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.     

Determinants of Nutritional Status of School Children

Background

A cross sectional study was carried out to determine the nutritional status of school children in Army School, Pune.

Methods

Anthropometric survey of 760 school children was carried out and compared against the NCHS/WHO reference standards to determine their nutritional status. Associations of nutritional status with socio-economic status, education status of parents, mothers working status and family size were determined.

Result

The prevalence of stunting was 13.81%, wasting 6.71% and under nutrition 9.87%. Mothers’ educational level, wasting, socio economic status and family size were significantly associated with the nutritional status of the child.

Conclusion

Maternal educational status, socio-economic status and family size are important determinants of nutritional status of school children.Key Words: Nutritional status, Maternal education     

Study of Disorders of Visual Acuity among Adolescent School Children in Pune

Background

Disorders of visual acuity are known to affect the learning abilities of school children. Various authors have reported varying prevalence in India and abroad.

Methods

A rapid, community based survey was conducted to assess the prevalence of disorders of visual acuity among adolescent school children in three schools in Pune Cantonment. A sample of 236 children studying in six sections were examined after random selection by a two stage sampling technique ensuring representation to each of the classes. Visual acuity was assessed for all the children available in the selected section on the date of survey. A questionnaire based study of the knowledge and attitude of the parents of the 50 affected children was also conducted.

Result

50 children (25 males and 25 females) were found to have errors of refraction, resulting in prevalence rate of 21.19% with confidence intervals of 15.97% to 26.40%.

Conclusion

The study highlights significantly high prevalence of uncorrected errors of visual acuity among adolescent school children as well as the need for instituting IEC activities aimed at improving the general lack of appreciation of the seriousness of the problem by the parents and consequent neglect of urgent corrective measures.Key Words: Visual defects, Adolescent school children     

Risk Factors for Suicide in Wives of Military Personnel

Background

An increasing trend in attempted and completed suicide amongst wives of serving personnel was observed.

Methods

A questionnaire designed to elicit the known risk-factors for suicide, suicide attempts and suicidal ideation by women in the Indian context was administered to 222 wives of Indian military personnel living in a garrison with their husbands.

Result

A large number (28%) of the sample were child-less. Alcoholism in husband was reported by 22 women and domestic violence by four. Six had been bereaved in the past year. Chronic illness was reported by 10 women and psychiatric illness by four.

Conclusion

Wives of military personnel may need targeted community interventions focusing on the risk factors for suicide.Key Words: Suicide: Community, Risk-factors, Wives of military personnel     

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.     

Study of blood pressure profile of school children 6–15 years in a rural setting of Maharashtra

Background

High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra.

Aim & objectives

This cross sectional study was carried out to determine the prevalence of hypertension in children 6–15 years and to study the association between selected variables and blood pressure.

Material & methods

This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests.

Results

The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males.

Conclusion

In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this 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.     

A study to determine the prevalence of pulmonary arterial hypertension in children with Down syndrome and congenital heart disease

Background

Down syndrome (DS) is a common chromosomal abnormality associated with congenital heart disease (CHD). These cardiac abnormalities are known to be associated with pulmonary arterial hypertension (PAH).

Methods

The aim of this study was to assess the prevalence of PAH in DS children with CHD and to compare it with PAH prevalence in non-syndromic children with CHD. It was a cross-sectional study including all children presenting to Cardiology Department at a tertiary care center between Jan 2007 and Dec 2010.

Results

Thirty-five DS children with CHD were compared with 38 non-syndromic children with CHD. Atrioventricular septal defect (AVSD, 13/35) was the commonest CHD among DS children while isolated VSD (26/38) accounted for maximum cases in non-syndromic CHD. PAH was more prevalent among DS children with CHD (18/42) than among the control group (7/38, p = 0.038). In addition, 14/19 patients with AVSD in the entire cohort developed PAH.

Conclusion

DS children with CHD have a higher predisposition to develop PAH, and the likelihood is highest with underlying AVSD.     

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.     

The Prevalence of Depression among patients and its detection by Primary Health Care Workers at Matawale Health Centre (Zomba)

Background

Little information is available on the prevalence of depression in Malawi in primary health care settings and yet there is increased number of cases of depression presenting at tertiary level in severe form.

Aim

The aim of the study was to determine the prevalence of depression among patients and its detection by health care workers at a primary health care clinic in Zomba.

Methods

A cross-sectional survey was done among patients attending outpatient department at Matawale Health Centre, in Zomba from 1st July 2009 through to 31st July 2009. A total of 350 adults were randomly selected using systematic sampling. The “Self Reporting Questionnaire”, a questionnaire measuring social demographic factors and the Structured Clinical Interview for DSM-IV Axis I disorders Non-Patient Version (SCID-NP) were administered verbally to the participants.

Findings

The prevalence of depression among the patients attending the outpatients department was found to be 30.3% while detection rate of depression by clinician was 0%.

Conclusion

The results revealed the magnitude of depression which is prevalent in the primary health care clinic that goes undiagnosed and unmanaged. It is therefore recommended that primary health care providers do thorough assessments to address common mental disorders especially depression and they should be educated to recognise and manage depression appropriately at primary care level.     

Epidemiological Investigation of a Typhoid Outbreak

Background

An outbreak of typhoid fever among school children of a school in military station in central India is reported here. It comprises of 98 students out of which 87 students were from one school.

Methods

Detailed epidemiological case sheets were filled for cases and active case finding surveys were conducted among the school students during the period of study. It included 3313 students of the affected school.

Result

Attack rate of the affected school was 2.62 percent (RR 13.38, 99% CI of RR 10.8, 16.12). Blood samples were found to have Salmonella typhi in 5.43%. Eighty six blood samples (87.75%) were positive for Widal test. Sanitary survey revealed fecal contamination of water supply leading to the outbreak.

Conclusion

We recommend having a sound vaccination programme for children, adequate chlorination of water supply and formation of local groups at school level to monitor water quality on a daily basis.Key Words: Typhoid fever, Epidemiological investigation     

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.     

Women's groups' perceptions of neonatal and infant health problems in rural Malawi

Aims

To present the perceptions of women in rural Malawi regarding the health problems affecting neonates and infants and to explore the relevance of these perceptions for child health policy and strategy in Malawi.

Methods

Women''s groups in Mchinji district identified newborn and infant health problems (204 groups, 3484 women), prioritised problems they considered most important (204 groups, 3338 women) and recorded these problems on monitoring forms. Qualitative data was obtained through 6 focus-group discussions with the women''s groups and 22 interviews with individuals living in women''s group communities but not attending groups.

Results

Women in Malawi do not define the neonatal period according to any epidemiological definition. In order of importance they identified and prioritised the following problems for newborns and infants: diarrhoea, infection, preterm birth, tetanus, malaria, asphyxia, respiratory tract infection, hypothermia, jaundice, convulsions and malnutrition.

Conclusion

This study suggests that women in rural Malawi collectively have a developed understanding of neonatal and infant health problems. This makes a strong argument for the involvement of lay people in policy and strategy development and also suggests that this capacity, harnessed and strengthened through community mobilisation approaches, has the potential to improve neonatal and infant health and reduce mortality.     

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.     

Discussion Based on Analysis of the Suicide Rate and the Average Disposable Income per Household in Japan

Objective:

Suicide is one of the major social issues in Japan. According to a report of the National Policy Agency, there were approximately 22 000 to 24 000 annual suicides between 1994 and 1997 and there have been over 30 000 annual suicides in Japan since 1998. For these reasons, we think it is important to discuss the economic factor related to suicides in recent years.

Method:

In this study, we examined suicide rates and the average disposable income per household in Japan in the last 15 years (ie 1994–2008) and discussed the statistical analysis of the average disposable income per household and the associated suicide rates.

Results and Discussion:

During the research period, annual suicide rates per 100 000 population in Japan ranged from 16.9 to 25.5 among the total population, from 23.1 to 38.0 among men, and from 10.9 to 14.7 among women. The annual average disposable income per household (ten thousand yen) ranged from 424.0 to 549.9. The average disposable income per household was related to the suicide rate among the total population and among men. The average disposable income per household was not related to the suicide rate among women.

Conclusion:

We believe that this discussion will be useful in developing specific suicide preventive measures.     

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.     

Caesarean section in Malawi: preventable factors in maternal and perinatal mortality

Objectives

To examine factors that may influence maternal and perinatal mortality associated with caesarean section in an African country.

Design

A prospective observational study, conducted between January 1998 and June 2000, of 8070 caesarean sections.

Setting

25 district and 2 central hospitals in Malawi.Main outcome measures. Association between hospital type, ward or operative care, training of surgical and anaesthesia personnel, preoperative complications, method of anaesthesia, blood loss and anaesthetic technique on maternal and perinatal mortality.

Results

Questionnaires were returned for 5236 caesarean sections in district and 2834 in central hospitals. 95% were emergencies, 65% for obstructed labour. Pre-operative haemorrhagic shock was present in 7.6% of women, anaemia in 6.2% and ruptured uterus in 4.1%. Previous caesarean section did not appear to predispose to ruptured uterus. There were 85 maternal deaths (1.05% mortality), 65 of which occurred postoperatively on the wards. Maternal mortality was increased with ruptured uterus (adjusted odds ratio 3.9, 95% CI 2.3–6.5), little anaesthetic training (2.3, 1.3 to 4.1) and blood loss requiring transfusion (19.3, 9–41). In mothers without preoperative haemorrhage spinal anaesthesia was associated with lower maternal mortality than general anaesthesia (0.23, 0.1–0.7). Perinatal mortality was 11.2% overall, and was significantly associated with ruptured uterus, halothane and ketamine anaesthesia.

Conclusion

Maternal and perinatal mortality rates among women undergoing caesarean section in Malawi are high. Improving resuscitation in postoperative wards might reduce maternal mortality. Blood loss and pre-operative complications are both strongly associated with mortality. Spinal anaesthesia was associated with good outcome.     

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.     

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.