Tuberculosis Drug Resistance and Outcomes among Tuberculosis Inpatients in Lilongwe,Malawi

Setting/Objective

We evaluated clinical characteristics, yield of solid vs. liquid culture, polymerase chain reaction (PCR)-based drug-resistance profiles, and clinical outcomes of tuberculosis (TB) inpatients in Lilongwe, Malawi.

Design

We enrolled adult patients admitted to the Bwaila TB Ward from Jan-Aug/2010. Evaluations included questionnaires, clinical exam, chest radiograph, HIV status, CD4 lymphocyte count, plasma HIVRNA and sputum analysis including Auramine-O stain, Lowenstein-Jensen (LJ) and Mycobacterial Growth Indicator Tube (MGIT) culture, and susceptibility testing using the HAIN GenoType® MTBDRplus.

Results

Eighty-eight patients were enrolled (88% re-treatment, 42% smear positive, 93% pulmonary TB, 74% HIV co-infected). At baseline, 44/88 (50%) MGIT and 28 (32%) LJ cultures were positive with a mean time to positivity of 12.1 (Range 1–42) and 21.5 (Range 7–58) days, respectively. Four percent (3/77) of retreatment patients or 8% of the 38 MGIT+ PCR-confirmed retreatment cases had multi-drug resistant tuberculosis (MDR TB). One MDR TB patient was smear negative and only one MDR patient was identified with LJ. Lower mean hemoglobin at admission was associated with mortality (10.5 vs. 7.5; p<0.01; CI 101 9.8–11.0).

Conclusions

The MDR TB burden among the retreatment population in Lilongwe, Malawi is similar to regional estimates by the WHO (7.7% 95% CI 0–18.1). MDR TB patients are not routinely identified with sputum smear or LJ, suggesting more efficient technology should be adopted.     

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.     

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.     

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.     

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.     

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.     

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.     

Health Professionals Expose TB Patients to Stigmatization in Society: Insights from Communities in an Urban District in Ghana

Objectives

To determine how the activities and attitudes of health professionals expose TB patients to stigmatization in the community.

Design

Qualitative research approach using individual interviews and focus groups

Setting

Shama Ahanta East Metropolitan district in the western region of Ghana

Participants

Members in nine communities in the district

Outcome measures

Words and statements that depict how activities and attitudes of health professionals may expose TB patients to stigmatization

Results

Five interrelated ways by which activities and attitudes of health professionals may expose TB patients to stigmatization in the community were identified in data: TB control practices; fear-based responses to TB; inappropriate health education messages; medical licensing for sellers; and prohibition of burial rites.

Conclusions

The findings may explain the diagnostic delay and low TB case detection rate in Ghana. This calls for intensification of education on TB and regular organization of refresher courses and possibly retraining of health professionals in TB control and management. When health professionals are seen to be treating TB patients as ‘normal’ individuals, it has the potential of changing the society''s perception about the disease.     

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Introduction

Up to half of all children presenting to Nutrition Rehabilitation Units (NRUs) in Malawi with severe acute malnutrition (SAM) are infected with HIV. There are many-similarities in the clinical presentation of SAM and HIV. It is important to identify HIV infected children, in order to improve case management. This study aims to identify features suggestive of HIV in children with SAM.

Methods

All 1024 children admitted to the Blantyre NRU between July 2006 and March 2007 had demographic, anthropometric and clinical characteristics documented on admission. HIV status was known for 904 children, with 445 (43%) seropositive and 459 (45%) seronegative. Features associated with HIV were determined.

Results

Associations were found for the following signs: chronic ear discharge (OR 14.6, 95%CI 5.8–36.7), lymphadenopathy (6.4, 3.5–11.7), clubbing (4.9, 2.6–9.4), marasmus (4.9, 3.56.8), hepato-splenomegally (3.2, 1.8–5.6), and oral Candida (2.4, 1.8–3.27). Any one of these signs was present in 74% of the HIV seropositive, and 38% of HIV uninfected children. A history of recurrent respiratory infection (OR 9.6, 4.8–18.6), persistent fever, recent outpatient attendance, or hospital admission were also associated with HIV. Persistent diarrhoea was no more frequent in HIV (OR 1.1). Orphaning (OR 2.1,1.4–3.3) or a household contact with TB (OR 1.7,1.1–2.6), were more common in HIV. Each of these features were present in > 10% of seropositive children. HIV infected children were more stunted, wasted, and anaemic than uninfected children.

Conclusions

Features commonly associated with HIV were often present in uninfected children with SAM, and HIV could neither be diagnosed, nor excluded using these. We recommend HIV testing be offered to all children with SAM where HIV is prevalent.     

Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim

Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers'' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided.

Methods

This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC).

Results

Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians'' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care.

Conclusion

Serious deficiencies in providers'' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.     

A pilot study to evaluate the diagnostic accuracy of local terminology for malaria screening among children in rural Malawi

Background

Malaria is a serious health problem in Malawi. It is responsible for 43% of all out patient visits and 19% of all deaths occurring to children under five years of age. Rapid diagnosis and appropriate treatment can avert most malaria deaths. However this is not always possible in resource limited settings where functioning laboratories are almost nonexistent.

Methods

This paper assesses the accuracy of local terminology in detecting parasitemia in children using blood smears as the reference standard.

Results

The study observes that there are local terms that can be used as an inexpensive, readily available and easily implementable malaria screening test in Malawian children in rural areas. These terms include “malungo” (official name for malaria), “kutentha thupi” (hot body), “kutsegula m''mimba” (official term for diarrhoea) and “kukhosomola” (coughing). The local terms “malungo” and “kutentha thupi” yielded better results.

Conclusion

Although the local terminology produced results that are less than optimal, the study concludes that the knowledge of sensitivity and specificity of local terminology can be used by local healthcare practitioners to identify children who could benefit from malaria confirmation testing and presumptive treatment. The study, however, cautions that these terms should be used as an entry point to malaria case management as they do not distinguish the severity of the malaria infection and all of them produced a sensitivity of less than 50%.     

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.     

HIV and AIDS workplace interventions; Gaps between policy and practice at the College of Medicine

Introduction

This study set out to identify gaps between policy and practice of HIV and AIDS workplace interventions in the University of Malawi, in particular College of Medicine in line with the UNIMA HIV and AIDS policy.

Objectives

The main objective was to establish whether the HIV and AIDS workplace interventions at College of Medicine were in line and guided by the University of Malawi HIV and AIDS policy.

Methods

This was a cross sectional qualitative study. A random sample of 25students and 15 members of staff were interviewed using in-depth interviews. Interviews were tape-recorded and data was analyzed using thematic content analysis.

Results

There are a number of activities relating to HIV and AIDS in place while others are still in the pipeline, however the majority of respondents did not know about the UNIMA HIV and AIDS policy or any HIV and AIDS activities that are guided by the policy. This is due to lack of interest on their part or lack of knowledge on the existence of the workplace programme.

Conclusion

The COM HIV and AIDS committee should strive to fast track key programme areas such as VCT centre and clinic and coordination of different activities to increase programme visibility and patronage.     

Abstracts of the 15th College of Medicine dissemination conference

Background

Contact tracing (CT) has rarely been used to improve HIV case finding in sub-Saharan Africa because of concerns regarding privacy protection and possibly high costs.

Methods

We estimate the relative cost of identifying an undiagnosed HIV infection through CT compared with client-initiated voluntary counseling and testing (VCT) and door-to-door provider-initiated testing (PIT). We used data from the Likoma Network Study, a study of sexual networks and HIV infection conducted on the small island of Likoma in northern Malawi, to inform these calculations.

Results

In Likoma, the probability that partners of HIV index cases could be traced and that they would consent to HIV testing and counseling was high and varied by partner type. HIV prevalence ranged from 48.1% to 66.7% among the partners who were tested. Per newly diagnosed infection, CT is rarely a cheaper case finding approach than VCT in populations with HIV prevalence > 5%. In populations with HIV prevalence < 5%, CT is an attractive case-finding approach relative to VCT when few HIV infected individuals are aware of their status. Compared with door-to-door PIT, CT is almost always preferred when the population prevalence is below 10%, unless CT costs are prohibitively high. When HIV prevalence is > 10%, providing CT for current spouses of index cases remains an attractive approach to HIV case finding.

Conclusions

CT could complement client-initiated VCT or door-to-door PIT in a large number of Malawian and sub-Saharan populations affected by generalized epidemics of varying magnitudes.

• Malawi Med J. 2011 Dec; 23(4): 129–160.
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• Do Peripheral Blood Monocytes Perform Innate Immune Functions Similar to Macrophages?

2011 Dec; 23(4): 129–160.

Do Peripheral Blood Monocytes Perform Innate Immune Functions Similar to Macrophages?

D Banda, K Jambo, D Russell, R Heyderman, and H Mwandumba Copyright and License information DisclaimerCopyright notice     

HIV Disclosure: Parental dilemma in informing HIV infected Children about their HIV Status in Malawi

Background

Increasingly many perinatally HIV-infected children are surviving through adolescence and adulthood as a result of improvements in the management of paediatric HIV infection, particularly the increased use of combination therapy. It is usually the parents or guardians of these children who are faced with the task of informing the child living with HIV about his or her positive status. However, many parents—particularly biological parents —find this disclosure process difficult to initiate, and this study explored some of the difficulties that these parents encounter.

Objective

This study set out to explore potential factors that challenge parents and guardians when informing their perinatally HIV-infected child about the child''s HIV status.

Design

This was a qualitative narrative study that employed in-depth interviews with parents or guardians of children perinatally infected with HIV. A total of 20 parents and guardians of children who attend the outpatient HIV clinic at the Baylor College of Medicine-Abbott Fund Children''s Clinical Centre of Excellence (COE) in Lilongwe, Malawi were interviewed. Of these, 14 were biological parents and six were guardians.

Results

Guardians and parents expressed uneasiness and apprehension with the disclosure conversation, whether or not they had already told their child that he or she had HIV. Participants who had not told their children recounted that they had contemplated starting the conversation but could not gather enough courage to follow through with those thoughts. They cited the fear of robbing their child of the happiness of living without the knowledge of being positive, fear of making their own status known to more people, and fear of confrontation or creating enmity with their child as impediments to disclosing their child''s positive HIV status to him or her.

Conclusions

It is apparent that guardians—more particularly biological parents—of children perinatally infected by HIV find it difficult to inform their children about their children''s HIV status. From this disempowered position, parents dread the disclosure of a positive HIV status to a child as a psychosocial process that has the potential to disturb a family''s previously established equilibrium with threats of stigmatization, marginalization, and parent-child conflict. This calls for strategies that could support parents to make disclosure to the child less challenging.     

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background

Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization''s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.

Methods

A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.

Results

Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.

Conclusions

The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.     

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.