Prevalence and correlates of herbal medicine use among Anti-Retroviral Therapy (ART) clients at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi: a cross-sectional study

BackgroundThere has been an unprecedented explosion in the popularity of herbal preparations during the last few decades. Herbal medicines are commonly used by HIV/AIDs clients. There is limited data on the prevalence of herbal medicine and correlating factors of herbal medicine use in Malawi. This study establishes prevalence and factors contributing to the use of herbal medicine among HIV/AIDS clients attending the ART clinic at QECH, Blantyre Malawi.MethodsA cross-sectional study design was used to interview 211 conveniently sampled clients at QECH ART clinic. The questionnaire addressed socio-demographic, clinical characteristics, NCD-HIV comorbidity, and herbal medicine utilization. The main outcome of the study was herbal medicine use since the initiation of ART. Logistic regression analysis was done in Stata version 16. Both unadjusted and adjusted models were fitted for potential confounders.ResultsThe prevalence of use of herbal medicine was reported in 17.5% (n=37) of the ART clients. The adjusted logistic regression analysis showed that urban residence was statistically associated with reduced use of herbal medicine (adjusted Odds Ratio – AOR: 0.04, 95% CI: 0.169, 0.976).ConclusionThere is a high prevalence of use of herbal medicine among clients taking ART. Herbal Medicine has the potential to cover the gaps in health coverage in rural communities.     

Maternal mortality at Queen Elizabeth Central Hospital, 1989 to 1990

An obstetrician examined records of all maternal deaths that occurred in the Chatinkha Maternity Wing of Queen Elizabeth Central Hospital in Blantyre, Malawi, during 1989-1990. None of the deaths were caused by conditions unrelated to pregnancy. In 1989 there were 78 maternal deaths out of 14,272 live births (a maternal mortality ratio of 546/100,000 live births). In 1990 there were 73 maternal deaths out of 14,281 live births (a maternal mortality ratio of 511/100,000 live births). In each year, 37 women died directly from complications of pregnancy, delivery, or their management. In 1989, the leading cause of maternal death was postabortal sepsis (15 cases), followed by obstructed labor (8 cases) and puerperal sepsis (6 cases). In 1990, the leading causes were puerperal sepsis (13 cases) and postabortal sepsis (10 cases). The number of HIV-seropositive women among direct maternal deaths was 8 for both years. In 1990, the cesarean section rate was 6.5%. Women who had undergone a cesarean section faced a risk of puerperal sepsis-related death 8.5 times greater than that of women who had delivered vaginally. The 1990 mortality rate among induced abortion cases may have been as high as 8%. There were 41 and 36 indirect maternal deaths in 1989 and 1990, respectively. The leading causes of indirect maternal death were fever (8 cases) and bacterial meningitis (5 cases). The cause could not be determined in 15 cases. By 1990, the leading causes of indirect maternal death were bacterial meningitis (8 cases) and AIDS (6 cases). 5 of the 8 bacterial meningitis cases tested positive for HIV. The 4 patients with tuberculosis and 3 patients with septicemia were HIV positive. 41% and 56% of maternal deaths in 1989 and 1990, respectively, were avoidable. When one excluded uncertain avoidable factors, 21% and 45% of maternal deaths could not be avoided. The leading avoidable factors were deficient hospital care (18 cases), patient's delay (12 cases), and illegal abortion (10 cases) in 1989; they were patient's delay (10 cases) and illegal abortion (8 cases) in 1990.     

Patients' satisfaction with reproductive health services at Gogo Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi

Patient satisfaction is an individual''s state of being content with the care provided in the health system. It is important for reproductive health care providers to get feedback from women regarding satisfaction with reproductive health services. There is a dearth of knowledge about patient satisfaction in Malawi.

Aim

The specific objective of the study was to determine the extent to which women are satisfied with the care they receive when they come to deliver at the Queen Elizabeth Central Hospital maternity unit.

Methods

A cross sectional study of postpartum women using interviewer administered semi-structured questionnaires was conducted between November 2008 and May 2009. The questionnaires captured mainly quantitative data.

Results

1562 women were interviewed. Most women were housewives (79%) who were referred from Health Centres within the city. Ninety five percent delivered a live baby. The majority of women (97.3%) were satisfied with the care they received from admission through labour and delivery and the immediate postpartum period. Most women cited doctors'' and nurses'' reviews (65%) as what they liked most about the care they received during their stay in the unit.Most women expected to receive efficient and definitive care. The women''s knowledge on patient''s rights was extremely low (16%) and equally very few women were offered an opportunity to give an opinion regarding their care by the doctors and nurses in the maternity unit.

Conclusion

Most women who deliver at the hospital are satisfied with the care offered. This satisfaction is mainly due to the frequent reviews of patients by nurses and doctors in the unit. There is a great need to educate both the population of women served and the health workers that serve them on patient''s rights.     

Epidemiology of paediatric trauma admissions at Queen Elizabeth Central Hospital,Blantyre

We conducted an audit of paediatric trauma admissions to QECH, Blantyre, in September 2003. There were 107 trauma cases representing 8.8% of all paediatric admissions and mean age was 6 years. The commonest cause of trauma was falls (42.9%) followed by burns (31.8%) and road traffic accidents (14.9%). Of the road traffic accidents, only one case was a passenger, the rest were pedestrians hit by moving vehicles. Fracture of limbs was the commonest injury sustained (44.9%) and burns the second commonest injury (31.8%). Most (52.6%) children were brought into hospital within 24 hours of injury while 26.3% came in between 24 hours and 48 hours and 21.1% after 48 hours or more. Death occurred in 7.5% of cases. The mean number of days in hospital was 8.9 days.     

Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre,Malawi

Introduction

Jaundice is the yellowish pigmentation of the skin, sclera, and mucous membranes resulting from bilirubin deposition. Children born to mothers with HIV are more likely to be born premature, with low birth weight, and to become septic—all risk factors for neonatal jaundice. Further, there has been a change in the prevention of mother-to-child transmission (PMTCT) of HIV guidelines from single-dose nevirapine to a six-week course, all of which theoretically put HIV-exposed newborns at greater risk of developing neonatal jaundice.

Aim

We carried out a study to determine the incidence of severe and clinical neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH) in Blantyre.

Methods

Over a period of four weeks, the incidence among non-exposed neonates was also determined for comparison between the two groups of infants. Clinical jaundice was defined as transcutaneous bilirubin levels greater than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific treatment threshold according the QECH guidelines. Case notes of babies admitted were retrieved and information on birth date, gestational age, birth weight, HIV status of mother, type of feeding, mode of delivery, VDRL status of mother, serum bilirubin, duration of stay in CN, and outcome were extracted.

Results

Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed. One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIV-non-exposed infants developed severe jaundice requiring therapeutic intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%) of the non-exposed neonates had clinical jaundice of bilirubin levels greater than 5 mg/dL (p < 0.001).

Conclusions

The study showed a significant difference in the incidence of clinical jaundice between the HIV-exposed and HIV-non-exposed neonates. Contrary to our hypothesis, however, the incidence was greater in HIV-non-exposed than in HIV-exposed infants.     

Ocular infection from Staphylococcus aureus bacteraemia in a sero-positive HIV patient from Queen Elizabeth Central Hospital,Blantyre, Malawi

Ocular involvement in Staphylococcus aureus bacteraemia occurs with metastatic infection and has been identified as an independent risk factor for mortality. It manifests as either endophthalmitis or chorioretinitis and often leads to visual loss, particularly with delayed diagnosis. We present a case report of endogenous endophthalmitis and chorioretinitis in the background of methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia in a 23-year-old HIV-positive woman.     

An audit of Heart failure management among ambulatory adult patients at Queen Elizabeth Central Hospital (QECH), Malawi

BackgroundThere are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi.MethodsIn a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities.ResultsA total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5–70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodeling. Most patients were on at least a single neurohormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively.ConclusionsHypertension is the commonest comorbidity in patients with heart failure, who are mostly females with NYHA class I or II symptoms. Most had LV remodeling changes and are on at least one neurohormonal antagonist but most remain sub optimally treated.     

Adult pedestrian and cyclist injuries in Lilongwe,Malawi: a cross-sectional study

BackgroundPedestrian and cyclist injuries are a major concern globally, but especially in low-income countries. Locally conducted research is needed to measure the size of the problem and advise policy on road safety interventions. We wanted to investigate the precise circumstances of these injuries in Lilongwe, Malawi and to identify risk factors for severe injuries.MethodsCross-sectional study of all adult pedestrian and cyclist injuries presenting to a large central hospital. This was a sub-study of a larger study with all types of road users included. All patients provided detailed information about the incidents leading to injury and were tested for alcohol.ResultsThere were 222 pedestrians, 183 bicycle riders and 42 bicycle passengers among the 1259 adult road traffic injury victims that were treated at Kamuzu Central Hospital during a 90-day period in 2019. Of these injuries, 60.2% occurred while the victim was walking/cycling along the road and 22.3% when the victim was trying to cross the road. The majority of the victims were men (89.1%). Helmet use for bicyclists was almost non-existent. Only 1 patient had used reflective devices when injured in the dark, despite 44.7% of these injuries occurring in reduced light conditions. There was an increased risk for serious and fatal injuries for pedestrians compared with bicyclists, and also compared with all types of road users. Patients injured in rural areas and those hit by lorries were more severely injured. Consuming alcohol before being injured was associated with more severe injuries in bicyclists. Being injured while crossing the road at painted zebra crossings was associated with an increased risk of serious and potentially fatal injuries.ConclusionThis study identified important risk factors for severe injuries in pedestrians and cyclists. Implications for preventive measures are presented in a Haddon Matrix.     

多胎妊娠减胎术对妊娠结局妊娠期并发症及新生儿出生结局的影响

目的探讨多胎妊娠减胎术(MPR)对妊娠结局、妊娠期并发症和新生儿出生结局的影响。方法收集2005年1月至2016年1月在安徽医科大学第一附属医院生殖中心行MPR的孕妇479例为减胎组,选取243例同期怀孕女性为对照组,比较两组孕妇妊娠结局、妊娠期并发症和新生儿出生结局。根据减胎后保留胚胎数,将减胎组分为保留双胎组(n=245)与保留单胎组(n=234)。根据妊娠胚胎数,将对照组分为普通双胎组(n=133)与普通单胎组(n=110),比较4组孕妇妊娠结局、妊娠期并发症和新生儿出生结局。结果减胎组(保留双胎组与保留单胎组)的自然流产率(10.61%和9.83%)均高于普通双胎组(0.75%),保留双胎组的自然流产率高于普通单胎组(3.64%),差异有统计学意义(P<0.05)。保留双胎组与普通双胎组的妊娠期高血压、胎膜早破、早产及新生儿低出生体质量(保留双胎组分别为8.98%、13.47%、41.10%和42.30%,普通双胎组分别为9.02%、11.28%、39.39%和42.80%)的发生率均高于保留单胎组、普通单胎组,新生儿平均出生体质量低于保留单胎组、普通单胎组,差异均有统计学意义(P<0.05)。结论 MPR可能会导致自然流产、自然减胎的风险增加。MPR后保留胎儿数以及正常妊娠胎儿数是影响妊娠期并发症和新生儿出生结局的重要因素。     

An audit of deliveries and outcome at Queen Elizabeth Central Hospital,Blantyre, in 1999

A one-year audit of deliveries at Queen Elizabeth Central Hospital, Blantyre, was undertaken for 1999. The main objective of the audit was to obtain baseline data on forms of deliveries and pregnancy outcome. A total of 12,293 births occurred during the study period. Of these, 11,565 were singleton deliveries, 349 twin deliveries and 10 triplets. Characteristics of singleton deliveries were analysed further when data were available. The age distribution of the mothers ranged from 10 to 55 years with a mean age of 23.4 years. Of 10,314 singleton deliveries, 8710 (84.4%) were spontaneous vertex deliveries, 1121 (10.8%) were caesarian section, 304 (2.94%) were vacuum extraction and 169 (1.63%) were assisted breech deliveries. Breech deliveries had the worst outcome. The maternal mortality rate for the year 1999 was 1224 per 100,000 live births and the perinatal mortality rate was 49.3 per 1000 live births.     

Post exposure prophylaxis of HIV transmission after occupational injuries in Queen Elizabeth Central Hospital, Blantyre, Malawi, 2003 - 2008

Health care worker (HCW) in Malawi may acquire HIV infection through occupational injuries, in particular since HIV prevalence among inpatients and incidence of occupational injuries are high. A post exposure prophylaxis (PEP) programme for occupational injuries at Queen Elizabeth Central Hospital (QECH) commenced in 2003. We performed an audit of this programme from 2003 through 2008. 203 Occupational injuries were reported. The majority were needle stick injuries (76.3%). Half of the clients were in a training position. A dual ART regimen was most frequently prescribed. Triple therapy use increased over time and was more frequent in expatriate students. Many nurses and clinical officers were not fully vaccinated for HBV. Based on previous incidence data, occupational injuries were likely to be underreported. Data on side effects were incomplete, however PEP discontinuation due to side effects occurred only twice. Follow up visits were poorly attended, therefore the efficacy of PEP could not be evaluated. Prevention efforts for occupational injuries should be increased and specifically target HCWs in training positions. Measures to improve quality of the PEP programme include effective publicity campaigns, compulsory Hepatitis B vaccination and active tracing of HCWs who default follow up after PEP.     

Availability,Accessibility and Proper Use of Personal Protective Equipment in Wards at Queen Elizabeth Central Hospital (QECH) Blantyre,Malawi: An Observational Study

BackgroundThe purpose of this study was to evaluate the availability, accessibility and proper use of personal protective equipment (PPE) in the wards at Queen Elizabeth Central Hospital (QECH).MethodsWe conducted an observational study with a cross-section design. Convenience sampling method was used for selection of healthcare workers (HCWs) in wards. HCWs filled a checklist on accessibility of PPEs and they were observed on proper use of PPE while conducting clinical procedures. Nurse ward in-charge was asked to fill out a checklist on availability of PPE in their ward.ResultsPPE was available in 75.8% of wards, not available in 12.5%. Goggles were absent in 70.8% of wards. PPEs were 71.4% accessible and 28.6% inaccessible to healthcare workers in the wards. The most inaccessible PPEs were goggles (83.2%) and footwear (73.7%) while facemasks, sterile and non-sterile gloves and aprons were readily accessible. Non sterile gloves were 100% available and accessible. Only 13.5% of the HCWs had good compliance with PPE standard procedures. The average PPE compliance score of those who had been trained was 6 % greater than those who were not trained.ConclusionThis study identified areas of improvement in healthcare system delivery regarding standard precautions with emphasis on PPE. Improvements in training during professional college education and in-service refresher training could improve compliance with appropriate use of PPE for relatively low cost. Management support could improve availability and accessibility of PPE in the wards at QECH, with active supervision to improve adherence levels to personal protective equipment usage. The study can also help in the development of policies and guidelines regarding PPE usage by showing that most HCWs need to be trained in proper PPE usage.     

A multidrug-resistant Stenotrophomonas maltophilia clinical isolate from Kamuzu Central Hospital,Malawi

BackgroundStenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi.MethodsA ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to the National Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate''s multidrug-resistance (MDR) phenotype.ResultsSm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all β-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded bla_L1 metallo-β-lactamase and bla_L2 β-lactamase genes; this was consistent with the isolate''s resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate.ConclusionHerein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism.