Malawi Medical Journal 2021-01-22T15:58:52+00:00 Prof. Adamson S. Muula Open Journal Systems The <em>Malawi Medical Journal </em>is a peer reviewed publication of scientific medical research and serves as a forum for the dissemination of findings of health-related research undertaken in Malawi to health workers in Malawi. It incorporates original research studies, policy analysis, case reports, literature reviews and occasional special features. It is published both in print and electronically on a quarterly basis. <br /><br /><p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> Explaining the gender disparities in SARS-Cov 2 infection and Covid-19 Disease in Malawi 2021-01-22T14:12:15+00:00 Adamson S Muula <p>Global Covid-19 data show that there is higher morbidity and mortality among males compared to females1-3. Why, is this the case, and what needs to be done to save lives? Alternatively is this a situation where the observed status is only good for reporting but not worth interventions?</p> 2021-01-17T00:00:00+00:00 Copyright (c) The prevalence of pulmonary tuberculosis among miners from the Karonga, Rumphi, Kasungu and Lilongwe Districts of Malawi in 2019 2021-01-22T14:30:45+00:00 Ethel Rambiki Andrew Dimba Wingston Ng’ambi Knox Banda Belaineh Girma Birru Shight Levi Lwanda Levi Lwanda Isaias Dambe Jaya Prasad Tripathy Mumbi Chola Pascalina Chanda -Kapata James Mpunga Damson Kathyola <p><strong>Introduction</strong></p> <p>Miners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess the burden of TB among these miners. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and health-seeking behaviour (HSB) in a population of miners in Malawi, and a range of associated factors. Our goal was to develop a method to identify missing cases of TB. <br><strong>Methods</strong><br>We conducted a cross-sectional study in the Karonga, Rumphi, Kasungu and Lilongwe districts of Malawi in 2019. We calculated frequencies, proportions, odds ratios (ORs) and their 95% confidence intervals (95% CIs), and used the chi-square test in STATA version15.1 to investigate the burden and magnitude of PTB in the mining sector. Bivariate and multivariate logistic regression models were also fitted for PTB and HSB. <br><strong>Results</strong><br>Of the 2400 miners approached, we were able to interview 2013 (84%). Of these, 1435 (71%) were males, 1438 (71%) had known HIV status and 272 (14%) had PTB. Multivariate analysis showed that the miners performing informal mining were 50% more likely to develop PTB compared with those in formal mining (adjusted odds ratio [AOR]=1.50, 95% CI: 1.10–2.05, P=0.01). A total of 459 (23% of 2013) miners had presumptive TB. Of these, 120 (26%) sought health care; 80% sought health care at health facilities. Multivariate analysis also showed that miners who experienced night sweats were less likely to seek health care compared with those without night sweats (AOR=0.52, 95% CI: 0.30–0.90, P=0.02).<br><strong>Conclusion</strong><br>The prevalence of PTB was higher among miners than in the general population. Consequently, targeted TB screening programmes for miners may represent a suitable strategy to adopt if we are to end TB by 2030. Poor health-seeking behaviours among miners is worrisome and further qualitative research is necessary to understand the barriers to accessing health care in these settings.</p> <p>&nbsp;</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Could flank pain be an indicator of COVID-19 infection? 2021-01-22T14:38:45+00:00 Emrullah Durmus Fesih Ok Ömer Erdogan Semih Saglik <p><strong>Background</strong><br>We describe the incidental detection of patients infiltrates due to COVID-19 in lung basal sections in patients undergoing abdominal computed tomography (CT) with flank pain attending the urology outpatient clinic during the current pandemic.<br><strong>Methods</strong><br>We retrospectively analysed 276 patients admitted to the Siirt Training and Research Hospital Urology outpatients clinic between 15 March 2020 and 9 August 2020 with a complaint of flank pain and undergoing non-contrast abdominal CT. A total of 10 patients with COVID-19 compatible findings in CT were defined as the study group. A control group was formed from 10 patients with only urological pathologies (kidney stones, ureteral stones, and hydronephrosis) without a COVID-19 compatible appearance on CT.<br><strong>Results</strong><br>Ten (3.6 %) patients were identified with COVID-19 and pneumonic infiltrations in the basal regions of the lungs; diagnosis was made by cross-sectional abdominal CT. The visual analog scale (VAS) score of flank pain was significantly higher in the control group (p&lt;0.001); these subjects had urological pathology and no evidence of COVID-19 in the basal regions of the lungs on abdominal CT. There were no signs of COVID-19 disease detected during the admissions procedure in the urology outpatient clinic, including fever, cough, and shortness of breath.<br><strong>Conclusion</strong> <br>During the COVID-19 pandemic, it is important to consider a diagnosis of COVID_19 in patients reporting non-severe flank pain if no urological pathology is evident on abdominal CT scans. </p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Adult pedestrian and cyclist injuries in Lilongwe, Malawi: a cross-sectional study 2021-01-22T14:47:26+00:00 Mads Sundet Gift Mulima Chifundo Kajombo Hallvard Gjerde Asbjørg S. Christophersen Sven Young <p><strong>Background</strong></p> <p>Pedestrian and cyclist injuries are a major concern globally, but especially in low-income countries. Locally conducted research is needed to measure the size of the problem and advise policy on road safety interventions. We wanted to investigate the precise circumstances of these injuries in Lilongwe, Malawi and to identify risk factors for severe injuries.<br><strong>Methods</strong><br>Cross-sectional study of all adult pedestrian and cyclist injuries presenting to a large central hospital. This was a sub-study of a larger study with all types of road users included. All patients provided detailed information about the incidents leading to injury and were tested for alcohol. <br><strong>Results</strong><br>There were 222 pedestrians, 183 bicycle riders and 42 bicycle passengers among the 1259 adult road traffic injury victims that were treated at Kamuzu Central Hospital during a 90-day period in 2019. Of these injuries, 60.2% occurred while the victim was walking/cycling along the road and 22.3% when the victim was trying to cross the road. The majority of the victims were men (89.1%). Helmet use for bicyclists was almost non-existent. Only 1 patient had used reflective devices when injured in the dark, despite 44.7% of these injuries occurring in reduced light conditions. There was an increased risk for serious and fatal injuries for pedestrians compared with bicyclists, and also compared with all types of road users. Patients injured in rural areas and those hit by lorries were more severely injured. Consuming alcohol before being injured was associated with more severe injuries in bicyclists. Being injured while crossing the road at painted zebra crossings was associated with an increased risk of serious and potentially fatal injuries. <br><strong>Conclusion</strong><br>This study identified important risk factors for severe injuries in pedestrians and cyclists. Implications for preventive measures are presented in a Haddon Matrix.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 A cross-sectional study on factors associated with health seeking behaviour of Malawians aged 15+ years in 2016 2021-01-22T14:58:14+00:00 Wingston Ng’ambi Tara Mangal Andrew Phillips Tim Colbourn Dominic Nkhoma Joseph Mfutso- Bengo Paul Revill Timothy B. Hallett <p><strong>Introduction</strong><br>Health seeking behaviour (HSB) refers to actions taken by individuals who are ill in order to find appropriate remedy. Most studies on HSB have only examined one symptom or covered only a specific geographical location within a country. In this study, we used a representative sample of adults to explore the factors associated with HSB in response to 30 symptoms reported by adult Malawians in 2016.<br><strong>Methods</strong><br>We used the 2016 Malawi Integrated Household Survey dataset. We fitted a multilevel logistic regression model of likelihood of ‘seeking care at a health facility’ using a forward step-wise selection method, with age, sex and reported symptoms entered as a priori variables. We calculated the odds ratios (ORs) and their associated 95% confidence intervals (95% CI). We set the level of statistical significance at P &lt; 0.05.<br><strong>Results</strong> <br>Of 6909 adults included in the survey, 1907 (29%) reported symptoms during the 2 weeks preceding the survey. Of these, 937 (57%) sought care at a health facility. Adults in urban areas were more likely to seek health care at a health facility than those in rural areas (AOR = 1.65, 95% CI: 1.19–2.30, P = 0.003). Females had a higher likelihood of seeking care from health facilities than males (AOR = 1.26, 95% CI: 1.03–1.59, P = 0.029). Being of higher wealth status was associated with a higher likelihood of seeking care from a health facility (AOR = 1.58, 95% CI: 1.16–2.16, P = 0.004). Having fever and eye problems were associated with higher likelihood of seeking care at a health facility, while having headache, stomach ache and respiratory tract infections were associated with lower likelihood of seeking care at a health facility.<br><strong>Conclusion</strong><br>This study has shown that there is a need to understand and address individual, socioeconomic and geographical barriers to health seeking to increase access and appropriate use of health care and fast-track progress towards Universal Health Coverage among the adult population.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Histopathological profile of childhood thyroid carcinoma in Ibadan, Southwestern Nigeria 2021-01-22T15:06:57+00:00 Mustapha A. Ajani Sebastian A. Omenai John I. Nwadiokwu Ayodeji A. Salami <p><strong>Background</strong><br>Thyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment.<br><strong>Methods</strong><br>This was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours. <br><strong>Results</strong><br>There were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases.<br><strong>Conclusion</strong><br>Childhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases. </p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 The participation of community pharmacists in the case management of malaria in Enugu metropolis, Nigeria: a cross-sectional survey 2021-01-22T15:14:15+00:00 Chibueze Anosike Cordelia Ngozi Chu-Madu Nneka Uchenna Igboeli Maxwell Ogochukwu Adibe Chinwe Victoria Ukwe <p><strong>Background</strong><br>Nigeria accounts for approximately 25% of the global malaria burden. Malaria is a major cause of morbidity and mortality, especially in children and pregnant women. Pharmacists play vital roles in the fight against malaria. However, in Nigeria, the role of the community pharmacist in managing cases of malaria has received very little research attention. This study aimed to evaluate the level of participation of community pharmacists in the management of malaria cases in Enugu metropolis and to explore factors associated with such participation.<br><strong>Methods</strong><br>A cross-sectional survey was conducted among community pharmacists in Enugu metropolis using a modified and re-validated 16-item self-administered questionnaire. The questionnaire was distributed to participants in selected pharmacies for completion. Descriptive statistics and the chi-square test were used for statistical analysis. <br><strong>Results</strong> <br>Out of the 103 participants, more than half (55.3%) were male. More than half of the pharmacists satisfactorily provided preventive (57.3%), pharmaceutical (62.1%), and curative (51.1%) services for patients with malaria. Overall, 57% of the pharmacists satisfactorily participated in the management of malaria cases. The number of years of practice was significantly associated with the pharmacists level of involvement in preventive (P=0.003) and curative (P=0.018) services. However, the provision of pharmaceutical care services for malaria patients was significantly associated with the sex of the respondents (P=0.023).<br><strong>Conclusions</strong><br>Our results suggest that more than half of the community pharmacists in Enugu metropolis were satisfactorily involved in the management of malaria cases. However, the number of years of practice and sex were factors associated with the extent of pharmacist involvement in the management of malaria cases.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 First case report of a successfully managed severe COVID-19 infection in Malawi 2021-01-22T15:24:38+00:00 Ndaziona Peter Banda Wilned Hara Derek Cocker Samantha Musasa Rachael Mary Burke Comfort Brown Vita Nyasulu Jonathon Mandalo Dumizulu Tembo Mtisunge Kachingwe Jenifer Cornick Ben Morton <p>The coronavirus disease 2019 (COVID-19) pandemic is now established on the African continent, with cases rapidly increasing in Malawi (1742 confirmed cases and 19 deaths as of 5 July 20201). Clinicians require guidelines, deliverable in the Malawi context, to effectively and safely treat patients for the best possible outcome. In Malawi, key public messages around social distancing, hand washing and shielding for at-risk individuals have been widely distributed by the Ministry of Health. However, it has not been possible to implement strict lockdown measures in Malawi due to the risk of widespread economic disruption, hunger, worsened food insecurity, risk of violence and mass political rallies. Testing rates are low such that the number of confirmed cases in Malawi is likely to significantly under-represent the actual number of cases. As the epidemic unfolds, it is vital that doctors implement standardised case management guidelines to improve survival for patients who require hospital admission. The majority of patients hospitalised with COVID-19 require medical-ward level care, including provision of adequate oxygen3. Increased oxygen provision has been a major focus of COVID-19 preparedness activities in Malawi.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Infection or drug toxicity? Acute ataxia and encephalopathy after uncomplicated falciparum malaria and efavirenz dose adjustment 2021-01-22T15:29:14+00:00 William P. Brasher Menard Bvumbwe Peter N. Kazembe <p>Acute ataxia in children is a rare clinical syndrome usually caused by an infectious, post-infectious, or toxin-related aetiology. Although infrequent, acute ataxia can be related to more common diseases and treatments in Southern African countries including side effects of efavirenz-based anti-retroviral therapy (ART) for HIV or the post-malaria neurologic syndrome (PMNS) after infection with falciparum malaria. We describe a case from Lilongwe, Malawi of a 16-year-old HIV-positive patient with viral load suppression who presented with acute ataxia, confusion, and diplopia. Although he was on efavirenz-based ART for many years, his dose was increased 6 weeks prior, and he was treated for uncomplicated falciparum malaria 5 weeks prior with resolution of symptoms. Studies including cerebrospinal fluid analyses were normal, and he had rapid improvement of symptoms following discontinuation of efavirenz-based ART. Several case series have described supratherapeutic levels of efavirenz leading to acute ataxia as well as the self-limiting PMNS after non-complicated falciparum malaria. Though rare, recognition of efavirenz and PMNS as causes of ataxia is important to inform prompt treatment for HIV patients with acute ataxia in Malawi and other similar settings.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Ocular infection from Staphylococcus aureus bacteraemia in a sero-positive HIV patient from Queen Elizabeth Central Hospital, Blantyre, Malawi 2021-01-22T15:35:52+00:00 Thokozani Zungu Shaffi Mdala Chatonda Manda Petros Kayange <p>Ocular involvement in Staphylococcus aureus bacteraemia occurs with metastatic infection and has been identified as an independent risk factor for mortality. It manifests as either endophthalmitis or chorioretinitis and often leads to visual loss, particularly with delayed diagnosis. We present a case report of endogenous endophthalmitis and chorioretinitis in the background of methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia in a 23-year-old HIV-positive woman.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 Prospects of telemedicine during and post COVID-19: highlighting the environmental health implications 2021-01-22T15:41:35+00:00 Oluseyi Ademola Adejumo Oludamilola Adebola Adejumo <p>The outbreak of the coronavirus disease 2019 (COVID-19) in late 2019 had severe implications on the normal course of events across the globe. The imposition of lockdown, quarantine, and isolation measures by most countries to curtail the spread of the coronavirus led to the rapid development of information, communication, and technological (ICT) solutions to minimize the effect of the lockdown, and as an alternative to normal day-to-day physical interactions. Telemedicine involves the delivery of health care services by qualified health professionals using ICT for the exchange of valid information where distance is a critical factor, thus enhancing access to health care services. The use of ICT as a tool to improve access to health care services and for tackling the raging pandemic was one of the options embraced and considered by many countries. Indeed, there are indications that the use of telemedicine as a complementary option to current traditional medical practice will continue in the post-COVID period. The shift to telemedicine has severe health and environmental health implications and should be done with caution. Poor management of generated electronic waste was found to be responsible for environmental pollution and health hazards affecting major organs of the human body. Countries, especially those in the developing world, lack infrastructure for effective implementation of policies required to appropriately manage electronic waste. Therefore, it is highly imperative that adequate measures are put in place to mitigate the potential hazardous effects of the shift to telemedicine.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021 The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): South African resilience and survival strategies 2021-01-22T15:47:50+00:00 Mojapele V. Maserame Karl Rumbold Clarence S. Yah <p>Containment of the COVID-19 pandemic relies on accurate data regarding symptoms, transmission, prevention, nature of the virus, strains, immunological factors, relevant demographic and behavioural factors, and control strategies. In South Africa, epidemiological infection data revealed 622,551 cases and 231 deaths per million population as of 29 August 2020. This study describes the strategies South Africa is applying in containing the COVID-19 outbreak that could be used to inform appropriate monitoring and surveillance in other settings, and to improve global health preparedness.</p> 2021-01-17T00:00:00+00:00 Copyright (c) 2021