Malawi Medical Journal <p>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> <p>Other websites related to this journal:&nbsp;<a title="" href="" target="_blank" rel="noopener"></a></p> Medical Association of Malawi en-US Malawi Medical Journal 1995-7270 Copyright for articles published in this journal is retained by the journal. Malawi: What are the implications that aspartame is now a “possible carcinogen”? <p>Aspartame is an artificial non-saccharide sweetener 200 times sweeter than sucrose. It is commonly used as a sugar substitute in foods and beverages. Aspartame is a methyl ester of the aspartic acid/phenylalanine dipeptide category. It (aspartame) was approved by the United States Food and Drug Administration (FDA) in 1974. Its approval was revoked in 1980 before being re-instated a year later. It is one of the most studied food additives in the human food supply. Because of its low caloric value, it is often a preferred sweetener when there are concerns of weight gain, an attribute glucose and sucrose do not have (it is an ingredient of many diet drinks and chewing gum), the latter being, among other concerns, obesitogenic and diabetogenic.</p> Adamson S. Muula Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 79 79 Malawi’s LGBTQI controversy <p>Same-sex sexual activity is prohibited in Malawi under the Penal Code, which criminalises acts of ‘carnal knowledge against the order of nature’ as well as ‘gross indecency’; proclaiming a maximum penalty of 14 years imprisonment.</p> Thengo Kavinya Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 130 131 Anopheles funestus sensu stricto Giles (Diptera:Culicidae) bites after sunrise at two rural villages in northern Malawi and its implications for malaria vector control <p><strong>Introduction</strong> <br>Malawi has scaled up distribution and use of LLINs but their effectiveness depends on vector behaviour. This study reports information on where and when peak biting takes place by <em>Anopheles</em> vectors at two study sites in northern Malawi. <br><strong>Methods</strong><br>The study was carried out at a single village each in Nkhata Bay and Karonga districts, northern Malawi. Monthly, three teams of four people each sampled mosquitoes using Human Landing Collections (HLCs) from 6.00 pm to 6.00 am. Mosquitoes were counted and identified by PCR. <em>Plasmodium falciparum</em> sporozoites were detected by ELISA and an entomological inoculation rate was estimated. <br><strong>Results</strong><br>A total of 4,668 and 2,079 mosquitoes were sampled in Nkhata Bay and Karonga districts respectively. <em>An. funestus s.s</em> was common (91.3%; n = 2,611) in Nkhata Bay while <em>An. arabiensis</em> was common (96.9%; n = 706) in Karonga. <em>Pf sporozoite</em> rates varied from 0.8% (4/484) to 3.3% (51/1558). Individuals in Nkhata Bay received more bites (approx. 200 bites/ person/ night) compared to Karonga (approx. 50 bites/ person/ night). An. funestus was more likely to bite indoors (p=0.002) while<em> An. arabiensis</em> was (p=0.05) more likely to bite outdoors. Furthermore, An. funestus peak biting was in the early morning hours from 4:00 am (approx. 331 and 177 bites/ person/ night indoors and outdoors respectively) and remained high till 6:00 am. An. arabiensis peak biting (approx. 63 and 62 bites/ person/ night indoors and outdoors respectively) was around mid-night (12:00). An EIR of 108.4 infective bites/ person/ year was estimated for Nkhata Bay compared to 9.1 infective bites/ person/ year for Karonga.<br><strong>Conclusion</strong> <br><em>An. funestus s.s</em>. had a considerable <em>Pf sporozite</em> infection rate and EIR. The shift in biting behaviour shown by this species poses a challenge to malaria control. Further studies are required to understand the biting behaviour of Anopheles vectors in Malawi.</p> <p>&nbsp;</p> Themba Mzilahowa Steven Gowelo John Chiphwanya Andrew Bauleni Mavuto Mukaka Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 80 88 The Self-efficacy of Malawian Nursing Educators towards the use of Case Study Teaching Method <p><strong>Introduction</strong> <br>The case study teaching method is important in imparting critical thinking and clinical reasoning skills in nursing students. The self-efficacy of the nurse educators towards the use of the case study teaching method is a critical aspect of determining the quality of teaching using this method. This study, therefore, aimed at assessing the self-efficacy of the nurse educators towards the use of the case study teaching method in Malawi. <br><strong>Method</strong><br>A cross-sectional study utilizing a quantitative research design was conducted at eight nursing colleges that are under the Christian Health Association of Malawi. Only nursing colleges offering college diplomas in nursing and midwifery technician were involved. A total of 145 nurse educators completed the Self-Efficacy towards Teaching Inventory. The computer software of Statistical Package for Social Sciences version 23.0 was used to analyze the data.<br><strong>Results</strong> <br>The results show that the nurse educators are confident in using the case study teaching method (mean=78.4, SD=11.166). The study results also show that there are differences in mean scores between the nurse educators who attended an education workshop and those who did not (t=5.2334; P&lt;0.001). <br><strong>Conclusion</strong> <br>The study indicates that Malawian nurse educators have moderate levels of self-efficacy in using the case study teaching method. This study, therefore, has shown a need for nurse educators to participate in strategies that can increase their level of self-efficacy in using case studies.</p> Burnett Chila Chiona Masauko Msiska Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 89 94 Association of menopausal symptoms and menopausal quality of life with premenstrual syndrome <p><strong>Background</strong><br>Premenstrual symptoms at reproductive age resemble menopausal symptoms and have symptomatic commonalities. We hypothesized that women with previous premenstrual syndrome may be more prone to develop menopausal symptoms and aimed to investigate the association of menopausal symptoms and menopausal quality of life with premenstrual symptoms. <br><strong>Methods</strong><br>The study included 120 postmenopausal women. We evaluated the current menopausal symptoms with menopause rating scale (MRS) and quality of life with menopause-specific quality of life scale (MSQoL), previous premenstrual symptoms with premenstrual syndrome scale (PMSS) retrospectively and compared the associations statistically. <br><strong>Results</strong><br>According to retrospective PMSS, participants were divided into two groups; with and without premenstrual syndrome (PMS). PMS group included 29 (24.2%) participants and 91 (75.8%) participants were in group without PMS. Sociodemographic characteristics of groups were similar. Somatic and psychological symptoms were higher in MRS of PMS group. Evaluating the MSQoL; psychosocial and physical symptoms were impaired in the PMS group. Vasomotor, urogenital and sexual symptoms were similar in both groups. <br><strong>Conclusion</strong><br>Premenstrual and menopausal symptoms were related in terms of somatic, and psychosocial symptoms but not in vasomotor, urogenital, and sexual symptoms. It seems that women with previous premenstrual symptoms are more likely to develop menopausal symptoms in some ways. However, a prospective longitudinal study may be needed for more conclusive results.</p> Fatma Tuygar- Okutucu Gamzenur Cimilli- Senocak Hacer A. Ceyhun Halil Ozcan Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 95 100 A survey of ORF8 sequence and immunoinformatics features during alpha, delta, and wild type peaks of the SARS-CoV-2 pandemic in Iran <p><strong>Background</strong><br>The Coronavirus disease 2019 (COVID-19) pandemic influences all around the world. The SARS-CoV-2 ORF8 accessory gene represents multiple functions in virus-host interaction. The current study aimed to compare the ORF8 substitutions and epitope features of these substitutions in the various SARS-CoV-2 outbreaks including delta, alpha, and wild type variants in Iran from 2020 to 2022. In addition, we evaluate B cell, HLA I and II epitopes, by in-silico approach to ORF8 binding site prediction.<br><strong>Methods</strong><br>The samples were collected from patients diagnosed with SARS-CoV-2 infection via a real-time PCR assay. Then, a conventional PCR was carried out for ORF8 mutations analysis and further Sanger sequencing. Possible important alterations in epitope features of the ORF8 were evaluated by epitope mapping. B cell, HLA class I and II epitopes, evaluated by online databases ABCpred, NetMHCpan-4.1, and NetMHCIIpan-3.2, respectively.<br><strong>Results</strong> <br>The current study results could not represent novel variations in seven full-length ORF8 sequences or major ORF8 deletions in 80 evaluated samples. In addition, we could not find any ORF8 Δ382 during each outbreak of variants. Epitope mapping represents differences between the Alpha and other variants, especially in B cell potential epitopes and HLA I.<br><strong>Conclusion</strong><br>The immunoinformatic evaluation of ORF8 suggested epitopes represent major differences for the Alpha variant in comparison with other variants. In addition, having mild pathogenesis of the Omicron variant does not seem to be associated with ORF8 alteration by phylogenetic evaluation. Future in-vitro studies for a clear conclusion about the epitope features of ORF8 are required.</p> Alireza Tabibzadeh Mohammad Hadi Karbalaie Niya Hossein Keyvani Sajad Karampoor Parastoo Yousefi Mohammad Hossein Razizadeh Leila Mousavizadeh Maryam Esghaei Copyright (c) 2023 MMJ 2023-06-30 2023-06-30 35 2 101 105 Predictors of Students’ Performance in Nursing and Midwifery Technician Licensure Examination in Southern Malawi <p><strong>Introduction</strong><br>Success in the nursing and midwifery licensure examination is the only legal prerequisite to practice as a nurse and midwife in Malawi. However, the past decade has registered poor performance of students in Nursing and Midwifery Technician (NMT) licensure examinations for candidates who failed on the first attempt. The study sought to unravel whether students’ socio-demographic and academic characteristics could predict NMT licensure examination performance on the first attempt.<br><strong>Methods</strong> <br>We conducted a quantitative ex post facto using stratified random sampling. We reviewed 280 former NMT licensure exam candidate records from 2013 to 2017 with a study population of 2,668 NMTs. We reported descriptive statistics and used Chi-square / Fisher’s exact test and logistic regression to determine the significance of associations and predictors respectively. <br><strong>Results</strong><br>We found that the NMT licensure examination could be predicted by students’ academic characteristics, especially entry Malawi School Certificate of Education (MSCE) point scores [p &lt; 0.001, OR 0.830, 95% CI (0.771-0.892)], and exit college final scores [p &lt; 0.001, OR 1.214, 95% CI (1.131-1.303)]. We established that students’ socio-demographic characteristics like age [χ2 (2, N =280) =13.143, p &lt; 0.001], and marital status [χ2 (1, N = 280) = 5.645, p = 0.018] were significantly associated with NMT licensure examination performance but were not predictors of NMT licensure examination outcome. Furthermore, we did not find any association between NMT licensure examination performance and the sex of the students [χ2 (1, N = 280) = 0.523, p = 0.470]. <br><strong>Conclusion</strong><br>NMT licensure examinations performance predictors are academic variables like entry MSCE and exit college final scores. Consequently, teaching institutions should frame relevant admission criteria, and timely support the students at risk of failure in licensure exams.</p> Mc Geofrey Mvula Annie Msosa Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 106 110 Adequacy of completion of radiology request forms at St. Francis’ Hospital of Katete District: A clinical audit in Zambia <p><strong>Background</strong><br>Most imaging examinations use ionising radiation which causes biological effects on the body. For this reason, only justified examinations should be requested by adequately completing the radiology request form (RRF) by clinicians. The RRF allows radiographers and radiologists to assess if the benefit outweighs the risk associated with medical radiation exposure. Inadequately or incorrectly filled RRFs leads to unnecessary radiation exposures, imaging errors, and delays in performing the examination. Therefore, this study aimed at auditing the adequacy of completion of general RRFs at St. Francis’ Hospital of Katete District in Zambia.<br><strong>Methods</strong><br>This was a quantitative study in which RRFs for general radiography from January to December 2020 were audited. Data were collected retrospectively using a checklist from a total of 974 RRFs. The filled-in forms were assessed for completeness of information related to the patient, examination, and referring clinician. Data were analysed using descriptive statistics. The standard of completeness was based on the Royal College of Radiologists (RCR) guidelines requiring all the designated variables completed on the RRF.<br><strong>Results</strong><br>Most N=881(90.5%), RRFs were incompletely filled. With regards to patient’s identification, the findings revealed N=4(0.5%), N=597(61.3%), N=3(0.4%), and N=2(0.3%) RRFs devoid of patient’s name, hospital number, age, and gender, respectively. Regarding the examination, the findings revealed N=3(0.4%), N=68(7%), N=449(46.2%), and N=336 (37%) RRFs devoid of requested examination, indication, clinical history, and level of urgency, respectively. Regarding the referrer, the findings revealed N=135(13.9%), N=173(17.8 %), N=472(48.5%), and N=31(3.2%) RRFs were devoid of information relating to the ward, clinicians’ name, referring department, and signature, respectively.<br><strong>Conclusion</strong> <br>This audit reports that most of the RRFs were incompletely filled-in at St. Francis’ Hospital. Furthermore, the hospital number, clinical history and level of urgency were the frequently unfilled variables. Overall, there were gaps in completion of RRFs requiring remedying.</p> Mubanga Bwalya Osward Bwanga John. Y. Mvula Foster Munsanje Bretina Muntanga Copyright (c) 2023 MMJ 2023-08-02 2023-08-02 35 2 111 116 Perceptions of Physiotherapy students about their teaching environment at Kamuzu University of Health Sciences in Malawi <p><strong>Introduction</strong><br>The learning environment is defined as an environment where teaching is taking place, as perceived by both students and teachers. A conducive learning environment is critical for successful curriculum implementation, which also affects students’ academic performance. There have been initiatives introduced to improve the learning environment at Kamuzu University of Health Sciences (KUHeS). The purpose of this study was to ascertain physiotherapy final year students’ perceptions of their learning environment at KUHeS in Malawi.<br><strong>Methodology</strong><br>This study was conducted at KUHeS among final-year physiotherapy students. A retrospective, quantitative cross-sectional design was used. The study utilised secondary data on education environment which had already been collected using Dundee Ready Education Environment Measure (DREEM) forms. There were 26 completed DREEM forms for 2019/2020 academic year. Demographic data were captured. Mean and standard deviation were used to analyse the DREEM scores. Inferential analysis was conducted with p-value set at ≤ 0.05. <br><strong>Results</strong> <br>The total DREEM mean score was 120/200 which represented a positive perception of students learning environment. Students’ academic self-perception scored the highest (69.13%), followed by students’ perception of learning (61.94%), students’ social self-perception (59.46%), students’ perception of atmosphere (56.25), and students’ perception of teachers (55.50%). Married students had negative perceptions (p-value = 0.05) of their teachers and students with previous college experience had positive perceptions of their academic performance (p-value = 0.02). Many statements under items of perception of teachers (mean score = 24) and social self-perceptions (mean score = 16) were considered negatively. <br><strong>Conclusion</strong><br>Students in their final year of physiotherapy had positive perceptions of their learning environment. However, students’ perceptions of their teachers and social life were low. The learning environment had a significant impact on married students and those who had no prior experience with college life. Faculty development initiatives should aim to improve these critical areas. </p> Grace Mukoka- Bwezani Nesto Tarimo Enock Madalitso Chisati Emma Thomson Copyright (c) 2023 MMJ 2023-06-30 2023-06-30 35 2 117 123 Fatigue has a prominent impact on health lasting 12-weeks after COVID-19 infection <p><strong>Background</strong><br>While the amount of information on many issues related to COVID-19 has increased, the long-term consequences of illness and disability remain largely unclear. In previous studies on COVID-19 infections, long-lasting functional and symptomatic abnormalities have also been shown. It is predicted that survivors of COVID-19 may have to deal with physical or psychological problems later.<br><strong>Aim</strong> <br>We aimed to evaluate long-lasting symptoms including fatigue and investigate the associated risk factors.<br><strong>Methods</strong> <br>In this prospective cohort study, 132 consecutive COVID-19 patients who were previously diagnosed and admitted 13±1 weeks after diagnosis were included. The Functional Assessment of Chronic Illness Therapy (FACIT) – Fatigue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Lawton Instrumental Activities of Daily Living (IADL) Scale were applied in the follow-up visit.<br><strong>Results</strong><br>The median age of the patients (76 male, 56 female) was 52. Eighty (61%) of the patients were hospitalized, while 52 (39%) of them were not hospitalized. At least one symptom persisted in 103 (78%) patients, with fatigue (n=48, 36%) being the most common symptom. Both dyspnea and fatigue were more prominent in women than in men (34% vs. 11%, p=0.001 and 46% vs 29%, p=0.03; respectively). Persisted symptoms including fatigue were not significantly associated with hospitalization status. The FACIT scores of the patients at 12 weeks were positively associated with their depression and anxiety levels (R: 0.55, p=0.0001 and R: 0.42, p=0.0001), while they were negatively associated with their IADL scores (R: -0.25, p=0.004).<br><strong>Conclusions</strong> <br>Fatigue was the most frequent persistent symptom. The initial fatigue scores were higher in the severely ill patients. Persistent fatigue was not associated with disease severity but was closely associated with anxiety and depression.</p> Birsen Pınar Yıldız Didem Görgün Hattatoğlu Cihan Aydin Gülnihal Darçın Copyright (c) 2023 MMJ 2023-06-30 2023-06-30 35 2 124 129