Malawi Medical Journal 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> Medical Association of Malawi en-US Malawi Medical Journal 1995-7262 Copyright for articles published in this journal is retained by the journal. Herbal Medicine, Diabetes Care at Primary Care Facilities and Prevention of Vertical HIV Transmission <p>In this September 2021 issue of the Malawi Medical Journal, three articles which attracted my attention are those by Mbali <em>et al</em>, Zimba <em>et al</em>, and Pfaff <em>et al.</em> Perhaps as Editor-in-Chief of the Journal, I should endeavor to be impartial and “love” all the articles the same. This time however, I have selected <br>these articles because they touch on important health issues in Malawi, with Mbali et al, reporting on the use of herbal medicines among individuals living with HIV and receiving life-saving antiretroviral therapy (ART).</p> Adamson Muula Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 229 230 10.4314/mmj.v33i3.12 Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy <p><strong>Aim</strong><br>The purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor <br>function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the <br>results with sham stimulation and standard treatment.<br><strong>Methods</strong><br>Patients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function <br>Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into <br>three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard <br>treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu <br>Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), <br>selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).<br><strong>Results</strong><br>In all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No <br>changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups <br>in terms of any clinical assessment parameter.<br><strong>Conclusions</strong><br>All groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic <br>capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other <br>approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as <br>much as standard exercise treatment.</p> Natalya Özen Ece Unlu Ozgur Zeliha Karaahmet Eda Gurcay Ibrahim Gundogdu Ebru Umay Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 144 152 10.4314/mmj.v33i3.1 Prevalence and correlates of herbal medicine use among Anti-Retroviral Therapy (ART) clients at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi: a cross-sectional study <p><strong>Background</strong> <br>There has been an unprecedented explosion in the popularity of herbal preparations during the last few decades. Herbal medicines are <br>commonly used by HIV/AIDs clients. There is limited data on the prevalence of herbal medicine and correlating factors of herbal <br>medicine use in Malawi. This study establishes prevalence and factors contributing to the use of herbal medicine among HIV/AIDS <br>clients attending the ART clinic at QECH, Blantyre Malawi.<br><strong>Methods</strong> <br>A cross-sectional study design was used to interview 211 conveniently sampled clients at QECH ART clinic. The questionnaire <br>addressed socio-demographic, clinical characteristics, NCD-HIV comorbidity, and herbal medicine utilization. The main outcome <br>of the study was herbal medicine use since the initiation of ART. Logistic regression analysis was done in Stata version 16. Both <br>unadjusted and adjusted models were fitted for potential confounders. <br><strong>Results</strong><br>The prevalence of use of herbal medicine was reported in 17.5% (n=37) of the ART clients. The adjusted logistic regression analysis <br>showed that urban residence was statistically associated with reduced use of herbal medicine (adjusted Odds Ratio –AOR: 0.04, 95% <br>CI: 0.169, 0.976).<br><strong>Conclusion</strong><br>There is a high prevalence of use of herbal medicine among clients taking ART. Herbal Medicine has the potential to cover the gaps <br>in health coverage in rural communities.</p> Hawah Mbali Jessie Jane Khaki Sithole Alinane Linda Nyondo-Mipando Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 153 158 10.4314/mmj.v33i3.2 Decentralising diabetes care from hospitals to primary health care centres in Malawi <p><strong>Background</strong><br>Non-communicable diseases (NCDs) such as diabetes and hypertension have become a prominent public health concern in Malawi, where health care services for NCDs are generally restricted to urban centres and district hospitals, while the vast majority of Malawians live in rural settings. Whether similar quality of diabetes care can be delivered at health centres compared to hospitals is not known. <br><strong>Methods</strong><br>We implemented a pilot project of decentralized diabetes care at eight health centres in four districts in Malawi. We described differences between district hospitals and rural health centres in terms of patient characteristics, diabetes complications, cardiovascular risk factors, and aspects of the quality of care and used multivariate logistic regression to explore factors associated with adequate diabetes and blood pressure control. <br><strong>Results</strong><br>By March 2019, 1339 patients with diabetes were registered of whom 286 (21%) received care at peripheral health centres. The median duration of care of patients in the diabetes clinics during the study period was 8.8 months. Overall, HIV testing coverage was 93.6%, blood pressure was recorded in 92.4%; 68.5% underwent foot examination of whom 35.0% had diabetic complications; 30.1% underwent fundoscopy of whom 15.6% had signs of diabetic retinopathy. No significant differences in coverage of testing for diabetes complications were observed between health facility types. Neither did we find significant differences in retention in care (72.1 vs. 77.6%; p=0.06), adequate diabetes control (35.0% vs. 37.8%; p=0.41) and adequate blood pressure control (51.3% vs. 49.8%; p=0.66) between hospitals and health centres. In multivariate analysis, male sex was associated with adequate diabetes control, while lower age and normal body mass index were associated with adequate blood pressure control; health facility type was not associated with either. <br><strong>Conclusion</strong><br>Quality of care did not appear to differ between hospitals and health centres, but was insufficient at both levels.</p> Colin Pfaff Gift Malamula Gabriel Kamowatimwa Jo Theu Theresa J Allain Alemayehu Amberbir Sunganani Kwilasi Saulos Nyirenda Martias Joshua Jane Mallewa Joep J van Oosterhout Monique van Lettow Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 159 168 10.4314/mmj.v33i3.3 Timed Average Mean Maximum Velocity (TAMMV) of Cerebral Blood Flow of Children and Adolescents with Sickle cell Disease: correlation with clinical and hematological profiles in country <p><strong>Background</strong><br>Detection of abnormal TAMMV with transcranial Doppler is fundamental in primary stroke prevention in children with sickle cell disease (SCD). The study aimed at evaluating TAMMV and correlating it with clinical and hematological profiles of children and adolescent with SCD. <br><strong>Methods</strong><br>Transcranial Doppler was performed on subjects aged 2-16 years, using a 2 MHz probe placed over the transtemporal windows. Pulse oximetry was used to determine the peripheral oxygen saturation while clinical and hematological profiles were retrieved from their medical records.<br><strong>Results</strong> <br>One hundred and thirty five patients were recruited. The mean TAMMV was 125cm/s. Patients with HbSS had a significantly higher TAMMV (131cm/s) than those with HbSC (107cm/s). Only one (0.74%) patient had abnormal TAMMV. TAMMV correlated inversely with oxygen saturation, Hct and patient’s age, and positively with white cell and platelet counts. Previous history of acute chest syndrome (ACS) and recurrent painful crises increased the risk of development of abnormal and conditional velocity.<br><strong>Conclusion</strong> <br>Frequency of abnormal TAMMV in this study was low. Younger children and those with HbSS had higher TAMMV. Age, oxygen saturation and haematocrit correlated negatively while white cell and platelet counts correlated positively with TAMMV. Previous history of ACS and recurrent bone pain were associated with increased risk of having abnormal and conditional TAMMV.</p> Bartholomew Chukwu Lyra Menezes Thiago Fukuda Jamary Filho Marilda Goncalves Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 169 177 10.4314/mmj.v33i3.4 Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study <p><strong>Background</strong><br>High HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. <br><strong>Methods</strong><br>A qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.<br><strong>Results</strong><br>Four categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.<br><strong>Conclusions</strong><br>Understanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.</p> Chifundo Zimba Gwen Sherwood Barbara Mark Jeenifer Leeman Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 178 185 10.4314/mmj.v33i3.5 Epidemiology of Cancers in Zambia: A significant variation in Cancer incidence and prevalence across the nation <p><strong>Background</strong><br>Cancer is one of the leading causes of death worldwide. More than two-thirds of deaths due to cancers occur in low- and middle-income countries where Zambia belongs. This study, therefore, sought to assess the epidemiology of various types of cancers in Zambia.<br><strong>Methods</strong><br>We conducted a retrospective observational study using the Zambia National Cancer Registry (ZNCR) population based data from 2007 to 2014. Zambia Central Statistics Office (CSO) demographic data were used to determine catchment area denominator used to calculate prevalence and incidence rates of cancers. Age-adjusted rates and case fatality rates were estimated using standard methods. We used a Poisson Approximation for calculating 95% confidence intervals (CI). <br><strong>Results</strong><br>The seven most cancer prevalent districts in Zambia were Luangwa, Kabwe, Lusaka, Monze, Mongu, Katete and Chipata. Cervical cancer, prostate cancer, breast cancer and Kaposi’s sarcoma were the four most prevalent cancers as well as major causes of cancer related deaths in Zambia. Age adjusted rates and 95% CI for these cancers were: cervix uteri (186.3; CI = 181.77 – 190.83), prostate (60.03; CI = 57.03 – 63.03), breast (38.08; CI = 36.0 – 40.16) and Kaposi’s sarcoma (26.18; CI = 25.14 – 27.22). CFR were: Leukaemia (38.1%); pancreatic cancer (36.3%); lung cancer (33.3%); and brain, nervous system (30.2%). The cancer population was associated with HIV with p- value of 0.000 and a Pearson correlation coefficient of 0.818.<br><strong>Conclusions</strong><br>The widespread distribution of cancers with high prevalence observed in the southern zone may have been perpetrated by lifestyle and sexual culture (traditional male circumcision known to prevent STIs is practiced in the northern belt) as well as geography. Intensifying cancer screening and early detection countrywide as well as changing the lifestyle and sexual culture would greatly help in the reduction of cancer cases in Zambia.</p> Maybin Kalubula Heqing Shen Mpundu Makasa Longjian Liu Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 186 195 10.4314/mmj.v33i3.6 Assessment of risk factors for Non-Communicable diseases among a cohort of community health workers in Western Cape, South Africa <p>Community Health Workers (CHWs) have been identified as the key health professionals to drive the agenda of the prevention of health risk behaviours, linked to non-communicable diseases (NCDs) in South Africa. They are regarded as the agents of change, who will provide impetus <br>to the achievement of the health behaviour goals, set out by the South African National Department of Health.</p> Levona Johnson Laura Schopp Firdouza Waggie J.M Frantz Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 196 203 10.4314/mmj.v33i3.7 Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria <p><strong>Background</strong><br>Burns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA).<br><strong>Methods</strong><br>A five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics.<br><strong>Results</strong><br>A total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death.<br><strong>Conclusion</strong><br>The good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ.</p> Ugochukwu U. Nnadozie Charles C Maduba Gabriel M. Okorie Lucky O. Lawani Anikwe C Chidebe Obiora G. K Asiegbu Amaechi Ugbala Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 204 209 10.4314/mmj.v33i3.8 Pharmacists’ Readiness to Receive, Recommend and Administer COVID-19 Vaccines in an African Country: an online multiple-practice settings survey in Nigeria <p><strong>Background</strong><br>Without a cure, vaccination is the most reliable means of combating COVID-19 pandemic, since non-pharmacological measures could not prevent its spread, as evidenced in the emergence of a second wave. This study assessed the readiness of pharmacists to receive, recommend and administer COVID-19 vaccines to clients in Nigeria.<br><strong>Methods</strong> <br>This was a cross-sectional study in which responses were collected from pharmacists in Nigeria through Google Form link. A 21-item questionnaire was developed and validated for the study. The link was shared on the WhatsApp groups of eligible respondents. The response was downloaded into Microsoft Excel (2019) and cleared of errors. This was uploaded into KwikTables (Beta Version 2021) for data analysis. Descriptive statistics such as frequencies and percentages were used to describe the data. Chi-squared test was used to determine the relationship between all the responses and the practice areas of the pharmacists.<br><strong>Results</strong><br>A total of 509 pharmacists responded to the study, but 507 indicated their areas of practice. The highest response of 247(48.7%) was obtained from hospital pharmacists, then community pharmacists; 157(31.0%). Hospital and community pharmacists accounted for 96 and 66 of the 191(37.7%) pharmacists that would probably accept the vaccine (p=0.126). The Pfizer-bioNTech vaccine was the preferred brand for 275(54.2%) respondents. Healthcare Professionals&gt;Elderly&gt;General Populace&gt;Children was the order of roll-out recommended by 317(62.5%). Adverse-effect-following-immunization was the concern of 330(65.1%) pharmacists. Age was a factor in their likelihood of recommending the COVID-19 vaccine to clients (p=0.001).<br><strong>Conclusion</strong> <br>This study established that most pharmacists are willing to accept to be vaccinated against COVID-19, recommend and administer it to other citizens. They were impressed by the effectiveness and cost of some of the vaccines, but were concerned about their possible adverse effects. The pharmacists would want the authorities to consider strategies that will make the vaccines accessible to all citizens.</p> Abdulmuminu Isah Chukwuemeka Michael Ubaka Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 210 220 10.4314/mmj.v33i3.9 Seroprevalence of hepatitis B and C viral infections in the premarital adult population of Al Majmaah, Saudi Arabia <p><strong>Background</strong><br>Viral hepatitis is a major global health problem affecting millions of people worldwide. The main objective of the present study was to estimate the seroprevalence of hepatitis C and hepatitis B in Saudi adults undertaking premarital screening voluntarily.<br><strong>Methodology</strong> <br>This observational retrospective study was conducted at King Khaled General Hospital, Al Majmaah, Saudi Arabia, for a period of 3 years (October 1, 2016 to September 30, 2019). The prevalence of hepatitis B and hepatitis C infections was calculated using Microsoft Excel and the hematological data analysis was performed using SPSS software. A total of 3755 premarital Saudi adults who voluntarily participated in the premarital screening were included in this study. Subjects were screened for hepatitis C virus (HCV) and hepatitis B virus (HBV). The demographic and epidemiological parameters included patient age, sex, nationality, and seropositivity for HBV and/or HCV. <br><strong>Results</strong><br>Of the 3755 subjects, eight (0.242%) and 12 (0.364%) subjects were positive for HCV and HBV, respectively. Among the 12 HBV-positive subjects, nine (75%) subjects were men, and three (25%) subjects were women. However, among the eight HCV-positive subjects, five (62.5%) subjects were men, and three (37.5%) subjects were women.<br><strong>Conclusion</strong> <br>This study concluded that the prevalence of HBV infection was slightly higher than that of HCV infection among the Saudi adult population of Al Mjamaah. In addition, both HBV and HCV were less prevalent in women than in men in the study population.</p> Shabir Ahmad Mir Bader Alshehri Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 221 225 10.4314/mmj.v33i3.10 Breast metastasis from rectal carcinoma: A case report and review of the literature <p><strong>Background</strong><br>Metastasis from extramammary primary tumor to breast is extremely rare. <br><strong>Case Summary</strong><br>A 59-year-old woman with 1-year history of rectal cancer presented with asymptomatic breast mass. At 16 months after the diagnosis of rectal mucinous adenocarcinoma, a breast mass was confirmed by ultrasonography and identified by pathology and immunohistochemistry as a metastasis from the rectal cancer. Treatments included chemotherapy (6 cycles: 300 mg irinotecan on day 1, 4.5 mg raltitrexed on day 2, 450 mg bevacizumab on day 3), radiotherapy, and surgical resection. Two years of follow-up examinations (6-months intervals) showed no evidence of recurrence or novel distant metastasis. <br><strong>Conclusion</strong><br>Breast metastasis from rectal carcinoma is a rare secondary malignancy. Final diagnosis can be established by histopathology and <br>immunohistochemistry.</p> Dan -Dan Wang Su -Jin Yang Wei -Xian Chen Wei -Xian Chen Copyright (c) 2021 MMJ 2021-09-27 2021-09-27 33 3 226 228 10.4314/mmj.v33i3.11