Evaluation of antiretroviral therapy results in Blantyre,Malawi

We performed a cross sectional study to evaluate treatment results of the paying antiretroviral therapy clinic of Queen Elizabeth Central Hospital, Blantyre. The only antiretroviral therapy was a fixed drug combination of stavudine, lamivudine and nevirapine.

Methods

Interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. 422 (59 %) of the patients who started antiretroviral therapy since 2000 were lost to follow up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy and personal financial constraints.

Conclusions

1. Many patients were lost to follow up.
2. High nevirapine levels contributed to good therapy results in those studied.
3. Simple adherence questions predicted sub-therapeutic nevirapine levels.
4. Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non-adherence.

     

Quality of life after first-ever stroke: An interview-based study from Blantyre,Malawi

Background

In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL.

Aim

The aim of this study was to describe QOL more than six months after first-ever stroke in Malawi.

Methods

This was an interview-based study about a stroke-surviving cohort. Adult patients were interviewed six or twelve months after their first ever stroke. HIV status, modified stroke severity scale (mNIHSS) score, and brain scan results were recorded during the acute phase of stroke. At the time of the interviews, the modified Rankin scale (mRS) was used to assess functional outcome. The interviews applied the Newcastle Stroke-specific Quality of Life Measure (NEWSQOL). All the data were analysed using Statview™: the X² test compared proportions, Student''s t-test compared means for normally distributed data, and the Kruskal-Wallis test was used for nonparametric data.

Results

Eighty-one patients were followed up at least six months after the acute stroke. Twenty-five stroke patients (ten women) were interviewed with the NEWSQOL questionnaire. Good functional outcome (lower mRS score) was positively associated with better QOL in the domains of activities of daily living (ADL)/self-care (p = 0.0024) and communication (p = 0.031). Women scored worse in the fatigue (p = 0.0081) and cognition (p = 0.048) domains. Older age was associated with worse QOL in the ADL (p = 0.0122) domain. Seven patients were HIV-seroreactive. HIV infection did not affect post-stroke QOL.

Conclusion

In Malawi, within specific domains, QOL after stroke appeared to be related to patients'' age, sex, and functional recovery in this small sample of patients.     

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre,Malawi

Background

Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations.

Aim

To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables.

Methods

We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or blood-borne infection. We performed the haematological tests at the Malawi-Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories.

Results

Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer''s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer''s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups.

Conclusions

Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results.     

Falls and other geriatric syndromes in Blantyre,Malawi: a community survey of older adults

Background

The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi.

Methods

This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on age-associated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out.

Results

Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), self-reported memory problems (p=0.004) and AMT score < 7 (p=0.02).

Conclusions

Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.     

Prevalence of HIV,HepBsAg and Hep C antibodies among inmates in Chichiri prison,Blantyre, Malawi

Objective

To determine HIV, HepatitisBsAg and Hepatitis C antibodies including knowledge, attitudes, practices and risk factors that may facilitate the spread of HIV among inmates at Chichiri Prison, Blantyre, Malawi.

Design

This was a cross sectional study. Informed consent was sought from each of the participants before interviewer-administered questionnaires were used to collect socio-demographic data. Blood specimens were collected for HIV and hepatitis B and C serology.

Setting

Chichiri Prison in Blantyre which is one of the largest prison facilities in Malawi. Adult males and female inmates participated while juveniles were excluded.

Results

A total of 164 prison inmates comprising 142 males (86.6%) and 22 females (13.4%) participated in the study. The age range was 18–65 years with mean age at 28.6 years. Overall HIV prevalence rate was 36.6%; among male inmates it was 29.9%, and among the 22 female inmates tested, 11(50%) were reactive. Five males (3.5%) tested positive for HepBsAg with one of them dually infected with HIV. All participants were hepatitis C negative. 141 (86%) inmates acknowledged that they knew that man to man sex occured in the prison, 55(33.5%) believed that mosquito bites could spread HIV; 33(20.1%) said that sex was the only way HIV could be spread, 8(4.9%) thought that HIV/AIDS could be spread through food sharing. 20 (12.2%) believed that HIV couldn''t be spread from mother to child and 135 (82.3%) acknowledged that tattooing was practiced among the inmates. 130(79.3%) acknowledged knowledge of use of cannabis in prison; 3 (2.1%) male inmates actually accepted being homosexuals. None of the inmates reported knowledge of use of injectable drugs within the prison.

Conclusions

HIV prevalence rate (36.6 %) at the Chichiri Prison is higher than the national average of 14%, while female infection rates were higher than males. There are gaps in the inmates'' knowledge of the epidemiology of HIV which need to be bridged through awareness programmes. Homosexuality and injecting drug use may not be a major factor in HIV transmission within prisons in Malawi. The low prevalence of Hepatitis BsAg (3.5%) and the inability to detect Hepatitis C antibodies deserve further study.     

Abstracts of the 1st Annual Malawi Mental Health Research andPractice Development Conference, 7th & 8th February 2011, Blantyre,Malawi

Introduction

Contemporary mental services delivery is moving towards cost-effective community based as opposed to institutionalized care (Harrison, Alam & Mashall, 2001). Domiciliary mental health care is one example of such service that is being promoted in developed countries. Domiciliary mental health care refers to the delivery of mental health services in the home for purposes of restoring and maintaining the health of clients when they are in acute state (Campbell, 1996). This paper highlights successes and lessons learnt in the domiciliary mental health care approach that St. John of God Community Services is implementing in the northern city of Mzuzu.

Objectives of the program

The broad objective of domiciliary mental health care in Mzuzu service is to provide an alternative community based mental health care to clients with mental health problems in the city of Mzuzu and its environs through care delivery, family education, community participation and alleviation of stigma associated with psychiatric admission.

Strategies

Strategies used in the program include provision of nursing care to clients in their homes; mobile clinics and mental health education to family members and the entire community.

Successes

Some successes of this cost-effective initiative include attainment of optimum level of functioning by 275 clients since establishment in 2006; reduced recovery period when compared with those in residential unit; family/community involvement, reduced stigma associated with admission to a psychiatric hospital and the freedoms enjoyed whilst in the homes.

Challenges

The biggest challenge is that some carers do not cooperate and prefer that their client be managed in the hospital even when client is less problematic at home.

Conclusion

Domiciliary mental health care is cost-effective and feasible in Malawi provided families are given support within their communities.

• Malawi Med J. 2011 Sep; 23(3): 99–103.
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• Increasing the Capacity of Health Surveillance Assistants in Community Mental Health Care in Zomba District — Interim Findings of an Education Intervention

2011 Sep; 23(3): 99–103.

Increasing the Capacity of Health Surveillance Assistants in Community Mental Health Care in Zomba District — Interim Findings of an Education Intervention

Jerome Wright, Dr Stephanie Common, Dr Felix Kauye, and Mr Chikayiko ChiwandiraAuthor information Copyright and License information Disclaimer“Zomba Link”, Harrogate, UK and Zomba Mental Hospital, Zomba, MalawiCopyright notice