Malawi Medical Journal

Profile Interview: Thengo Kavinya talks to Dr. Yohane Gadama, Neurologist on his career

2025-03-28T08:55:17+00:00

As a clinician and lifelong learner, my academic journey has been shaped by curiosity, determination, and the desire to make a meaningful impact. My academic journey has taken me across different districts in Malawi and beyond its borders, shaping my adaptability and resilience. While many assume that I have always been in Blantyre, my early years were quite the opposite.

Cardiovascular disease risk factors and the ten-year cardiovascular disease risk among employees of a public university in Blantyre, Malawi

2025-03-20T14:40:02+00:00

Background
Atherosclerotic Cardiovascular diseases (ASCVD) are the leading cause of death globally and disproportionately affect developing countries such as Malawi. Screening and management of significant ASCVD risk factors is essential. In Malawi, the prevalence of ASCVD risk factors among university staff, an economically important population, has not been well reported. This study investigated the prevalence of risk factors for ASCVDs and the ASCVD risk among employees of the Kamuzu University of Health Sciences, in Blantyre, Malawi.
Methods
This was a cross-sectional study conducted in 2022 with 105 participants. Sociodemographic data, medical history, and anthropometric measurements were recorded. Blood samples were analyzed for HbA1C and serum lipids. Associated risk factors for ASCVD were assessed. The 10-year risk for ASCVD was calculated based on the Framingham Risk Table to predict 10-year cardiovascular outcomes. Statistical analysis included descriptive statistics and multivariate logistic regression to evaluate associations while adjusting for potential confounders.
Results
Overweight and obesity were prevalent in 78% of the participants, while 43% and 42% of the participants had blood pressure readings in the pre-hypertension and hypertension categories, respectively. A proportion of 21% and 8% of the participants had HbA1c readings in the category of pre-diabetes and diabetes, respectively. Dyslipidaemia was detected in 72% of the participants. Regarding ASCVD risk, 58% had intermediate risk, while 13% had high risk. Being overweight or obese and age over 30 years predicted intermediate to high ASCVD risk (AOR 1.24 (95% CI 1.04 – 1.49) p=0.02, and (AOR 1.51 (95% CI 1.16 – 1.97) p < 0.01, 0.0001 respectively.
Conclusion
This study reveals a high prevalence of ASCVD risk factors among KUHeS employees, with two-thirds of the population having an intermediate or high 10-year ASCVD risk. Routine screening and tailored management strategies are essential to reduce the ASCVD risk and burden in this population.

Characterization of Mycobacterium Tuberculosis (MTB)-Positive Individuals within the Healthcare Catchment Area of Mzuzu Central Hospital, Malawi

2025-03-20T15:03:36+00:00

Purpose
To investigate the characteristics of the Mycobacterium tuberculosis (MTB)-positive population within the healthcare service area of Mzuzu Central Hospital in Malawi, with the objective of providing a scientific foundation for tuberculosis (TB) prevention and control strategies in the region.
Methods
This retrospective study encompassed 4,711 patients who underwent GeneXpert (GeneXpert MTB/RIF or GeneXpert MTB/RIF Ultra) testing. Data on laboratory results, demographics, HIV status, and residential addresses were analyzed.
Results
Among 4,711 patients, 424 (9%) tested MTB-positive. A strong correlation was observed between MTB and HIV infection, as HIV/TB co-infection accounted for 47.9% of MTB-positive cases (χ²=46.311, p<0.001). The MTB positivity rate for males, at 12.4% (291/2341), is significantly higher ( χ²=66.858, p<0.001) than that for females, which stands at 5.6% (133/2370), irrespective of HIV status. The age distribution of MTB-positive patients peaked in the 21-55 age bracket, with a median age of 37.0 (29.0, 47.0). The third quarter of each year, particularly September exhibited the highest positivity rate of 13.1%. Within Mzimba District, 87.8% of TB patients resided in Mzuzu city, with Luwinga (21.8%), Mchengautuwa (12.5%), and Zolozolo (9.9%) being the top three townships. Most newly diagnosed cases received treatment (85.1%), but the rifampicin resistance rate (4.7%) exceeded the national average.
Conclusion
Within the healthcare catchment area of Mzuzu Central Hospital, MTB infection is significantly associated with HIV. Males show a higher MTB positivity rate than females. The study identifies high-risk age groups, temporal trends, and geographical TB patterns. Rifampicin resistance is a critical issue needing urgent attention.

An audit of the HIV drug resistance testing program in Malawi

2025-03-20T15:15:14+00:00

Introduction
For persons failing on dolutegravir- and protease inhibitor-based antiretroviral therapy (ART) regimens, Malawi’s HIV program requires confirmation of HIV drug resistance (HIVDR) before switching to next-line regimens. Approval of applications for HIVDR testing is determined by a national HIVDR committee that also provides management recommendations based on HIVDR test results. We audited HIVDR test applications for all ages in Malawi’s national ART program to evaluate the HIVDR testing process and explore short-term outcomes, including viral suppression.
Methods
We conducted a retrospective review of routinely collected data from applications for HIVDR testing registered between July 2020 and December 2021. We determined drop-offs at steps of the HIVDR testing cascade: approval for genotyping, sample collection, receiving results, completion of genotypic sequencing, provision of management recommendations and implementation of recommendations. We assessed ART outcomes, including the first viral load (VL) result ≥6 months after recommendations from the HIVDR committee.
Results
228 HIVDR applications were received, of which 75% (172/228) were approved. Of these, 72% (124/172) had samples sent to laboratory and 122 genotyping results were obtained. 75% (92/122) of samples were successfully sequenced and 68% (65/92) sequences had ≥1 major drug resistance-associated mutation, including 17% with moderate or high-level dolutegravir resistance of individuals on dolutegravir-based regimens. Treatment outcomes were available for 90 clients: 65 were alive on ART, 3 had defaulted, 12 died, 9 transferred out and 1 stopped ART. Of 68 available follow-up VL results, 34 (51%) were <1,000 copies/mL.
Conclusions
This audit demonstrates gaps in Malawi’s HIVDR testing cascade and concerning clinical outcomes among those with follow up results: considerable attrition from care and low VL suppression. These results suggest that improvements in HIVDR testing in the Malawi HIV program need to be considered, including in-country sequencing and more efficient procedures for applications, approvals, clinical recommendations and clinical follow up.

The cost of unnecessary test orders: a retrospective study

2025-03-20T15:34:19+00:00

Background
Limited resources available to meet unlimited human needs necessitate the prevention of unnecessary use in the field of health. One of the unnecessary expenditures in health is the use of laboratory tests. The aim of this study is to determine the level of unnecessary laboratory test requests and the risk factors affecting unnecessary use in a university hospital.
Material and Methods
In the study, the 15 most frequently used biochemistry tests in a university hospital were evaluated retrospectively. The Rational Laboratory Test Request Procedure of the Ministry of Health was used to determine the use of unnecessary tests. Multivariate logistic regression analysis was used to identify factors affecting unnecessary test use.
Results
The analysis results showed that the ratio of unnecessary use of 15 biochemistry tests was 9.1%, and the cost of unnecessary tests was 584.186,3 TL (114.997,3 $). It was found that the probability of requesting unnecessary tests differed significantly according to the branches of the tests requested, the age and gender of the patients and the academic title of the physicians (p<0.001).
Conclusions
It is thought that the study will provide important clues in the development of managerial interventions to prevent unnecessary test usage and control costs.

Assessment of diagnostic efficacy: High fluorescent cells combined with CEA, NSE, and Cyfra21-1 in Malignant Pleural Effusion Identification

2025-03-20T15:38:55+00:00

Objective
To determine routine and biochemical parameters, as well as tumor markers, that are significantly different between malignant pleural effusion (MPE) and benign pleural effusion (BPE), and to evaluate the diagnostic efficacy of the combination of routine and biochemical parameters, along with carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and cytokeratin 19 fragment (Cyfra21-1) measurements in pleural effusion for identifying MPE.
Methods
1,238 patients with pleural effusion from the First Affiliated Hospital of Xi’an Jiaotong University were recruited and categorized into two groups: MPE (n = 397) and BPE (n = 841). Biomarker levels were compared, and receiver operating characteristic (ROC) curves were performed on the statistically significant indicators to assess the diagnostic efficacy for MPE.
Results
High-Fluorescent cells (HFC), CEA, NSE, and Cyfra21-1 were significantly elevated in MPE (P < 0.001) and positively correlated with its presence (P < 0.001). The area under the curve (AUC), cutoff value, sensitivity, and specificity were: [0.726 (95% CI: 0.696-0.756), 17.5, 8.5%, 57.4%]; [0.894 (95% CI: 0.873-0.914), 5.78, 80.7%, 88.6%]; [0.703(95% CI: 0.672-0.735), 10.97, 59.3%, 71.9%] and [0.774 (95% CI: 0.746-0.802), 34.61, 74.7%, 67.9%], respectively. When focusing on multi-biomarker strategy, the combination of HFC and CEA offered the highest diagnostic efficiency (AUC: 0.868; 95% CI: 0.847-0.889), with a sensitivity of 88.4% and a specificity of 70.7%.
Conclusion
HFC, CEA, NSE, and Cyfra21-1 are valuable diagnostic markers for MPE, with optimal cutoff values of 17.5 × 106/L, 5.78 ng/mL, 10.97 ng/mL, and 34.61 ng/mL, respectively. The HFC+CEA combinations enhanced diagnostic sensitivity and clinical utility.

Hypertension and its association with anthropometric indices among Nigerian adolescents

2025-03-20T15:50:38+00:00

Background
Hypertension has become increasingly common among adolescents such that it poses a significant health concern. To develop effective prevention and management strategies, it is essential to understand the association between hypertension and various factors. This study therefore sought to investigate the prevalence of hypertension and its association with anthropometric indices among Nigerian adolescents.
Methods
A cross-sectional study was conducted among Nigerian adolescents aged 10-19 years in 2022, using a multi stage sampling method. Anthropometric measurements were obtained using mobile stadiometer, bathroom weighing scale, measuring tape, and personal body fat caliper while blood pressure was determined using digital blood pressure monitor. Statistical analysis was performed using IBM Statistical Product for Service Solution, version 23 and significance was accepted at p < 0.05.
Results
A total of 455 respondents (58.5% females & 41.5% males) with mean age of 14.7±2.3 years participated in the study. Their mean weight (kg), height (cm) and BMI (kg/m2) were 55.1 ± 11.5, 162.7±71.3, and 21.5±3.1, respectively. More females than males had hypertension (19.9% vs. 12.7%), whereas more males than females had pre-hypertension (19.0% vs. 17.7%). Obese adolescents had significantly (p = 0.000) higher prevalence of hypertension (18.2%) compared to pre-hypertension (1.2%). Adolescents who had abnormal triceps and sub-scapular skinfold thicknesses also had significantly (p = 0.000) higher prevalence of hypertension (11.7% vs. 7.8%) compared to pre-hypertension (4.8% vs. 3.6%) and normal blood pressure (2.4% vs. 0.3%). No significant (p > 0.05) association was observed between the waist-hip ratio and blood pressure.
Conclusion
Blood pressure showed positive correlation with anthropometric indices except for waist- hip ratio, which had no significant association with blood pressure. Regular screening for hypertension among at-risk adolescents and early initiation of treatment for affected individuals should be conducted to prevent potential complications in later life.

Turkısh translatıon and valıdatıon of the Oslo Sports Trauma Research Center (OSTRC) Questıonnaıres

2025-03-20T15:56:57+00:00

Background
Exposure to repetitive activities and heavy workloads makes athletes vulnerable to overuse injuries in time. Well-timed detection of these injuries is crucial to maintaining their sports career healthily. The Oslo Sports Trauma Research Centre questionnaires for Overuse Injury (OSTRC-O) and Health Problems (OSTRC-H) are universally used as valid and reliable tools in athlete health screening. We aimed to make them available to Turkish athletes and assess their psychometric properties.
Methods
The questionnaires were adapted to Turkish based on systematic guidelines. Seventy-two athletes were recruited from various sports branches. The internal consistency, reproducibility, and validity of the questionnaires were checked. Their total scores were compared with the scores of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and the Nottingham Health Profile (NHP) for concurrent validity. Thirty-three participants were screened for six weeks to detect score changes and calculate effect sizes.
Results
The Cronbach alpha values of the OSTRC-O and OSTRC-H were very high (.90 and .91, respectively). Test-retest reliability was excellent for both questionnaires (.98, p<.01). There was a moderate correlation between OSTRC-O and OSTRC-H scores with CMDQ and NHP (p<.01). The area under the curve (AUC) values were higher than .70 for all scales. The effect size values were moderate for all scales.
Conclusions
Turkish versions of the OSTRC-O and OSTRC-H questionnaires are valid and reliable tools for Turkish-speaking athletes in different sports branches.

How to improve the comprehensive capabilities of radiographers at Mzuzu Central Hospital within the context of modern medical imaging technology?

2025-03-20T16:04:29+00:00

Objective
This study aimed to investigate strategies for comprehensively enhancing the capabilities of radiographers at Mzuzu Central Hospital (MCH), within the framework of contemporary medical imaging technology advancements.
Methods
The current study comprehensively assessed the technical proficiency of radiographers working at MCH, while concurrently looking at the challenges encountered during routine CT operations. Subsequently, a multifaceted exploration was conducted to identify avenues and devise strategies aimed at augmenting the overall capabilities of the radiographers.
Results
The primary duty of radiographers at MCH involves operating imaging equipment and performing diagnostic procedures using ultrasound, X-ray, and CT scans on patients. Notably, these radiographers often perceive themselves academically underqualified and only occupying a supportive role in the hospital setting. Specifically, CT scanning, a pivotal diagnostic tool is hindered by suboptimal technician performance, characterized by inadequate operational proficiency, a negligible focus on scan optimization and minimal concern for CT scan quality. These deficiencies compromise the quality of CT scans, thereby negatively affecting diagnostic precision and subsequent treatment outcomes. Consequently, the study recommends a three-pronged approach for improvement: (1) a robust enhancement of radiological professionals’ overall competence; (2) support for professional development and self-directed learning; (3) strengthening personnel management and promoting accountability within the Radiology Department.
Conclusion
Radiographers at MCH were imperative to continuously elevate their expertise in order to keep pace with the ever-evolving requirements of their profession and the significant advancements in contemporary medical imaging technology. This ongoing professional development was crucial for ensuring optimal patient care and harnessing the full potential of advanced imaging modalities.