommended vaccines at each milestone age (6, 10, 14, weeks, 9 months and 12-15 months) in a period will be calculated by dividing the number of children who received all routine vaccine doses before a milestone age by the number of eligible children who reached that milestone age during the period. Complete vaccination coverage by month from April to July 2019 and April to July 2020 will be estimated. - Expected findings and their dissemination. The study anticipates finding reduced vaccine coverage. Findings will prompt the Government of Malawi and stakeholders to introduce or roll out adequate communication strategies in order to reduce concerns about vaccinations and to redress the decline in vaccination coverage that will occur during the covid-19 pandemic period. At the same time, it will inform ministry for the need for immunization catch up campaign.
- ItemRestrictedImpact of the COVID -19 pandemic on morbidity and mortality due to enteric infections in children < 5 years of age in Malawi(Malawi Liverpool Welcome Trust, 16-03-22) Jere, KhuzwayoStudy type: Observational study Problem: Since April 2020, Malawi has experienced three waves of Sars-Cov-2 rapid transmission and associated deaths. The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has impacted health services globally. Consequent disruption of routine health services is expected to have long-term and far-reaching consequences. Significant reductions in the numbers of inpatients or attendance to primary/community health care clinics for illnesses other than COVID-19 have been described in many settings. Among other reasons, these changes could be due to movement restrictions preventing travel to health care facilities, lack of space at these facilities due to COVID-19, or avoidance of medical institutions due to concerns of exposure. Main objective: This protocol aims to assess the impact of COVID-19 on morbidity and mortality associated with enteric illness in Low -Middle-Income Countries (LMICs). Specific objectives: a. Evaluate the temporal diarrheal trends in relation to national and, where available, local COVID-19 activity, by examining routinely collected data on hospital admissions or attendance to the outpatient department (OPD) and community health clinics with a diagnosis of diarrhea. b. Assess the temporal trends in diarrheal disease severity and mortality among children under 5 years of age in relation to COVID-19 activity, by examining hospitalization data with a diagnosis of diarrheal illness. c. Estimate the impact of disruption to Extended Programme on Immunisation (EPI) on rotavirus diarrheal disease Methodology: Data on the monthly number of diarrheal disease cases, on monthly EPI vaccine and dose-specific administration, and on inpatient diarrheal cases’ associated mortality for children <5 for all 28 districts of Malawi will be obtained from the Ministry of Health’s Health Management Information System (HMIS). Data will be aggregated by the 5 health zones (Northern, Central East, Central West, Southeast, and Southwest regions of Malawi). Exploratory analysis will include data aggregation by urban-rural categories too. Where data gaps exist in the electronic database inspection of the physical records will be done in the districts. Expected Results and Dissemination: A negative impact on seeking care for diarrheal disease and on EPI is expected due to fear of contracting COVID19 at health facilities. Once the data is generated and analyzed for trends, the findings thereof will be shared with the College of Medicine Research Ethics Committee (COMREC), the Ministry of Health (MoH), published in peer reviewed journals and will be disseminated to the general public through the annual College of Medicine Research dissemination conference.
- ItemRestrictedReproductive health practices among women with heart disease at Queen Elizabeth Central Hospital, version 3.0(Kamuzu University of Health Sciences, 16-03-22) Kumwenda, WanangwaType of Study This is a qualitative study that is going to be conducted at an outpatient clinic at Queen Elizabeth Central Hospital. Problem Heart disease is one of the leading causes of Indirect Maternal deaths in developed countries (1). The obstetric transition concept suggests that as a country’s maternal mortality ratio decreases, as has been the case for Malawi, the burden of maternal mortality switches from direct to indirect causes, such as heart disease (2–5). In Malawi, data for heart disease in pregnancy is meagre but likely to be underestimated. However, studies in LMICs have demonstrated heart disease in pregnancy to be associated with increased mortality and morbidity, as the provision of optimal care is challenging in most circumstances (6). The recommended strategies for reducing the burden of heart disease on maternal health include counselling on the possible complications that can arise if they get pregnant, avoiding unintended pregnancies by offering appropriate contraception, optimising health before pregnancy and good antenatal care with a multidisciplinary approach (7,8). These strategies are recommended to be started at the time of diagnosis or as early as menarche for those with congenital heart disease (9). There is need to understand the local reproductive health practices among women with heart disease as the obstetric transition happens. This understanding will help identify the factors to address when promoting the reproductive health of women with heart disease. Objectives The main objective is to understand the factors affecting the reproductive health practices among women with heart disease who attend the Chest Clinic at QECH. Specific Objectives • To identify the factors that influence the desired fertility of women with heart disease • To assess perceptions of effects of heart disease on reproductive health among women with heart disease • To explore perceptions about the effects of pregnancy on heart disease among women with heart disease To compare provisions contained in the international, national, and local normative guidance on the care of pregnant women with heart disease with the actual practice of providing care to this group at QECH Methodology This study will use qualitative methods. It will be done at Queen Elizabeth Central Hospital and will recruit 25 women with heart diseases and 3 medical key informants. In-depth interviews will be used to collect the data, and thematic analysis will be done. Expected Findings This study will provide an understanding of the reproductive health practices among women with heart disease and the factors affecting them. This knowledge will help with areas of focus when planning ways of promoting the reproductive health of women with heart disease
- ItemRestrictedEpidemiology of HBV and HCV among pregnant women at QECH(Kamuzu University of Health Sciencies, 16-06-21) Nkhata, Charles; Kalongonda, Milton; Mvula, MemoryType of study This will be a descriptive cross sectional study. The problem to be studied Viral Hepatitis is a predominant cause of liver damage worldwide with approximately 1.4million deaths annually. HBV and HCV are common causes of high morbidity and mortality rates worldwide. It is estimated that approximately, 248million people are living with chronic HBV infection and that 110million people are HCV antibody positive. This disease is neglected in developing countries due to lack of proper treatment and screening programs. Unfortunately, infected pregnant women pose a high risk to neonates before or during delivery. Very little is known about the prevalence of these viruses among pregnant women in Malawi. The objectives Broad objective • To assess the epidemiology of Hepatitis B Virus and Hepatitis C Virus among pregnant women at Queen Elizabeth Central Hospital. Specific objectives 1. To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at Queen Elizabeth Central Hospital 2. To assess risk factors associated with HBV and HCV infection in pregnant women. 3. To determine distribution of HBsAg and Anti-HCV among pregnant women. Methodology The study will be conducted at the antenatal clinic and antenatal ward at Queen Elizabeth Central Hospital. We plan to recruit pregnant women who are willing to take part in the research. Simple random sampling will be used for the women who provide consent to participate in the study. We will the collect blood sample which will be sent to the COM lab for ELISA for HBsAg and Anti- HCV The data will be analyzed using Epi info and SPSS version 22. Association between serological results variables (risk factors) will be established using Chi-square and association will be measured using odds ratio. Expected findings and their dissemination. The study results are expected to uncover the epidemiology of HBV and HCV among pregnant women of different age groups at QECH. We expect to detect low to undetectable levels of HCV as opposed to HBV makers. The results of the study will be disseminated to COMREC, QECH and at the COM Research dissemination conference. A manuscript will also be submitted for publication in peer reviewed journals. 1. INTRODUCTION Viral hepatitis is the predominant cause of liver diseases such as liver fibrosis, cirrhosis and hepatocellular carcinoma in the world (1). There are five types of hepatitis virus(A-E) that cause infection but Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the most common causes of acute and chronic liver infections. Globally, every year about 1.4 million people die of viral hepatitis (2). Despite its deadliness, the disease is neglected in developing countries due to lack of screening programs and treatment. Therefore, viral hepatitis has become one of the major leading causes of high viral associated mortality and morbidity rates (3). The burden of chronic HBV and HCV remains disproportionately high in Sub-Saharan Africa and 5-15% of the population is chronically infected with HBV followed by HCV. HBV and HCV have common modes of transmission and rarely these viruses can exist together (4). In 2018, HBV sero-prevalence was estimated to be about 8.1% among the Malawian general population and HCV was below 1% (3). HBV is manly contracted at birth from infected mothers and during early childhood whereby those infected develop chronic infections. 90 percent of infants born to infected mothers with chronic hepatitis are at risk of developing chronic HBV later in life. In contrast when HBV is contracted during adulthood, 5-10 percent of adults develop persistent chronic HBV infections (5). HBV is a partially double stranded DNA virus with an icosahedral capsid and envelope. HBV is classified as an ortho-hepadnavirus in the family of hepadnaviridae. HBV resembles a retrovirus replication mode by using an intermediate RNA stage. HBV contains several antigens that can be 16-Jun-2021 3 used as disease makers these include; Hepatitis B surface antigen (HBsAg), Hepatitis B core antigen (HBcAg), Hepatitis B e-antigen (HBeAg) (6). Hepatitis C is a positive sense single stranded RNA virus (+ssRNA) that belong to the genus hepacivirus and is a member of flaviviridae family. In acute infections, HBV invade hepatocytes by binding to the host cellular receptors to enter and replicate in the cells. During incubation period high copies of the virus are present before the host immune response develops and controls the virus. As the virus replicates, HBcAg and HBeAg get expressed on the cytoplasmic membrane which trigger B and T cell response. Damage to hepatocytes is due to antibody dependent, Natural Killer, and Cytotoxic T cell action. HCV pathogenesis is regulated by host immunity and metabolic responses that influence liver function. HCV does not cause cytopathic effect to the hepatocytes rather during replication it causes cell necrosis by several mechanisms including immune mediated cytolysis and other contributing factors such as hepatic steatosis, oxidative stress and insulin resistance (7). Viral hepatitis is caused by different subtypes of Hepatitis viruses for example, HBV and HCV which are considered to be blood borne pathogens. HBV and HCV cause acute hepatitis which can clear spontaneously or progress to chronic hepatitis (8). Chronic hepatitis is also a predominant cause of liver damage, cirrhosis and hepatocellular carcinoma (HCC) in general population globally (3),(9). There are several risk factors that are associated with viral hepatitis transmission, and these include; reuse of needles among individuals and needle stick injuries, blood transfusion, local barbers (10). In other literatures the following have also been known to be risk factors; multiple sexual partners, family history of hepatitis or any other liver diseases, surgery, IV infusion, tooth brush sharing (11). Individuals who are at a high risk of contracting these blood borne infections include; individuals from countries with high prevalence of HBV and HCV or international travelers, recipients of blood and blood products, injecting drug users, patients with liver diseases, health care workers and hemodialysis patients. Several measures have been put in place to control blood borne viral hepatic infections. Treatment against acute hepatitis B has not been developed but limited and non-curative treatment for chronic hepatitis B is available, a combination of lamivudine and alpha-interferon is given to suppress HBV viral load (12). Unlike hepatitis C there is a vaccine for hepatitis B. The vaccine was discovered in 1965 by Dr. Baruch Blumberg and his team (13). The vaccine is administered as an active prophylaxis in three doses; after the first dose, the second dose is given after a month and the third (booster) is administered after six months. In infants, the first dose is administered within 24 hours and the two remaining doses follow a similar pattern as in adults (14). In an exposed individual a passive prophylaxis in form of an intra-muscular injection that contains Hepatitis B immunoglobulin is given within seven days of exposure to offer short-term protection. Other preventive measures like civic education have been put in place by the WHO to minimize risk behaviors among infected population and sensitize risk groups on how to prevent spreading of hepatitis (8). At present it is thought that giving the hepatitis B vaccine to pregnant women is relatively safe(15) in addition, current vaccines contain noninfectious HBsAg and should cause no risk to the fetus(16). 2. JUSTIFICATION Several studies have been conducted in various countries around the world on the epidemiology of HBV and HCV in the general population as well as in pregnant women. Literature shows that viral hepatitis during pregnancy is associated with a high risk of maternal complications, has a high rate of vertical transmission causing fetal and neonatal hepatitis and has been reported as a leading cause of maternal deaths (7). For these reasons, screening antenatal women for hepatitis B surface antigen and Hepatitis C antibody can give a reliable prevalence of these diseases in a population and provide an avenue for preventing mother to child transmission of the viruses. Despite the importance of Hepatitis B and C infections in pregnancy, there is paucity of data on the prevalence of Hepatitis B and C viruses in the pregnant women in Malawi. We therefore feel that this study will contribute to the body of knowledge to bridge this gap 3. OBJECTIVES OF THE STUDY 3.1. BROAD To assess the epidemiology of Hepatitis B Virus and Hepatitis C Virus among pregnant women at Queen Elizabeth Central Hospital. 3.2. SPECIFIC OBJECTIVES 1. To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at Queen Elizabeth Central Hospital. 2. To assess risk factors associated with HBV and HCV infection in pregnant women. 3. To determine the distribution of HBsAg and Anti-HCV infection among pregnant women of different age groups. 4. METHODOLOGY 4.1. TYPE OF STUDY The study will use prospective and descriptive cross-section study. Prospective analysis will be conducted whereby blood samples will be collected from the pregnant women and tested for HBV and HCV. Descriptive cross sectional study will be used to characterize lab results by looking at their qualitative and quantitative nature. 4.2. STUDY SITE The study will be conducted at QECH in Blantyre and College of Medicine Hematology laboratory. Participants will be recruited at the antenatal clinic and antenatal ward at QECH. Blood samples will be processed at COM Hematology Lab. 4.3. STUDY POPULATION This study will target pregnant women at QECH. 4.4. STUDY PERIOD The study will be conducted within a period of four weeks after approval from COMREC. The planned activities are indicated in the Gantt chart as follows;
- ItemRestrictedPrevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol(Kamuzu University Of Health Sciencies, 16-06-21) Phiri, WynessThis is an analytical cross-sectional study that aims to determine prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital. Problem to be studied Several factors are known to be associated with neonatal sepsis. Despite this, studies that have been conducted in Malawi have focused mainly on causative organisms. Understanding specific factors that are associated with neonatal sepsis is crucial in the prevention and management of neonatal sepsis. Therefore, this study aims at determining neonatal and maternal factors that are associated with neonatal sepsis at KCH in Lilongwe, Malawi. Objectives The study aims to determine factors associated with neonatal sepsis at KCH, Lilongwe Malawi. specifically, to determine the prevalence of neonatal sepsis to determine maternal factors associated with neonatal sepsis, and to determine neonatal factors associated with neonatal sepsis. Methodology We will use secondary data which will be extracted from the case notes. Neonates who were admitted from 1st January to 31st March 2021 will be included in the study. Neonates whose admission and discharge outcome data was captured by Neo-Tree bed-side tablet will be eligible for this study. Simple random sampling will be used to select participants of this study. The study will require a sample size of 380 participants to achieve a power of 80% at a 95% confidence interval. Collected data will be entered and cleaned in Microsoft excel then analyzed in Stata 16.0 to come up with odds ratios. Univariate and multivariate analysis will be done to identify statistically significant factors associated with neonatal sepsis. Expected findings and their dissemination It is expected that neonatal sepsis is associated with preventable risk factors. This study will add knowledge on the risk factors associated with neonatal sepsis which will help in coming up with evidence-based institutional interventions which will aim at reducing neonatal morbidity and mortality. The findings will be disseminated with Kamuzu Central Hospital, Reproductive Health Unit, College of Medicine library, and College of Medicine Research Ethics Committee (COMREC). 3.0 Background information and introduction The neonatal period is defined as the first 28 days of the life of a child. It is the most critical stage of life. Recent reports in 2019 show that 2.4 million children died in the first month of life globally. Sub-Saharan Africa and South Asia contributed to the highest neonatal mortality of 27 and 25 deaths per 1000 live births respectively [1] Recent reports of 2019 show that neonatal mortality for Malawi was at 19.8 deaths per 1000 live births [2]. Neonatal mortality is attributed to three major conditions which are preventable and treatable; Prematurity, intrapartum-related complications like birth asphyxia, and neonatal infections. These three major conditions account for 80% of neonatal deaths. [3] Neonatal sepsis is defined as a clinical syndrome characterized by signs and symptoms of infection in neonates from day 1 of life to 28 days [4]. Neonatal sepsis is divided into two; early- onset which occurs in the first 72 hours of life and late-onset which occurs after 3 to 7 days of life. The most critical one which contributes more to neonatal mortality is the early onset [5]. For a systematic review and a meta-analysis which was conducted, a pooled neonatal sepsis incidence from 26 studies of 2824 neonatal sepsis cases per 100 000 live births was estimated [6]. Neonatal sepsis attributes to 17% of neonatal deaths in Sub-Saharan Africa (SSA) [7]. Despite neonatal sepsis deaths surpassing that of HIV in neonates, neonatal sepsis does not receive much funding as a public health priority worldwide. Neonatal sepsis accounts for an annual economic burden ranging from 10 billion to 469 billion US dollars in SSA [8]. Several pathogens cause neonatal sepsis. Studies that have been conducted in developed countries have reported that group B streptococcus (GBS) is the commonest cause of neonatal sepsis. In developing countries, Gram-negative bacteria is the commonest cause contrary to developed countries. [13] Clinical signs are used to come up with the diagnosis of neonatal sepsis using the Integrated management of childhood illnesses (IMCI) guideline by WHO in developing countries including Malawi [14]. The presence of two or more of the following signs are signals neonatal sepsis; a core temperature of greater than 38.5 degrees Celsius or less than 36 degrees’ Celsius convulsions, bradycardia or tachycardia, lethargy, respiratory distress, apnoea, poor reflexes, abdominal distension, and bleeding [15] [16]. Several studies have been conducted in India [18], Ghana [19] [20], Nigeria [21], Ethiopia [22] [23], and Tanzania [24] [25] to identify maternal and neonatal risk factors associated with neonatal sepsis. Key maternal risk factors associated with neonatal sepsis were premature rupture of membranes (PROM) [18] [23] [25], maternal age [18] [7] [25], and place of delivery [21] [18] [25] while neonatal risk factors were neonatal age [18] [19] [20] [22] [4] [24], use of oxygen via 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 13 Mask [22] [18] [24], birth weight 20] [23], APGAR score [19] [24], and resuscitation at birth [19] [24]. Curiously, neonatal sepsis was not associated with gestation age [20] [22] [23] [25], antenatal care services [4] [19] [22] [23], and urinary tract infection [14] [19] [22]. A study in Nigeria investigated association of neonatal sepsis with change in antibiotics, and number of switches in antibiotics which were statistically significant factors [21]. These factor has not been investigated in most of studies conducted in Africa. Neonatal sepsis is managed by the administration of broad-spectrum antibiotics, fluids, vasoactive, and/or inotropic support [16]. In developing countries, neonatal sepsis is managed in line with IMCI guidelines as follows; hospitalization of the neonate with rapid administration of antibiotics either intravenously or intramuscularly, a combination of gentamicin and benzylpenicillin or ampicillin for 7-10 days [17]. Efforts have been put in place to achieve the Sustainable Development Goal (SDG) number 3 which aims at ending preventable deaths in neonates and under-fives. Thermal protection by skin to skin contact between a mother and the neonate, hygienic umbilical cord and skin care, early and exclusive breastfeeding, assessment of danger signs, and preventive treatment like immunization with BCG and vitamin K prophylaxis are some of the essential newborn care strategies to improve child survival and wellbeing [9]. However, with the current trends, it is reported that more than 60 countries will not be able to achieve the neonatal mortality target of at least less than 12 deaths per 1000 live births by 2030[10]. The government of Malawi in collaboration with USAID works to prevent neonatal and maternal deaths by integrating evidence-based activities in activities that address vital maternal, neonatal, and child health at households, community, and facility levels. At the facility level, they have provided Basic Emergency Obstetric and Newborn Care (BEMONC) life-saving signal interventions in some districts, the orientation of health workers on Kangaroo Mother Care (KMC), provision of Bubble Continuous Positive Airway Pressure mentorship to health workers through MOH Acute Respiratory Infections Programs and distribution of Maternal Newborn Child Health (MNCH) equipment and supplies [11] In 2015, Every Newborn Action Plan was launched in Malawi to guide the efforts of the Ministry of Health, district officers, and all stakeholders to design specific plans for accelerating progress toward ending preventable deaths among mothers and newborns and avoidable stillbirth. The plan calls for the provision of a skilled attendant at every birth, community involvement in maternal and neonatal care, and strengthening facilities that provide basic emergency obstetric and neonatal care and comprehensive emergency obstetric and neonatal care. [12] 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 14 4.0 Rationale/ justification for the research project To achieve the sustainable development goal number 3 by 2030 which aims to end preventable deaths of new-born and children under five years of age, there is a need to come up with strategies to reduce these neonatal deaths. Since neonatal sepsis is one of the major causes of neonatal morbidity and mortality, determining factors that are associated with neonatal sepsis at KCH will help in the early identification of neonates at risk of neonatal sepsis and coming up with an evidence-based institutional intervention that may help in reducing neonatal morbidity and mortality. The studies that have been conducted in Malawi have focused on the causative organisms [13] [26]. There is limited scientific knowledge on the factors that are associated with neonatal sepsis in Malawi. Although studies have been conducted in other African countries, findings cannot be applied in Malawi settings due to differences in health systems building blocks that exist among countries; leadership and governance, health care financing, health workforce, medical products and technologies, information and research, and service delivery. Therefore, this study will determine factors that are associated with neonatal sepsis in Malawi. The study will determine associations between maternal age, PROM, place of delivery, neonatal age, use of oxygen via face masks, birth weight, APGAR score, and resuscitation at birth which are statistically associated with neonatal sepsis in studies that have been conducted. The study will also determine associations between intravenous cannulation [24], immediate and exclusive breastfeeding [4], mode of feeding, and neonatal sepsis because few studies have assessed their associations with neonatal sepsis. 4.0 Objectives of the study 5.1 Broad objective To determine prevalence and factors associated with neonatal sepsis at KCH from 1st January 2021 to 31st March 2021 5.1.1 specific objectives To determine the proportion of neonates with neonatal sepsis To assessdetermine maternal factors associated with neonatal sepsis To identifydetermine neonatal factors associated with neonatal sepsis 1 1Maternal age, premature rupture of membranes(PROM), place of delivery, mode of delivery, age 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 16 of a neonate on admission, birth weight, resuscitation at birth, oxygen administration via face mask, time of initiation of breastfeeding, mode of feeding, APGAR score at one minute and five minutes, intravenous cannulation, and duration of staying in the hospital. 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 17 6.0 Methodology 6.1 Type of the study This is an analytical cross-sectional study that aims to determine factors associated with neonatal sepsis. 6.2 Study place The study will be conducted at KCH; Ethel Mutharika Nursery in Lilongwe, Malawi. It is located in the central region of Malawi. KCH has been chosen as a study site because it is a tertiary hospital with good diagnostic equipment to diagnosis neonatal sepsis. It also has specialist and consultants who are experts in giving definite diagnosis neonatal sepsis. Since all the facilities in Lilongwe and surrounding districts do not have the capacity to diagnose and manage neonatal sepsis, cases are referred to KCH. Lilongwe has a population of 1,170,870. Ethel Mutharika nursery is a referral facility that admits sick babies from the northern and central regions of Malawi. The facility admits 250 babies per month on average. The facility admits neonates with prematurity, birth asphyxia, neonatal sepsis, pneumonia, prematurity with respiratory distress syndrome, low birth weight, jaundice, congenital abnormalities, gastroschisis, meconium aspiration, and others which are categorized as other conditions. Consultants and specialists help in the management of patients at this facility. It has a bed capacity of about 100. The hospital uses Neo-Tree electronic system data capture to document admissions and outcome data. The Neo-Tree is a bedside digital tablet with an electronic admission form that was developed based on the facility guidelines. In between admission and discharge, care given to patients is documented manually in the case files. All the printouts from the Neo-Tree are attached to the patient's file. 6.3 Study population All neonates who were admitted from 1st January 2021 to 31st March 2021 at the Ethel Mutharika nursery unit will be the study population for this study. This period is when Neo-Tree came into effect at KCH. The system minimizes human errors during data collection. The following is the inclusion criteria; 1. Neonates admitted between 1st January 2021 to 31st March 2021 2. Case notes which data was captured by Neo-Tree on admission The following is the exclusion criteria; 1. Neonates admitted out of the study period 2. Case notes which data was not captured by Neo-Tree on admission 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021
- ItemRestrictedAssessing the perception and knowledge of voluntary medical male circumcision among middle aged men in peri-urban, Blantyre(Kamuzu University of Health Sciencies, 18-10-21) Khuliwa, Innocent; Singano,Nomsa; Chivunga, ConstanceAdequate sleep contributes to a student’s overall health and wellbeing. Getting proper amount of sleep helps one to stay focused, improve concentration and academic performance. Studies have shown that most youths who do not get enough sleep have a high risk of having many health problems including, obesity, DM type 2, poor mental health and injuries. They are more likely to have attention and behavioral problems which can contribute to poor academic performance. College students are among the most susceptible group of people to poor sleeping habits due to the increased academic pressure. Recent studies have shown that students with medical related majors are more likely to have poor quality of sleep in comparison to those with a humanities major. Despite the established evidence on how important sleep is, no studies have been conducted here in Malawi to assess quality of sleep among college students. This study seeks to bridge this gap by assessing quality of sleep and its associated factors among undergraduate medical students at Kamuzu University of Health sciences, Blantyre campus, Malawi. This research will be a cross sectional study design. Our problem objectives will be to establish the association between quality of sleep and other factors such as gender and mental health. A sample size of 428 will be used and participants will be systematically selected from the classes. Questionnaires will be used to collect data on both sleep quality and mental health. A Pittsburgh sleep quality index (PSQI) and patient health questionnaire (PHQ 9) will be used respectively. Data will be entered into excel and analyzed using epi info software. By the end of the study we expect get data on quality of sleep among medical students as well as its associated factors. This assessment will help us evaluate the extent of the burden of poor sleep among college students and how much this burden is affecting their life more especially academic performance. In the end we will be able to develop proper interventions such as proper sensitization on good sleep health. This will ensure that students get good quality sleep and in turn reduce the complications associated with poor sleep. The results of this study will be presented in a full report to COMREC. We will also present our study findings at an annual College research dissemination conference. The results will also be made available on medical research journal websites
- ItemRestrictedSerum levels of vitamin C and D in adult individuals with diabetes and hypertension compared to healthy controls, and the supplementation tendencies of the vitamins among non-severe COVID-19 patients in Blantyre, Malawi by Dr Kondwani Katundu(Kamuzu University of Health Sciencies, 18-10-21) Katundu, KondwaniExecutive Summary Study Title: Serum levels of vitamin C and D in adult individuals with diabetes and hypertension compared to healthy controls in Blantyre, Malawi. Study Type: Cross-sectional Background: Vitamin C and D mitigate the progression of atherosclerosis in individuals with Diabetes mellitus (DM) and hypertension. DM and hypertension are risks for worse outcome in COVID-19, and low blood Vitamin C and D associate with the severity of COVID-19 disease. Vitamin C and D status in healthy controls compared with DM and hypertension has not been well described in Malawi. Study Objectives: This study aims to determine the prevalence of serum vitamin C and D deficiency in adult individuals with diabetes and hypertension in Blantyre, Malawi. Methods: This will be a cross-sectional where we will analyse serum samples for vitamin C and D from a cross-sectional study in adult individuals with DM (n=75) and hypertension (n=75) at QECH and age-matched healthy controls (n=75). Sample-size: The sample size for the determination of serum vitamin C and D study of 75 participants in each of the three groups (total 225) was calculated to detect at least 15% prevalence of hypovitaminosis in the healthy individuals compared to the individuals with DM and hypertension, respectively, at a power of 80% and 95% confidence interval. Outcomes and definitions: The primary outcomes of the study will be the prevalence of vitamin C and D deficiency and insufficiency in the study population groups. Vitamin C deficiency and insufficiency will be defined as serum vitamin C concentration of ≤11.4 μmol/L and ≤23.0 - 28 μmol/L respectively. Vitamin D deficiency and insufficiency will be defined as 25(OH)D of ≤20 ng/ml (50 nmol/L) and ≤21–29 ng/ml respectively. Expected findings and dissemination: Vitamin C deficiency and insufficiency is prevalent (up 56%) in low-income countries, and the low fruit intake in most Malawian households likely predispose individuals to low vitamin C status. We expect low vitamin C status of at least 20% in the study populations. Low vitamin D status of up to 60% has also been reported in a recent African review, which did not include data from Malawian adults. We also expect a positive association between the low vitamin C status with HBA1C, dyslipidaemia and poorly controlled hypertension. The results once analysed will be published in an international scientific journal and will be presented both at local and regional or international conferences. Published results will also be submitted to the Malawi Liverpool Welcome Trust Clinical Research Programme, College of Medicine Research and Ethics Committee (COMREC), Kamuzu University of Health Sciences Library, Blantyre District Health and Social Services Office and Queen Elizabeth Central Hospital.
- ItemRestrictedEffect of Covid – 19 on Antiretroviral Treatment Therapy Outcomes in HIV/AIDS Clients at Partners in Hope, Lilongwe(Kamuzu University of Health Sciences, 19-01-22) Lifumba, MarloneType: A retrospective cohort study to study impact of covid-19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Problem: HIV/AIDS remains a big challenge worldwide especially in Southern Africa estimated at 37.9 million while in Malawi it’s at 1.1 million persons. Essentially, Anti-Retroviral Therapy (ART) have improved the livelihoods of people living with the disease as there is no cure to date but uptake is meeting challenges, at present Covid 19 being the main culprit. As such ART adherence is estimated at 65% thus for Partners in Hope though Malawi as a whole; it’s estimated at 75%. Treatment failure has resulted due to these adherence issues. This adherence level to ART is suspected that it may have dropped from 65% during the covid era as different clients have been switched on treatment regimens, more hospital admissions and, more deaths from those suffering from both HI/AIDS (and on treatment) and covid 19. Therefore, the study aims to effect of covid– 19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Main Objective: To investigate the impact of covid-19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Specific objectives: i). To evaluate risk factors of primary study outcomes including sociodemographic factors with ART outcomes during covid-19 pandemic. ii) To compare the incidence of primary study outcomes before and during covid 19 pandemic. Methodology: A retrospective cohort study design will be utilized to conduct this study. 82 participants will be recruited in the study through their patient files by data collectors: nurses and midwife technicians. Viral load results for the 2 years prior and during Covid-19 will be utilized to compare their health outcomes between the two time periods. Data will be collected from viral load registers and patient files through a question checklist formulated by the investigator. Data will be entered in Microsoft Excel and exported into Stata v14.0 for analysis. Permission to conduct the study will be sought from COMREC, Partners in Hope and Lilongwe District Council.
- ItemRestrictedThe effect of Covid-19 on uptake of HIV and AIDS health services at St Martin’s Community Hospital(Kamuzu University of Health Sciences, 19-01-22) Lusinje, AlinafeA cross-sectional study design and will employ both qualitative and quantitative methods. Data will be collected using questionnaires (refer appendix 12.3), review of registers, key informant interviews (refer appendix 12.5) and focus group discussions (refer appendix 12.7) Quantitative sample size will be 123 among HIV and AIDS clients and qualitative sample simple size will be 32 Malawi is one of the most affected countries with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic in the sub-Saharan Africa. The emergency of Corona Virus Disease 2019 (COVID-19) pandemic has disrupted provision of health services globally as well as nationally, and has led to low uptake of health services. This study seeks to assess the effect of COVID-19 pandemic on uptake of HIV and AIDS health services at St Martin’s Community Hospital in Mangochi. Results for this study may help to inform decision and policy makers on how to make HIV and AIDS programs resilient to emerging health issues. Methods This will be a cross-sectional study and will employ both qualitative and quantitative methods. Data will be collected using questionnaires (refer appendix 12.3), review of registers, key informant interviews (refer appendix 12.5) and focus group discussions (refer to appendix 12.7). Quantitative sample size will be 123 among HIV and AIDS clients and qualitative sample simple size will be 32; four key informant interviews with a priest, group village head, a nurse or clinician working at HIV service point of delivery and head of clinical department. Four sessions of focus group discussions comprising seven members who are HIV and AIDS clients will be conducted. Data will be analysed using STATA and thematic content analysis. Ethical approval will be sought from Kamuzu University of Health Sciences’ College of Medicine Research and Ethics Committee (COMREC).
- ItemRestrictedAn MRI Ancillary Study of Malaria fever (RCT)(Kamuzu University of Health Sciences, 20-09-16) Birbeck, GretchenDespite eradication efforts, ~400,000 African children sustained brain injuries as a result of CNS malaria in 2016. A higher maximum temperature (Tmax) during the acute malaria infection is an established risk factor for neurologic sequelae and a randomized controlled trial (RCT) of aggressive antipyretic therapy with acetaminophen and ibuprofen began enrollment in Malawi in 2019 (R01NS102176) with expansion into Zambia pending. In this clinical trial, the primary outcome is Tmax during the acute infection. However, the antipyretic therapies used in this RCT may offer neuroprotective effects without affecting Tmax--for example, neuroprotection through anti-inflammatory mechanisms. In this ancillary study, we propose to use neuroimaging in the context of the RCT to further evaluate the potential neuroprotective effects of aggressive antipyretic therapy for CNS malaria and explore possible mechanisms for these effects. Comparing children allocated to aggressive antipyretic therapy vs. usual care on the prevalence of structural brain abnormalities after recovery from CNS malaria will facilitate the evaluation of non-fever pathways for neuroprotection. Both Zambia and Malawi have an unusually well-developed infrastructure for advanced imaging in the academic centers where the RCT using aggressive antipyretic therapy will be conducted have MRI facilities. Brain MRIs will be obtained in children enrolled in the RCT at 1- and 12-months post recovery. Analyses will be completed comparing the odds of having any structural injury based upon RCT treatment allocation and based upon (Tmax) stratified by treatment allocation to assess changes specifically related to response to therapy in terms of fever reduction. Potential mechanisms of aggressive antipyretic-related injury will be evaluated including assessments for treatment-related CNS bleeds. Neuroimaging is a well-established, valid proxy for neurological outcomes after brain injury including in pediatric CNS malaria. Adding this MRI ancillary study to our fever RCT may elucidate mechanisms of treatment-associated injury and allow for early identification of neuroprotection from aggressive antipyretic use that would otherwise require long-term follow-up for cognitive and behavioral assessments. This MRI ancillary study when added to the Fever RCT will provide critical insights that could inform future neuroprotective studies of malaria that might incorporate imaging to optimize study design.
- ItemRestrictedAssessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi, a case of Thyolo District(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor Goldon1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas.
- ItemRestrictedAssessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas