Validation of the haemoglobin colour scale for screening blood donors in Malawi

Background

In 2009 Malawi introduced a new protocol to screen potential blood donors for anaemia, using the WHO Haemoglobin Colour Scale (HCS) for initial screening. Published studies of the accuracy of the HCS to screen potential blood donors show varying levels of accuracy and opinion varies whether this is an appropriate screening test. The aim of the study was to assess the validity of the HCS, as a screening test, by comparison to HemoCue in potential blood donors in Malawi.

Study design and methods

This was a blinded prospective study in potential blood donors aged over 18 years, at Malawi Blood Transfusion Service in Blantyre, Malawi. Capillary blood samples were analysed using the HCS and HemoCue, independent of each other. The sensitivity and specificity of correctly identifying ineligible blood donors (Hb≤12g/dL) were calculated.

Results

From 242 participants 234 (96.7%) were correctly allocated and 8 (3.3%), were wrongly allocated on the basis of the Haemoglobin Colour Scale (HCS) compared to HemoCue, all were subjects that were wrongly accepted as donors when their haemoglobin results were ≤12.0g/dL. This gave a sensitivity of 100% and specificity of 96.7% to detect donor eligibilty. The negative predictive value of the HCS was 100% but the positive predictive value to identify ineligible donors on the basis of anaemia was only 20%.

Conclusions

Initial screening with the HCS correctly predicts eligibility for blood donation in the majority of potential blood donors at considerable cost saving compared with use of HemoCue as the first line anaemia screening test, however, by this method a small number of anaemic patients were allowed to donate blood.     

Socio-demographic characteristics associated with HIV and syphilis seroreactivity among pregnant women in Blantyre,Malawi, 2000–2004

Objectives

We aimed to evaluate socio-demographic factors associated with HIV and syphilis seroreactivity in pregnant Malawians presenting for antenatal care in late third trimester of pregnancy.

Methods

Between December 2000 and March 2004 at Queen Elizabeth Central Hospital Blantyre, Malawi, we collected cross-sectional clinical and socioeconomic data from consenting women. HIV-1 status was determined using rapid HIV antibody tests and syphilis seroreactivity was determined using Rapid Plasma Reagin (RPR) and confirmed with Treponema pallidum hemagglutination assay (TPHA).

Results

Of 3,824 women screened for HIV, 1156 (30%) were HIV seropositive and 198 (5%) were RPR and TPHA seroreactive. In the multivariate analysis, HIV infection was positively associated with elevated socio-economic status, being formerly married, and age, but not with education level. HIV prevalence was lower in women of Yao ethnicity than in other women (OR: 0.78, 95%CI: 0.64 – 0.95). Increased maternal education was negatively associated with syphilis seroreactivity.

Conclusions

The seroprevalence of HIV and syphilis among women attending the antenatal ward in Blantyre remains unacceptably high. Demographic correlates of HIV and syphilis infections were different. Our results demonstrate the need for better strategies to prevent HIV and syphilis in women and calls for optimizing antenatal syphilis screening and treatment in Malawi.     

Environmental risk factors for oesophageal cancer in Malawi: A case-control study

Aim

There is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context.

Methods

A hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated.

Results

Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2–37.7), 5.4 (95% CI: 2.0–15.2) and 6.6 (95% CI: 2.3–19.3), respectively.

Conclusions

Several modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.     

Presentation of Primary Open Angle Glaucoma (POAG) at Lions Sight First Eye Hospital in Blantyre,Malawi

Objective

Primary open angle glaucoma (POAG) is the most common type of glaucoma in Africa. We carried out a study to determine the clinical presentation pattern of patients with primary open angle glaucoma (POAG) at a tertiary hospital in Malawi.

Design

A cross-sectional study

Setting

Lions Sight First Eye Hospital—a major referral and teaching state eye hospital in Blantyre, Malawi

Subjects

Study participants were newly diagnosed POAG patients at specialist eye clinic during study period.

Results

A total of 60 POAG patients were recruited into the study. The mean age was 58.7 years (SD= 16.6, range 18 - 86). There were more male (44, 73.3%) than female (16, 27.7%) patients. The majority of patients (73%) presented one year after onset of visual symptoms. Twenty-six patients (43%) had unilateral blindness (visual acuity < 3/60; WHO classification), while nine patients (15%) presented with bilateral blindness. A vertical cup-to-disc ratio (CDR) of 0.8 or worse was seen in 92 eyes (79%). The mean intraocular pressure (IOP) reading was 35.5 mmHg (SD 13.30). Of the thirty-three eyes that successfully underwent visual field analysis, very advanced defects were recorded in 12 eyes (36%).

Conclusion

This study demonstrates delayed presentation and male predominance among POAG patients at a tertiary eye hospital in Malawi. Glaucoma intervention programmes should aim at identifying patients with treatable glaucoma with particular attention to women.     

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.     

Deficiencies in education and experience in the management of acute kidney injury among Malawian healthcare workers

Background

Acute kidney injury (AKI) is a common but under-recognised disease process, which carries a high risk of mortality or chronic complications, such as chronic kidney disease and other organ dysfunction. Management of AKI, however, is suboptimal, both in developed settings and in Malawi. This is partly because of deficiencies in AKI education and training.

Aim

To establish current levels of AKI education in a range of healthcare workers in Malawi.

Methods

An AKI symposium was held in Blantyre in March 2015. Delegates were asked to complete a survey at the start of the symposium to assess their clinical experience and education in the management of AKI.

Results

From 100 delegates, 89 nurses, clinical officers, and physicians, originating from 11 different districts, responded to the survey. Twenty-two percent of healthcare workers (including 28% of district workers of the various cadres and 31% of nurses) had never received teaching on any aspect of renal disease, and 50% (including 63% of district workers and 61% of nurses) had never received teaching specifically on AKI. Forty-four percent did not feel confident managing AKI, and 98% wanted more support managing patients with renal disease. Thirty-four percent (including 55% of district workers) were unaware that haemodialysis was available at Queen Elizabeth Central Hospital (QECH) for the treatment of AKI and 53% (74% of district workers) were unaware that peritoneal dialysis was available for the treatment of AKI in children. Only 33% had ever referred a patient with AKI to QECH.

Conclusions

There are deficiencies in education about, and clinical experience in, the management of AKI among Malawian healthcare workers, in addition to limited awareness of the renal service available at QECH. Urgent action is required to address these issues in order to prevent morbidity and mortality from AKI in Malawi.     

Factors involved in selection of a career in surgery and orthopedics for medical students in Malawi

Aims

There is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitment into Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students'' choice of careers in surgical disciplines.

Methods

An on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format by several Malawian Medical Students, and then formal survey testing.

Results

Surgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appear to be a factor in specialty choice (p=0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices.

Conclusions

This is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty.     

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.     

Underreporting of side effects of standard first-line ART in the routine setting in Blantyre,Malawi

Introduction

In the Malawi ART programme, 92% of 250,000 patients are using the standard first-line regime of stavudine-lamivudine-nevaripine. National ART reports indicate <4% experience ART side effects, much less than expected from literature.

Methods

We interviewed adult patients on standard first-line ART for at least one year, after routine visits to an urban clinic in Blantyre, Malawi. We determined the prevalence of symptoms that are common side-effects, described discrepancies between symptoms that patients reported to us and those that had been recorded by attending staff as side-effects in the point-of-care electronic monitoring system, and studied factors associated with such discrepancies.

Results

Of 170 participants, 75 (44%) reported at least one symptom, most common were symptoms suggesting peripheral neuropathy (n=57) and lipodystrophy (n=16). Forty-six (66%) symptomatic patients said they reported symptoms to attending ART staff. Side-effects were recorded in the clinic database for just 4 patients. Toxicity recording was too low for meaningful analysis of factors associated with discrepancies between reporting and recording of side-effects. The prevalence of symptoms indicating characteristic side-effects of the standard first-line regimen was 39% based on interviews, and 2% in the electronic monitoring system.

Conclusion

There was gross under-recording of side-effects in this setting, mainly due to not recording by ART staff. Pressure of work and insufficient perceived benefit of side-effect recording are suspected causes. Local and national ART reports do not reflect the true toxicity of the standard first-line regimen.     

Sentinel surveillance of lymphatic filariasis, schistosomiasis soil transmitted helminths and malaria in rural southern Malawi

Background

Baseline prevalence and knowledge, attitude and perception (KAP) survey is a prerequisite for mass drug administration for the control of Lymphatic filariasis (LF) and other neglected tropical diseases.

Methods

In preparation for the first mass drug administration for LF elimination, a baseline survey was conducted in six sentinel sites in the southern Malawi, amongst participants aged five years or more. A standard questionnaire was used to obtain data on socio-demographic factors, ownership and use of bed nets, previous ingestion of ivermectin and KAP toward hydrocele and lymphoedema. Finger prick blood samples were collected from 22:00 to 01:00 hours for LF microscopy, malaria and haemoglobin examination. Stool and urine samples were collected for internal helminths and schistosomiasis respectively.

Results

A total of 1, 903 participants were enrolled. Knowledge on the cause of hydrocele and lymphoedema was low in all the sentinel sites (16%–42%, 10%–24% (respectively). Sexual intercourse with a menstruating woman, bad weather and HIV/AIDS were perceived causes of hydrocele. Microfilaraemia prevalence was 1.5% and varied little between sentinel sites (1.0%–2.1%). Childhood urinary schistosomiasis was common in Phalombe (94.9%) and Blantyre (26.9%).

Conclusion

Integrated approach and understanding of the community KAP is vital or successful implementation of LF elimination programme.     

Safety assessment in primary Mycobacterium tuberculosis smear microscopy centres in Blantyre Malawi: a facility based cross sectional survey

Introduction

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is transmitted mainly through aerosolization of infected sputum which puts laboratory workers at risk in spite of the laboratory workers'' risk of infection being at 3 to 9 times higher than the general public. Laboratory safety should therefore be prioritized and optimized to provide sufficient safety to laboratory workers.

Objective

To assess the safety for the laboratory workers in TB primary microscopy centres in Blantyre urban.

Methodology

TB primary microscopy centers in Blantyre urban were assessed in aspects of equipment availability, facility layout, and work practice, using a standardized WHO/AFRO ISO 15189 checklist for the developing countries which sets the minimum safety score at ≥80%. Each center was graded according to the score it earned upon assessment.

Results

Only one (1) microscopy center out nine (9) reached the minimum safety requirement. Four (4) centers were awarded 1 star level, four (4) centers were awarded 2 star level and only one (1) center was awarded 3 star level.

Conclusion

In Blantyre urban, 89% of the Tuberculosis microscopy centers are failing to provide the minimum safety to the laboratory workers. Government and other stake holders should be committed in addressing the safety challenges of TB microscopy centres in the country to ensure safety for the laboratory workers.

Recommendations

It is recommended that the study be conducted at the regional or national level for both public and private laboratories in order to have a general picture of safety in Tb microscopy centres possibly across the country.     

Perceptions towards private medical practitioners' attachments for undergraduate medical students in Malawi

Objective

To describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors'' offices.

Method

Qualitative cross sectional study conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis.

Results

In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. The lack of formal post-graduate qualifications by most private medical practitioners, and nationally-approved continued medical education programs were mentioned as reasons to suspect that private medical practitioners (PMPs) could be outdated in skills and knowledge. Private medical practitioners however reported participation in credible continued professional development (CPD) programs although these were not necessary for re-registration. Students and faculty suggested that the need for privacy in private institutions unlike in the public teaching hospitals as one reason why patients may not be willing to participate in the teaching in PMPs facilities. The fact that the patients profiles with regard to disease presentation (mostly ambulatory) and higher socio-economic status may be different from patients attending the public, free for service teaching hospital was not seen as a desirable attribute to allocate students to PMPs clinics.

Conclusion

Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.     

Prevalence and correlates of hunger among primary and secondary school children in Malawi: results from the 2009 Global School-based Health Survey

Background

Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.

Methods

The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chi-squared test and logistic regression.

Results

A total of 2359 students were available for analysis. The overall self-reported prevalence of hunger within the last 30 days was 12.5% (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger.

Conclusion

Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger.     

An analysis of Malawi's publication productivity

Background

Publications productivity, the number of scientific articles published, is a measure of a country''s scientific output. If measured carefully it can be a useful indicator that describes a countries'' research activity. Our objective was to analyze trends in publications originating from Malawi between 1996 – 2006.

Methods

The MEDLINE/PubMed database, a registry of articles from over 5,000 scientific journals was searched for articles originating from Malawi between 1996 – 2006 by typing Malawi in the author affiliation search field. A review of abstracts was performed to determine health field and origin of first author — Malawian vs foreign.

Results

506 articles were retrieved of which 489 were on health. 15.5% on TB, 14.5% on HIV and AIDS, 11.2% on infectious disease, 7.2% on TB and HIV, 7.2% on Malaria. 20.9% of the authors were of Malawian origin and Tropical Doctor was the journal that had the most articles originating from Malawi. The number of articles published from Malawi has grown by 106% in the past ten years.

Conclusions

Our results suggest there is growth in scientific publishing in Malawi but the main contribution is from foreign researchers residing in Malawi. More needs to be done to promote publishing by Malawian authors.     

Presentation of child sexual abuse cases to Queen Elizabeth Central Hospital following the establishment of an HIV post-exposure prophylaxis programme

Aims

To review child sexual abuse cases and their management presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, since the introduction of an HIV post-exposure prophylaxis (PEP) programme.

Methods

Demographic and medical data was collected from all children presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi between January 2005 and February 2007 with alleged child sexual abuse (CSA).

Results

Between January 2005 and February 2007, 217 children presented with alleged CSA. This is an average of 3 more per month since the previous year. The results of the physical examination in 60% (130/217) of the cases showed signs of trauma. 63% (137/217) of the cases presented within 72 hours of defilement. Overall in 42% (92/217) of children a one month course of HIV PEP was indicated and given. In 58% (125/217) HIV PEP was not indicated in view of normal examination, presentation too late (>72 hrs after abuse), multiple abuse episodes in the last 6 months, HIV test positive or HIV test refused. In 66% (144/217) of assessed children antibiotic treatment was given for the prevention and/ or treatment of sexually transmitted infections (STIs).

Conclusions

The introduction of an HIV PEP programme for victims of CSA has lead to increased numbers presenting and being treated. In conclusion it is likely that a significant number of children have been prevented from acquiring HIV and other STIs following CSA. The key area where our service needs to be improved is in establishing documented follow up of all cases to monitor medication compliance, side effects and rates of HIV seroconversion following CSA.     

Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Background

Breast cancer is the most common female cancer in Africa, yet no published studies have investigated breast cancer in Malawi. Understanding the clinical profile of breast cancer is important to develop early diagnosis efforts.

Aim

To describe clinical and pathological characteristics of breast specimens from a pathology laboratory at a national teaching hospital.

Methods

Secondary analysis of pathology reports from July 2011 to September 2013.

Results

Among 85 breast cancer cases, 55% were < 50 years. Median tumor size was 4 cm and 49% were grade 3. Median symptom duration was eight months.

Conclusions

Malawian women with breast cancer commonly have long symptom durations prior to diagnosis, young age, and poorly differentiated tumors. Improved clinical and pathological characterization, including hormone receptor status, are urgently needed to better understand this disease in Malawi.     

Neoadjuvant chemotherapy in Albinos with locally advanced skin cancer at a Blantyre Hospital: - Case Series

Albinism in Africa remains a public health concern with increasing numbers of advanced skin cancer in this population at presentation. There are challenges with availability of Radiotherapy (RT) units in Africa which is an important modality for controlling loco-regional disease alone or in combination with surgery. Proposed chemotherapy regimens have not been well validated through Randomized Controlled Trials thus posing difficulties for standard of care for units that do not have access to functional RT facilities. Malawi is one such country without radiotherapy.

Case summary

Seven patients with locally advanced skin cancer were seen in the adult oncology unit at Queen Elizabeth Central Hospital in Blantyre (QECH), Malawi between 2010 and 2013. QECH is one of the teaching hospitals in the country. All were subjected to neo-adjuvant chemotherapy. The primary treatment aim was cyto-reduction followed by surgery whilst the secondary outcome was general symptom control. Three patients achieved complete responses of which two underwent resection and a pectoralis major myocutaneous flap. One had a near complete response and three showed partial responses.

Conclusion

Neo-adjuvant chemotherapy may be a possible.     

Aerobic endurance in HIV-positive young adults and HIV-negative controls in Malawi

Background

Aerobic endurance is an important aspect of physical fitness that enables individuals living with HIV to endure in the work place as well as in agricultural operations in order to earn a living and improve their quality of life. However, despite high HIV prevalence rates, the aerobic endurance status of young Malawians living with HIV remains unknown. The objective of this study was to determine the difference in VO_2max between HIV-negative and HIV-positive individuals in Blantyre, Malawi.

Methods

Fifty five participants (17 males and 38 females) who have HIV and were not taking antiretroviral medication and 78 HIV-negative participants (45 males and 33 females) performed the Rockport submaximal treadmill exercise test. Measures of body weight, post-exercise heart rate and time to walk one mile were obtained and used to predict VO_2max. Comparisons between groups were adjusted for age differences using analysis of covariance (ANCOVA).

Results

VO_2max was significantly lower in HIV-positive subjects [31.1, 28.7 – 33.5mL.kg-1.min-1(mean, 95% CI)] compared with HIV-negative subjects [56.2, 54.3 – 58.1mL.kg-1.min-1].

Conclusion

Aerobic endurance was markedly reduced in HIV-positive participants compared with HIV-negative participants. Findings of the current study implicate factors associated with the HIV infection as contributors to a decreased aerobic endurance in people living with HIV.     

Consumption of sweetened beverages among school-going children in a densely populated township in Lilongwe,Malawi

Background

The growing global childhood obesity pandemic has not spared low-income countries like Malawi, where 8% of children below the age of five years are overweight. Globally, regular consumption of sweetened beverages is implicated among the factors that fuel childhood obesity. Despite the growing problem, there are no local studies on any aspect of sweetened beverage consumption among children in Malawi that could help in guiding interventions and public health nutrition policies.

Aim

We aimed to assess sweetened beverage consumption among school-going children in Chilinde, a densely populated township in Lilongwe, the capital city of Malawi.

Methods

A total of 60 school-going children whose caregivers gave verbal consent were included, and a structured questionnaire was administered to the caregiver (or other knowledgeable and responsible member of the household) of each eligible child.

Results

Our results showed that 50 of the 60 children sampled were consuming a wide-range of sweetened beverages on a regular basis on any day of the week, mostly during meal times (n = 23), before going to school (n = 22), and after school (n = 19). One-third of the children were reportedly consuming up to 300 mL of several sweetened beverages per day.

Conclusion

Like in many countries around the world, consumption of sweetened beverages appears to be common among young school-going children in this urban setting in Malawi. As the country builds public health responses to the growing problem of non-communicable diseases, early preventive interventions among children should be given priority.