Self Treatment of Eye Diseases in Malawi

Self-treatment for eye diseases is very common in most developing countries yet there has been little investigation of such attitudes and practices. In many settings, people do not proceed beyond self-treatment and do not receive care from either traditional healers or Western eye care providers. Visual impairment and blindness can be the result. We conducted population-based survey of use of eye care services and self-treatment in two districts of Malawi. Adults were administered a detailed interview regarding their use of eye care services (Western and traditional as well as self-treatment) and their knowledge and use of traditional eye medicines. Self-treatment was defined as use of either Western or traditional medicines by the individual for their most recent eye condition. Only eye conditions that were considered severe by the study subjects were correlated with treatment options. Interviews were carried out among 800 adults in the study areas. Self-treatment was reported for the last episode of eye disease by 39.8% of the study population. Factors associated with self-treatment included sex, religion and socioeconomic status. Even though 76.8% of the respondents reported treatment from the health center or hospital to be the least expensive option, many opted for self-treatment first. Among those opting for self-treatment 72% used traditional eye medicines. Even among cases that individuals considered to be quite severe (these included cataract, trachoma and conjunctivitis), self-treatment was the option of choice in 22.2% of cases.     

High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension

Background:Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population.Objective:We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications.Methods:We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as <140 mm Hg systolic and <90 mm Hg diastolic at all visits, or at all but one visit. We calculated an antihypertensive non-adherence score based on self-report of missed doses at each visit (higher score = worse adherence) and used rank sum and chi-square tests to compare sociodemographic and clinical factors (including adherence) associated with blood pressure control over the year.Results:At study entry, 158 participants (23.5%) were on antihypertensive medication; participants had a median age of 51.0 years, were 66.5% female, and had a median of 6.9 years on ART. 19.0% (n = 30) achieved blood pressure control over the year of follow-up. Self-reported non-adherence to hypertension medications was the only factor significantly associated with uncontrolled blood pressure. The average non-adherence score for those with controlled blood pressure was 0.22, and for those with uncontrolled blood pressure was 0.61 (p = 0.009).Conclusions:Adults living with HIV and hypertension in our cohort had low rates of blood pressure control over one year associated with self-reported non-adherence to antihypertensive medications. Given the high prevalence and incidence of hypertension, interventions to improve blood pressure control are needed to prevent associated long-term cardio- and cerebrovascular morbidity and mortality.