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> en-US Copyright for articles published in this journal is retained by the journal. (Prof. Adamson S. Muula) (Thengo Kavinya) Tue, 20 Jul 2021 12:49:12 +0000 OJS 60 Letter to editor regarding article “Clinical inter-professional education activities: Students’ perceptions of their experiences” <p>We read with great interest the publication entitled, “Clinical inter-professional education activities: Students’ perceptions of their experiences”1. Ntsiea, V et al., reviewed data gathered from post-inter-professional education (IPE) feedback forms from students at the Faculty of Health Sciences, University of Witwatersrand. The IPE activity was attended to by 309 students from the following fields: Physiotherapy, Medicine, Clinical associates, Occupational therapy, Biokinetics, Pharmacy, Dentistry, Nursing, Oral Science, Speech, and Audiology. The authors found that participating in the IPE activity made students gain appreciation and respect for other health professionals’ roles and scope</p> Yohane Gadama, George Chimatiro, Alinane Linda Nyondo-Mipando Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 The Kamuzu University of Health Sciences: a “semi” new university is born in Malawi <p>Community Health Workers (CHWs) have been identified On 4th May 2021, a new university, the Kamuzu University of Health Sciences (KUHeS) started its operations in Malawi following the notice of its commencement by the Ministry of Education. The (semi) new university emerged from the amalgamation of two (former) constituent colleges of the University of Malawi (UNIMA), i.e. the Kamuzu College of Nursing (KCN) and the College of Medicine (CoM).</p> Adamson S. Muula Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey <p><strong>Background</strong><br>Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce longterm effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need.<br><strong>Aim</strong><br>To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries.<br><strong>Methods</strong><br>A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. <br><strong>Results</strong><br>There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. <br><strong>Conclusion</strong><br>An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.<br><br></p> Carlos Varela, Asgaut Viste, Sven Young, Reinou S. Groen, Leonard Banza, Bip Nandi, Nyengo Mkandawire, Bente Elisabeth Moen Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 A multidrug-resistant Stenotrophomonas maltophilia clinical isolate from Kamuzu Central Hospital, Malawi <p><strong>Background</strong><br><em>Stenotrophomonas maltophilia</em> is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi.<br><strong>Methods</strong><br>A ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to the National Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1- PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate`s multidrug-resistance (MDR) phenotype.<br><strong>Results</strong><br>Sm-MW08 was identified as <em>S. maltophili</em>a and exhibited resistance to a range of antibiotics, including all β-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded <em>bla</em><sub>L1</sub> metallo-βlactamase and blaL2 β-lactamase genes; this was consistent with the isolate’s resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate.<br><strong>Conclusion</strong><br>Herein, we have described an MDR <em>S. maltophilia</em> from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism.</p> Geoffrey Peterkins Kumwenda, Watipaso Kasambara, Abel Phiri, Kenneth Chizani, Alick Banda, Faheema Choonara, Burnet Lichapa Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Potential of Malawi’s medicinal plants in Covid-19 disease management: A review <p>The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered <br>an international pandemic that has led to significant public health problems. To date, limited evidence exists to suggest that drugs <br>are effective against the disease. As possible treatments are being investigated, herbal medicines have shown potential for producing <br>novel antiviral agents for the COVID-19 disease. <br><strong>Aim</strong> <br>This review explored the potential of Malawi’s traditional medicinal plants for the management of COVID-19. <br><strong>Methods</strong><br>The authors searched on PubMed and Google scholar for medicinal plants that are used in Malawi and published in openly available <br>peer reviewed journals. Plants linked with antiviral treatment, anti-COVID-19 activity or COVID-19 symptoms management were <br>targeted. These included activity against pneumonia, inflammation, cough, difficulty in breathing, pain/aches, fever, diarrhoea, <br>rheumatism, fatigue, asthma, immunocompromised and cardiovascular diseases.<br><strong>Results</strong><br>11 studies were found with 306 plant species. 127 plant species had at least one COVID-19 related pharmacological activity. Of these <br>plant species, the number of herbal entities used for each indication was: pain/aches (87), fever (2), pneumonia (9), breathing/asthma <br>problems (5), coughing (11), diarrhoea (1), immunosuppression (8), blood issues (10), fatigue (2), heart problems (11), inflammation <br>(8), rheumatism (10) and viral diseases (12). Thirty (30) species were used for more than one disease and Azedarachta indica topped <br>the list (6 of the 13 COVID-19 related diseases). The majority of the species had phytochemicals known to have antiviral activity or <br>mechanisms of actions linked to COVID-19 and consequent diseases’ treatment pathways.<br><strong>Conclusion</strong><br>Medicinal plants are a promising source of compounds that can be used for drug development of COVID-19 related diseases. This <br>review highlights potential targets for the World Health Organization and other research entities to explore in order to assist in <br>controlling the pandemic.</p> Ibrahim Chikowe, Andrew G. Mtewa, David Tembo, Dallas Smith, Edna Ibrahim, Bonface Mwamatope, Justin Nkhungulu, Peter Kumpalume, Peter Kumpalume, Alfred Maroyi Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Evaluation of diabetic peer support in Malawi <p><strong>Background</strong><br>Type 2 diabetes is a major health concern worldwide and requires urgent attention from health care providers and policy makers. Due to shortage of health care workers in low-income countries, peer support programs have been viewed as a viable option in management of diabetes and have shown to be effective in sub-Saharan Africa. <br><strong>Objective</strong><br>The aim of this study is to assess and evaluate the Kamuzu Central Hospital (KCH) diabetic peer support program’s (DPSP) impact 4 years after its establishment by assessing knowledge, self-efficacy and behaviours of DPSP members compared to non-members.<br><strong>Methodology</strong> <br>This is a cross-sectional study done among diabetic patients attending clinics between 12th August and 25th September 2018 at KCH. Self and interviewer-administered questionnaires (designed based on validated survey instruments) were used. The participants (n=176) were recruited consecutively after consenting. <br><strong>Results</strong> <br>Results showed DPSP members were more knowledgeable regarding the effects of skipping meals and sweet juice on blood glucose and conditions not associated with diabetes. In terms of self-efficacy and behaviour changes, DPSP members believe that they are more able to correct hypoglycaemia, to communicate their concerns to health workers and to perform daily foot exam compared to non-members.<br><strong>Conclusion</strong> <br>The KCH (Lilongwe) Diabetes Peer Support program has positively impacted its members and should be scaled up to engage all diabetic patients in Malawi. Ongoing training for peer supporters is necessary to update and reinforce management, knowledge and skills, and to ensure fidelity in program implementation.</p> Henry T Mwakalinga, Yamikani M Nuka, Patrick C Banda, Thuy D Bui Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Type 2 diabetes mellitus risk assessment among doctors in Ondo state <p><strong>Introduction</strong><br>Diabetes Mellitus (DM) has become a disease of public health importance in Nigeria. Early identification of DM risk is important in the reduction of this disease burden. This study assessed ten-year risk of developing type 2 DM among some medical doctors in Ondo State. <br><strong>Methods</strong><br>This was a cross-sectional study that assessed ten-year risk of developing type 2 DM among some doctors using the Finland Diabetic Risk Score form. Known diabetics were excluded from the study. Body mass index (BMI), waist circumference (WC), blood pressure and total DM risk score were determined for each participant.<br><strong>Results</strong> <br>One hundred and ninety-two doctors participated in the study with a male: female ratio of 1.3:1. Majority (92.2%) were below 55 years, 22 (11.5%) were obese, 32(16.7%) had central obesity, 46(24%) reported physical inactivity, 49(25.5%) had family history of DM, 141(73.4%) do not take fruits and vegetables regularly. Forty-three (22.4%) were found to have elevated blood pressure while 6(3.1%) had elevated blood glucose. Fifty-seven (29.7%) of the participants had increased ten-year DM risk. Significant predictors of increase DM risk were age ≥ 45 years (AOR:9.08; CI 3.13-26.33; p = &lt;0.001 ) ; BMI ≥25kg/m<sup>2</sup> (AOR:11.41; CI:4.14-31.45; p = &lt;0.001) ; family history of DM (AOR:9.93; CI:3.25-30.39; p = &lt;0.001) ; abdominal obesity (AOR:6.66; CI:2.08-21.29; p= &lt; 0.001); and infrequent dietary intake of fruits and vegetable(AOR:3.11;CI:1.03:9.37: p = 0.04) <br><strong>Conclusion</strong><br>There was increased 10-year DM risk in about 30% of the participants. Lifestyle modification such as physical activity and regular consumption of fruits and vegetables should be encouraged among doctors.</p> Adenike Christianah Enikuomehin, Oluseyi Ademola Adejumo, Ayodeji Akinwumi Akinbodewa, Fakhraddeen Yahya Muhammad, Olutoyin Morenike Lawal, Oladimeji Adedeji Junaid Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Self-reported and clinically evident gingival bleeding and impact on oral health-related quality of life in young adolescents: a comparative study <p><strong>Background</strong><br>Very little is known about how self-reported gingival bleeding affects the oral health-related quality of life in adolescents compared with clinically evident bleeding. This study aimed to compare the impact of self-reported gingival bleeding and clinically evident gingival bleeding on the oral health-related quality of life in young adolescents.<br><strong>Methods</strong><br>This was a cross-sectional study involving 976 students (aged 10–14 years) in randomly selected primary schools in Ibadan. Data were obtained by oral examination and completion of the Child Oral Impact on Daily Performance Questionnaire. Data were analysed with SPSS version 24. The Mann Whitney U test was used to determine the association between gingival bleeding and the quality of life.<br><strong>Results</strong><br>The mean age of the participants was 11.4±1.3 years. Almost half (48.3%) of the participants reported gingival bleeding during tooth cleaning while the gingiva of 534 (54.7%) participants bled on examination. Pupils with self-reported bleeding suffered a significantly greater impact on their overall quality of life than those without self-reported bleeding (mean ranks: 528.1 vs. 451.6, P&lt;0.001). For pupils with self-reported bleeding, there were higher impacts on all domains relating to quality of life than those who did not report bleeding (eating: mean ranks=521.0 vs. 458.2; speaking: 502.2 vs. 475.8; teeth cleaning: 522.7 vs. 456.7; sleeping: 497.7 vs. 456.7; showing teeth/smiling: 503.4 vs. 474.6; emotional stability: 501.1 vs. 476.8; school work: 492.4 vs. 484.9, and enjoying contact with other children: 494.0 vs. 483.4). There was no statistically significant association between clinically evident bleeding and impacts on the quality of life (P=0.272).<br><strong>Conclusion</strong><br>Almost half of the students reported gingival bleeding while cleaning their teeth and over 50% experienced gingival bleeding on probing. Those with self-reporting of gingival bleeding had greater impacts on oral health-related quality of life compared with those with clinically evident bleeding.</p> Folake B. Lawal, Elizabeth B. Dosumu Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria <p><strong>Background</strong><br>Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations.<br><strong>Objectives</strong><br>The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography.<br><strong>Methods</strong><br>A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls.<br><strong>Results</strong><br>A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). <br>All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p&lt;0.005). <br><strong>Conclusion</strong><br>This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group</p> Josephat M Chinawa, Awore T Chinawa, Edmund N Ossai, Bartholomew F Chukwu, Ikenna K Ndu, Isaac N Asinobi Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 The Initial Economic Burden of Femur Fractures on Informal Caregivers in Dar es Salaam, Tanzania <p><strong>Background</strong><br>Femur fracture patients require significant in-hospital care. The burden incurred by caregivers of such patients amplifies the direct costs of these injuries and remains unquantified. <br><strong>Aim</strong> <br>Here we aim to establish the in-hospital economic burden faced by informal caregivers of femur fracture patients. <br><strong>Methods</strong></p> <p>70 unique caregivers for 46 femoral shaft fracture patients were interviewed. Incurred economic burden was determined by the Human Capital Approach, using standardized income data to quantify productivity loss (in $USD). Linear regression assessed the relationship between caregiver burden and patient time-in-hospital.<br><strong>Results</strong><br>The average economic burden incurred was $149, 9% of a caregiver’s annual income and positively correlated with patient time in hospital (p&lt;0.01). <br><strong>Conclusion</strong> <br>Caregivers of patients treated operatively for femur fractures lost a large portion of their annual income, and this loss increased with patient time in hospital. These indirect costs of femur fracture treatment constitute an important component of the total injury burden.</p> Ericka P. von Kaeppler, Erik J. Kramer, Claire A. Donnelley, Hao- Hua Wu, Elliot Marseille, Edmund Eliezer, Heather J. Roberts, David Shearer, Saam Morshed Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000 Unusual presentation of atrial Myxoma in a young Malawian male: Case report and review of literature <p>We report a 30-year-old male who presented with signs and symptoms of right heart failure who was later diagnosed with right-sided atrial myxoma. This patient, unfortunately, died while waiting for cardiac surgery outside Malawi and postmortem was not done to ascertain the cause of death.</p> Geoffrey Elihu Manda, Mwai Mtekateka, Sharon Kunkanga, Sharon Kunkanga, Noel Kayange Copyright (c) 2021 Wed, 30 Jun 2021 00:00:00 +0000