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- ItemRestrictedIncidence and predictors of hypertension and hypertension treatment success among adults on ART in Blantyre and Zomba, Malawi(Kamuzu University of Health Sciences, 2022-06-09) Nyirenda, OswardType of study: It is retrospective cohort study design embedded in a large randomized controlled clinical trial that recruited and followed HIV positive adults on ART from November 2012 to July 2018 in Blantyre and Zomba. Problem: People living with human immunodeficiency virus (PLHIV) are at increased risk of premature deaths due to cardiovascular diseases (CVD) compared to the general population because of additional HIV specific factors and exposure to antiretroviral therapy (ART) (1). Results from a cross-sectional study done by Dimala et.al (2016) demonstrated that hypertension is more prevalent in people on ART compared to ART naïve population (2). Few studies that have been conducted in sub-Saharan Africa (SSA) to understand the incidence and risk factors of hypertension in PLHIV, have reported conflicting results (3–5). Some studies have reported low incidence of hypertension (3) while other studies have reported high incidence of hypertension (4,5). In Malawi there is limited data regarding incidence of hypertension, risk factors of hypertension and factors that are associated with hypertension control. These gaps are very concerning in PLHIV given that this population is currently experiencing dual burden of infections and non-communicable diseases (NCD) (6). Thus, this study seeks to determine the incidence and risk factors of hypertension and factors that are associated with hypertension treatment control in adults on ART. The results from this study will provide knowledge to enhance equitable allocation of resources by the ART managers. If the managers know and understand the burden of hypertension and factors related to treatment success, they can retrain their staff and provide BP machines in ART clinics for the health care workers to routinely screen PLHIV for hypertension. Additionally, if we find high nonadherence to hypertensive treatment due to pill burden, we will advocate for antihypertensive treatment with a single pill combination (SPC) of two drugs along with appropriate lifestyle interventions. Objectives: The broad objective of this study is: • Too determine the incidence of hypertension among adults on ART in Blantyre and Zomba, Malawi between 2012 and 2018. The specific objectives are:To determine the prevalence of hypertension (Systolic BP ≥140mmHg, Diastolic BP ≥90mmHg) among PLHIV on ART screened between November 2012 and July 2018 in Zomba and Blantyre, Malawi • To determine the risk factors of hypertension among adult PLHIV on ART screened between 2012 and July 2018 in Zomba and Blantyre, Malawi. • To determine the risk factors for developing hypertension among adult PLHIV stable on ART and followed up between November 2012 and July 2018 in Zomba and Blantyre, Malawi • To determine the risk of uncontrolled hypertension among hypertensive PLHIV stable on ART who were recruited and followed up between November 2012 and July 2018 in Zomba and Blantyre, Malawi • To determine predictors of poor hypertension control among adult PLHIV stable on ART and followed up between November 2012 and July 2018 in Zomba and Blantyre, Malawi. Methodology: This is a retrospectiveprospective study design using data from a large randomized controlled clinical trial that was conducted from November 2012 to July 2018 which recruited HIV infected adults on ART in Blantyre at Blantyre Malaria Project (BMP), Ndirande Research Clinic and in Zomba at Dignitas International, Tisungane Research Clinic. Data was handed over to the Principal Investigator in an excel format. In the secondary analysis, we will extract data to the workable excel sheet before analysis. The sample size of 307 is ideal for this study, however, to ensure that our sample is well representative, we will analyze all 2, 237 screened participants and 1, 499 enrolled participants from the parent study. Expected findings and dissemination: This study will provide information on how many people develop hypertension in PLHIV on ART. This will eventually assist government to plan equitable allocation of resources to PLHIV on ART to mitigate hypertension. The study willalso provide information on whether it is time to advocate for one Single Pill Combination (SPC) for hypertension as the means to address pill burden which result in poor adherence of antihypertensives in PLHIV on ART. This will ensure that PLHIV on ART are able to control hypertension and live healthy life and able to participate in developmental activities in their communities. Results from this study will be presented at the College of Medicine Research Hypertension in PLHIV Version 3.02.0, 11 May12 March 2022 Page 8 of 26 Dissemination Conference and other international fora. We will also share the results with College of Medicine Research and Ethics Committee (COMREC) and the Ministry of Health in Malawi, NCD department. We will prepare a manuscript for a peer reviewed journal publication.
- ItemRestrictedInvestigating cardiovascular disease risks among Kamuzu University of Health Sciences (KUHeS) employees by Gomezgani Msiska Milca Mzunga(Kamuzu University of Health Sciences, 2022-02-09) Msiska, Gomezgani; Mzunga, Milca1.1 Type of Research This will be a descriptive cross sectional study by design. 1.2 The Problem to be Studied Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels. These include coronary heart diseases, heart attack, stroke and arrhythmias. Some of the cardiovascular risk factors include dyslipidemia, hypertension, smoking, diabetes, obesity and physical inactivity. Cardiovascular diseases are an important cause of morbidity and mortality across the globe, Malawi inclusive and contributes significantly to morbidity and mortality. Improving cardiovascular health requires knowledge of modifiable cardiovascular risk factors by populations at risk, screening for the risk factors and management of the risk factors when present. Mitigation of risk factors for CVD is therefore important. In Malawi, hypertension is highly prevalent with nearly a third of 25 to 64 years old people having raised blood pressure or taking antihypertensive medications [1]. The prevalence of diabetes in Malawi is 5.6 % among adults aged between 25 and 64 years [1]. There is an increased prevalence in urban gradient implicating changes in lifestyles as a key contributor. Sedentary lifestyles and lack of physical activity are strongly associated with obesity and overweight which are the most important causes of cardiovascular diseases particularly hypertension and diabetes. People who are obese have a high risk of developing type 2 diabetes, a condition where blood glucose is persistently high. Increased blood glucose levels can cause harm to the blood vessels, making them targets for hardening, called atherosclerosis. In obese individuals, the heart has to work extra hard to pump blood throughout the body, as a result of fatty substances accumulated in the arteries. This condition is called hypertension, where blood pressure on the inner walls of the arteries is extremely high. Kamuzu University of Health Science campuses being formal working institutions in urban setting, we expect the employees to live sedentary lifestyles which is a contributing factor to CVDs prevalence. 1.3 Objectives To investigate cardiovascular disease risks among KUHeS employees. To evaluate the prevalence of obesity, diabetes and dyslipidemia among KUHeS employees. To determine the cardiovascular disease riskusingAtheroscleroticCardiovascularDisease(ASCVD) Risk Estimator To correlate CVD risks to age group. 1.4 Methodology Demographic data will be collected using a questionnaire which will include age, gender, pregnancy and medical history. Anthropometry assessments will be done. These will include height, weight, Body Mass Index (BMI) and body circumference (waist, hip and limbs) using tape measures. Blood sample in both plane tube and anticoagulant tube will be drawn from our study participants and processed at the KUHeS hematology and biochemistry laboratory respectively. The tests will include glycosylated hemoglobin (HbA1C) and lipid analysis. Blood sample collection is an invasive technique that involves several risks. The following are some of the risks and how they can be mitigated. Hematoma formation o This is caused by blood leaking into the tissues after failure to penetrate the vein properly during insertion. o To avoid hematoma formation from venipuncture, puncture only the uppermost wall of the vein just under the skin, remove the tourniquet before removing the needle, use the majorsuperficial veins and when it occurs, release the tourniquet immediately, withdraw the needle and apply pressure. Infection o This is caused by inadequate cleansing and poor venipuncture technique o It can be prevented by good aseptic techniques Haemoconcentration o This is caused by prolonged tourniquet application. o It may cause a false increase in potassium ion, phosphorus, ammonia and total protein. Excessive bleeding o This caused by a reduced number of platelets due to either anticoagulants or infection. o The patient should not be left alone until bleeding has stopped. 1.5 Expected Findings and their Dissemination We expect a high number of KUHeS employees to be at a higher risk of developing CVDs Cardiovascular disease prevention is a major health concern across the country. The knowledge of CVD risk factors would help in the implementation of innovative interventions and lifestyle counselling to effectively guide people in developing lifestyle modification and achieve a sustainable behavior change. The study findings will be disseminated to College of Medicine Research and Ethics Committee (COMREC), and will be presented to KUHeS students and stuff.
- ItemRestrictedAssociation between knowledge and adoption of healthy living practices among hypertensive patients at Queen Elizabeth Central Hospital(Kamuzu University of Health Sciences, 2020-11-11) Kakowa, Zinenani; Matsimbe, Thokozani; Kankhuni, MaranathaHypertension remains the most rapidly rising cardiovascular disease in Africa. It is a highly prevalent Non-Communicable Disease (NCD) in Malawi with nearly a third of 25-to-64-year-olds having raised blood pressure or taking antihypertensive medication. Lifestyle modification is the first step in hypertension management. The high prevalence of hypertension calls for implementation of healthy living practices. In Malawi there is limited or no data on the knowledge and practice of healthy living practices among hypertensive patients hence this study. Therefore, this study will focus on the association between knowledge and adoption of healthy living practices among hypertensive patients at QECH. The chief objective is to assess the association between knowledge and adoption of healthy living practices amongst hypertensive patients. This study is necessary because it will enlighten the Ministry of Health on how many hypertensive patients are aware and adopt healthy living practices. Depending on the percentage of those who are aware and those who are not, the Ministry will be able to put in place interventions that will educate people on the healthy living practices hence managing and preventing hypertension. This will be a cross sectional descriptive study and will use mixed methods, both quantitative and qualitative. The study will be conducted at QECH in Blantyre, Malawi as captioned in the title. The study participants will be any patient within the age range of 25 to 64 years old admitted in the medical ward but has hypertension and those hypertensive patients coming to the general clinic. Convenience sampling method will be used to identify possible study participants and 126 participants are expected to be enrolled. The study participants will be only those hypertensive patients that are found at the hospital at that particular time. Data will be collected by doing indepth interviews with the study participants using an interview guide and the data will be analyzed using Epi-info. It is expected that not all the hypertensive patients that are aware of the healthy living practices adopt them, some are aware and adopt the healthy living practices and some who are not aware at all. All ethical regulations will be followed to ensure that the information assembled in this study is acceptable and probable limitations of this study will be managed to ensure that the data is precise. Finally, the data collected from this study will be presented at the CoMREC research dissemination.
- ItemRestrictedEvaluation of a pharmacist-led medication therapy management program for patients with hypertension at a tertiary hospital’s outpatient clinic in Malawi(Kamuzu University of Health Sciences, 2020-10-16) Msowoya, DeniseType of Study: Prospective Parallel Cohort Study Problem: Non-Communicable Diseases (NCDs) are causing significant morbidity and mortality within Malawi’s population. In particular, hypertension is a chronic health problem that often is under prioritized due to high prevalence of infectious diseases. The pharmacy profession is underutilized in efforts to address hypertension in the public health system due to gaps in data supporting ambulatory pharmacists’ inclusion in treatment. Objectives: This parallel cohort study intends to evaluate blood pressure control and adherence in patients receiving standard of care compared to patients receiving standard of care in addition to an ambulatory care pharmacist’s services in a hypertension clinic. Secondary objectives include evaluating goal blood pressure met in both study arms, determining types and quantity of pharmacist interventions, and collecting data on satisfaction and feedback from other healthcare professionals and patients. Methodology: A trained ambulatory care pharmacist will be incorporated into the hypertension clinic at Queen Elizabeth Central Hospital (QECH) from November 2020 to November 2021. There will be two arms of the study: the control arm being standard of care offered at the clinic, the intervention arm being standard of care plus the services of the aforementioned ambulatory care pharmacists. This pharmacist will collect baseline demographic data and treatment status along with treatment progression at follow-ups per the hypertension clinic’s guidelines. Medication adherence will also be monitored between both groups by the pharmacist. Patient satisfaction scores and feedback from the other members of the healthcare team will be collected throughout the study. Analysis of blood pressure changes, patients achieving goal blood pressure, and change in medication adherence will be conducted at 6 months and 12 months. Expected Findings: The expected outcomes will display a statistically significant benefit in health outcomes and adherence through the incorporation of an ambulatory pharmacist compared to the current standard of care. These results will also reveal patient satisfaction scores and healthcare provider feedback that will promote future inclusion of pharmacists in NCD outpatient treatment. Dissemination: The results will be presented at the 2021 International Pharmaceutical Federation (FIP) World Congress of Pharmacy and Pharmaceutical Sciences in Seville, Spain. The associated manuscript will be submitted to the peer reviewed Journal of Pharmacy Practice for publication. In addition, the results will be presented to the Malawi Ministry of Health by the pharmacy department at the College of Medicine to open discussion about creating ambulatory pharmacist positions. Finally, the results will be shared with COMREC upon the completion of the study.
- ItemRestrictedcritical analysis of hypertension care delivered in Balaka, Machinga, Mchinji and Rumphi Health Care facilities(Kamuzu University of Health Sciences, 2020-11-11) Mbulanje, LuciaProblem: Quality care services play an important role in the prevention, management and control of diseases as far as health promotion is concerned. Availability of resources and guidelines are among other things that contribute to achieve quality. However, despite adopting guidelines that promotes quality and universal access for hypertension care in Malawi, the intervention has not been formally assessed in these districts. Objectives: To explore whether and in what ways is hypertension care delivered in health care facilities consistent with WHO and Malawi guidelines for hypertension management. Specifically, this secondary review will assess health care provider’s qualification and expertise in delivering hypertension care, explore availability of guidelines for the management of hypertension at health facilities, explore the availability of the infrastructure and equipment essential for diagnosing and managing hypertension, explore the availability of drugs for the treatment of hypertension and compare the service delivered with what is stipulated in the guidelines. Methodology: This is a cross sectional study utilizing data from the Malawi Longitudinal Study for Families and Health (MLSFH). This secondary review will look into MLSFH data from 4 districts namely Machinga, Balaka, Mchinji and Rumphi. Data was collected from Health Facility managers of the facilities using interviews guided by a structured questionnaire. Data will be analyzed using STATA version 14 and descriptive statistics will be applied to summarize frequencies and proportions. Expected findings: The study will provide information on the extent the health care system is responding to hypertension management in Malawi. Dissemination: Research findings will be disseminated to COMREC, Rumphi, Mchinji and Balaka district health offices. Further manuscripts will be prepared for submission to appropriate journals.