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> en-US Copyright for articles published in this journal is retained by the journal. (Prof. Adamson S. Muula) (Thengo Kavinya) Fri, 16 Dec 2022 14:41:53 +0000 OJS 60 Prevalence and risk factors for Falls among older adults in a primary care facility in Ghana <p><strong>Background</strong><br>Falls are a serious problem and are among the leading causes of morbidity, functional dependency, and death in older adults. Falls<br>have become a social and global public health concern due to the current aging population in Africa and across the globe. However,<br>their prevalence and risk factors have received little attention in Africa.<br><strong>Purpose</strong><br>Thus, this study aimed to provide a baseline survey to determine the prevalence and associated risk factors for falls among older adults<br>attending a primary care facility in Cape Coast, Ghana.<br><strong>Results</strong><br>Participants (n = 244) were patients aged 60 years and older who visited the University of Cape Coast Hospital. The prevalence of<br>falls identified in this hospital-based study was 40.2%. The following independent variables were found to be statistically significant<br>predictors of risk of falls among the participants when compared with their respective reference categories; age 80 years and above<br>[OR = 3.707, 95% CI = 1.738 – 7.907, p = 0.001], participants who had a history of falls [OR = 2.234, 95% CI = 1.326 – 3.765, p<br>= 0.003], participants with three or more co-morbidities [OR = 16.456, 95% CI = 2.099 – 129.020, p = 0.008] and obesity [OR =<br>2.211, 95% CI = 1.151 – 4.250, p = 0.017].<br><strong>Conclusion</strong><br>The prevalence of falls among older adults is high. Thus, clinicians in the primary care setting should screen for, give fall prevention<br>education, and prescribe appropriate interventions to at-risk patients.</p> Madison Adanusa, Seth Kofi Pobee, Ebenezer Zaabaar, Vukey Mawuko, Kofi Asiedu, Solomon Kweku Amuzu, Wendy Adubofour, Celestine Bazayeya, Ethel Enam Yawo Senaya, Desiree Citsofe Ofori, Samuel Kyei Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Views and experiences of traditional and Western medicine practitioners on potential collaboration in the care of people living with mental illness in Malawi <p><strong>Introduction</strong><br>Collaboration between traditional and biomedical medicine can lead to holistic care and improved health outcomes for people with<br>mental illnesses. The current study aimed to explore the views and experiences of traditional and western medicine practitioners on<br>potential collaboration in the care of people living with mental illness in Blantyre, Malawi.<br><strong>Method</strong><br>A phenomenological qualitative research design was used. Data were collected using both one-on-one in-depth interviews (IDIs)<br>and focus group discussions (FGDs). Participants were traditional healers and western medicine practitioners in Blantyre, Malawi.<br>We conducted 10 in-depth interviews with traditional healers, 4 focus group discussions (2 for traditional healers and 2 for western<br>medicine practitioners) and 6 key informant interviews with leaders of the two groups. The sample was determined based on data<br>saturation. Thematic analysis was used to analyse the data. We used a combination of deductive and inductive coding.<br><strong>Results</strong><br>Five broad themes were identified from the data: experiences with collaboration, views on collaboration, models of collaboration,<br>barriers to collaboration, and factors that can facilitate collaboration. participants had no experience of formal collaboration between<br>traditional healers and western healthcare workers in the management of mental illness. However, some reported experience of<br>successful collaborations in other health areas such as safe motherhood, tuberculosis and HIV/AIDS. Many participants showed a<br>positive attitude toward collaboration and were in support of it. Barriers to collaboration included negative attitudes and a lack of<br>resources. Factors that can facilitate collaboration were dialogue, training and respect. Referral and training were the preferred forms<br>of collaboration.<br><strong>Conclusion</strong><br>With proper structures and respectful dialogue, a collaboration between traditional and western medicine practitioners is possible in<br>Blantyre, Malawi.</p> Demoubly Kokota, Robert C Stewart, Catherine Abbo, Chiwoza Bandawe Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 The Effect of the Covid-19 pandemic on emergency service home service calls due to home accidents in children aged 0-6 in Sakarya, Türkiye? <p><strong>Background and Aim</strong><br>The contribution of global pandemics to the emergence of home accidents is unknown. The study aims to retrospectively examine the<br>effect of the Covid-19 Pandemic on Emergency Service Home Service Calls Due to Home Accidents in Children aged 0-6.<br><strong>Methods</strong><br>Data are reported in two sections. The descriptive part is a retrospective analysis of patients admitted to Sakarya Training and Research<br>Hospital Pediatric Emergency and Adult Emergency Unit between March 16, 2019 and January 31, 2020 (non-COVID-19era) and<br>March 16, 2020 and January 31, 2021 (COVID-19era). The second part of the study, the comparative part, presents mean data for<br>2019-2020 (non-COVID-19era) and 2020-2021 (COVID-19era) from the same center and the same period. These data will then be<br>compared.<br><strong>Results</strong><br>A total of 9,110 pediatric patients applied to our center during the study period, of which 7,905 patients were in the non-Covid-<br>19era period and 1,205 patients were in the Covid-19 era. While the rate of hospital admissions decreased by 85% in the Covid-19era<br>compared to the non Covid-19era, when the periods are evaluated within themselves; the forensic report retention rate in the Covid-<br>19era increased by 180% and the rate of hospitalization increased by 75%, The rate of drug overdose increased by 280% and chemical<br>substance use increased by 325% compared to the non-Covid-19era. However The Covid-19 era, the fall rate decreased by 31% and<br>the burn rate decreased by 17% compared to the non-Covid-19 era.<br><strong>Conclusions</strong><br>During the national lockdown period, our pediatric emergency department experienced significantly reduced volumes of children.<br>Despite the decrease in hospital admission rate during the COVID-19 pandemic, there was still a very high increase in poisoning from<br>home accidents. This study can provide a basis for further research on alternative strategies to address the problem of home accidents<br>during the COVID-19 pandemic.</p> Özge Karakaya Suzan, Pınar Tabakoglu, Bahri Elmas, Nursan Çınar Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Perceived Stress and Stressors among Undergraduate Medical Students of a Nigerian Institution <p><strong>Aim</strong><br>To identity stressors and measure the intensity of stress perceived by clinical students in a Nigerian institution.<br><strong>Methods</strong><br>This study was a cross-sectional study of fifth and sixth-year medical students using the 40-item Medical Student Stressor Questionnaire<br>(MSSQ). Students marked their responses to each of the 40 questions on a Likert scale ranging from-causing no stress at all (0) to<br>causing severe stress (4)<br><strong>Results</strong><br>The median stress scores for the six domains were as follows: Academic related stressor (ARS)- 2.1, Teaching and Learning related<br>stress (TLRS)-1.29, Desire related stressors (DRS)- 1.00, Group activities related stressors (GARS)- 1.00, Social related stressor (SRS)<br>– 0.83, and Interpersonal related stressor (IRS)- 0.57. Overall, ARS was perceived to cause high-level stress in 51.6%, and severe stress<br>in 7.8% of students. Specifically, ‘Heavy workload’ and ‘large amount of content to be learnt’ caused severe stress in 45.3% and 40.6%<br>of students respectively. Skipping meals was frequent and associated with high stress scores in IRS, SRS and GRS domains.<br><strong>Conclusion</strong><br>Academic related stressors cause high-severe stress among a considerable proportion of medical students studied, while interpersonal<br>related stress caused mild stress. ‘Heavy workload’, ‘Tests/Examinations’, and ‘lack of time to review what has been learnt’ are some<br>major stressors identified. Universities need to prioritise accessibility to healthy meals, improved students’ living environment, provision<br>of psychological support and formal training on time management and other soft skills, to reduce stress and promote better academic<br>performance. There may be a need to review medical students’ curriculum to prioritise relevance over breadth of content.</p> Ogochukwu Chinedum Okoye Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective crosssectional study <p><strong>Background</strong><br>Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and<br>treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the<br>systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19<br>patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated<br>the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave.<br>The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients.<br><strong>Methods</strong><br>All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021.<br>All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness<br>(Acute Physiology and Chronic Health Evaluation –APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on<br>admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital’s electronic database. The<br>Charlson Comorbidity Index (CCI) was assessed for all patients.<br><strong>Results</strong><br>A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously<br>dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion<br>of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI<br>was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II.<br><strong>Conclusions</strong><br>In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors<br>confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.</p> Banu Cevik, Burcu Kuzhan, Elif Bombacı, Kemal Tolga Saracoglu Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Bibliometric analysis of three international journals on public health dentistry: A comparative study from 2011 to 2020 <p><strong>Background and Objective</strong><br>The research question was to conduct a comparative analysis of articles published ,citations,grants and authors co-occurence in<br>three journals of Public health dentistry namely Journal of Public Health (JIF-1.821),Community Dentistry and Oral Epidemiology<br>(JIF-3.803) and Community Dentistry Health(JIF-1.079).This study was triggered , because of the constant growth of the academic<br>production of articles in the world. The objective of this study is to describe the design of studies published in the period 2011 - 2020<br>of the three mentioned journals.<br><strong>Material and Methods</strong><br>A retrospective, observational, comparative study was conducted for JPHD, CDOE ad CDH. All issues of JPHD,CDH and CDOE<br>from 2011 to 2020 were manual searched and also assessed through Scopus database.The data were organized and analyzed using<br>software SPSS version 21.0; and citation mapping process using VOSviewer software.<br><strong>Results</strong><br>A total of 1544 articles were retrieved from all the three journals .The largest number of manuscripts was published in the<br>Community Dentistry and Oral Epidemiology journal.The pattern of study design in JPHD (65.69%) and CDH(74.79%) was majorly<br>cross sectional studies followed by cohort studies(19.46%) and randomized controlled trials (8.34%) respectively.In all the three<br>journals,maximum authors were more than three in number .Majority of the original research work focused on oral health such as<br>oral health status,literacy,oral health quality of life.<br><strong>Conclusion</strong><br>The publication pattern in all the three journals were interestingly related to each other; most articles published were original research<br>work intending an enhanced inclination of researchers toward observational affirmations.</p> Gunjan Kumar, Payal Dash, Samikshya Jena Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Healthcare workers’ experiences in caring for critically ill COVID-19 patients at a tertiary hospital in Malawi <p><strong>Introduction</strong><br>The coronavirus pandemic overwhelmed the healthcare landscape, placing a strain on healthcare workers worldwide. In addition to<br>directly causing the deaths of people, the COVID-19 pandemic disrupted critical health services in developing countries. The study<br>aimed to explore the experiences of healthcare workers who cared for critically ill COVID-19 patients at a tertiary hospital in Malawi.<br><strong>Methods</strong><br>A qualitative descriptive design was used. Data were gathered through in-depth interviews with doctors, clinical officers, nurses, and<br>allied staff (n=25) who were involved in the care of critically ill COVID-19 patients at the hospital’s COVID-19 treatment centres during<br>the first and second waves of the pandemic in Malawi. The interviews were conducted in English, audiotaped, and later transcribed<br>verbatim. Conventional content analysis was used to analyse the data following the steps proposed by Hsieh and Shannon1.<br><strong>Results</strong><br>The overall experience of the health workers was negative. However, delivering care to critically ill COVID-19 patients was associated<br>with positive and negative experiences. The positive experience was a result of teamwork among staff and support from hospital authorities<br>and the community. Negative experiences, on the other hand, were attributed to a lack of knowledge and skills in managing critically ill<br>COVID-19 patients, a lack of resources, and abuse by some patients and members of the community. Furthermore, there was fear of<br>contracting the virus from patients and fellow health workers while providing care.<br><strong>Conclusion</strong><br>The findings point to the need for adequate preparedness within the health sector to support and protect the healthcare workers and<br>individuals they look after. There is a need for disease awareness strategies for health workers and the general public for future pandemics.</p> Beatrice Gundo, Joyce Beyamu, Alice Singo, Deliwe Chipeta, Rodwell Gundo, Abigail Kazembe Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia <p><strong>Aim</strong><br>This study aimed to assess the awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students<br>in Zambia.<br><strong>Materials and Methods</strong><br>We conducted a cross-sectional study among 326 undergraduate pharmacy students in Lusaka, Zambia, from February to April 2021.<br>Data were analysed using Stata version 16.1. Multivariable logistic regression was used to determine key factors influencing vaccine<br>acceptance.<br><strong>Results</strong><br>Of the 326 participants, 98.8% were aware of the COVID-19 vaccines, but only 24.5% would accept vaccination. Compared to other<br>religions, being of Christian faith was associated with reduced odds of awareness of the COVID-19 vaccine (aOR=0.01, 95% CI:<br>0.01-0.20). Conversely, factors associated with vaccine acceptance were being male, single and unemployed. Compared to females,<br>male respondents were 86% more likely to accept the vaccine if it was made available (aOR=1.86, 95% CI: 1.10-3.14). In addition,<br>unmarried respondents were 2.65 times as likely to accept vaccination than married respondents (aOR=2.65, 95% CI: 1.06-6.63).<br>Conversely, unemployed respondents were less likely to accept vaccination than their employed counterparts (aOR=0.32, 95% CI:<br>0.16-0.46). Barriers to the acceptability of the vaccine were possible side effects (78.5%) and scepticism about its effectiveness<br>(10.2%).<br><strong>Conclusion</strong><br>There was significant vaccine hesitancy toward COVID-19 vaccines among Zambian pharmacy students despite their awareness<br>of the vaccines. Health authorities must work collaboratively with training institutions to mitigate vaccine hesitancy, especially with<br>healthcare students being a key part of the future healthcare workforce overseeing disease prevention strategies.</p> Steward Mudenda, Moses Mukosha, Christabel Nang’andu Hikaambo, Johanna Catharina Meyer, Joseph Fadare, Martin Kampamba, Aubrey Chichonyi Kalungia, Sody Munsaka, Roland Nnaemeka Okoro, Victor Daka, Misheck Chileshe, Ruth Lindizyani Mfune, Webrod Mufwambi, Bwalya Angel Witika, Brian Godman Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 “Our [Yao people’s] circumcision is of the ‘brain’ not of the ‘penis’”: factors behind the resistance to voluntary medical male circumcision among Yao people of Mangochi in Southern Malawi <p><strong>Aim</strong><br>Malawi officially launched Voluntary Male Medical Circumcision (VMMC) in 2012 after the 2007 joint WHO /UNAIDS<br>recommendation that VMMC be a key HIV prevention strategy for Sub-Sahara African region. Malawi data, however, contradicted the<br>findings of three randomized studies conducted in Uganda, Kenya and South Africa between 2005 and 2007. While randomized trials<br>demonstrated that male circumcision could contribute to a 60% relative reduction of HIV acquisition by men through heterosexual<br>intercourse, HIV prevalence in Malawi was highest in the Southern Region where 47% of males were traditionally circumcised yet<br>Central Region had 15.4% and Northern Region, 6.3%. By December 2018, Malawi had only achieved 756, 780 surgeries constituting<br>31% against the target of 60% of eligible men. The low achievement was due to resistance to services even in traditionally circumcising<br>Yao communities. This study sought views of Yao respondents in Mangochi district, in Southern Malawi, on VMMC.<br><strong>Methods</strong><br>156 participants were interviewed (103 males and 53 females): 15 FGDs (involving 86 males and 50 females); 17 IDIs (involving 14<br>males, 3 females); 3 Key KIIs (involving 3 males, 0 females). For this paper, the authors only analyzed FGDs, IDIs and KIIs. Quotes<br>from FGDs were not significant.<br><strong>Results</strong><br>The study identified that VMMC: a) did not contribute to societal moral values; b) involved female circumcisers; c) threatened<br>chiefs’ political authority and economic gains; d) threatened continuity of jando; e) was impotent against witchcraft; f) provided by<br>inefficient providers; g) resembled Yao circumcision; h) wrongly translated as ‘m’dulidwe wa abambo.’<br><strong>Conclusions</strong><br>The key barrier to VMMC services in Yao communities of Mangochi was the mistrust between government and implementers on one<br>hand and Yao communities on the other due to inadequate engagement prior to the rollout of services.</p> Kent Y.G. Mphepo, Adamson S. Muula, John R. Sadalaki, Felix Phuka, Joseph Mfutso- Bengo Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 A complicated pregnancy: Eclampsia or COVID-19? <p>Pregnant women may be infected with SARS-CoV-2 virus and develop serious complications of the disease. Covid-19 causes primarily<br>a respiratory system infection but can also affect cardiovascular, renal, gastrointestinal, and neurological systems. Cardiovascular<br>involvement includes new onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism, and pre-eclampsia like syndrome.<br>We report a confirmed Covid-19 pregnant case presented with eclampsia to the emergency department and undergone emergent<br>cesarean section. Following surgery, she was admitted to the intensive care unit due to hypoxemia and hypertension. After observing<br>lymphopenia and high CRP level with hypoxemia, radiological imaging revealed typical findings for viral pneumonia and nasopharyngeal<br>swab, which was not carried out at admission, was positive for Covid-19. On the 20th hour of follow-up, she became hypotensive<br>requiring noradrenalin infusion. Echocardiography diagnosed cardiomyopathy with left ventricular ejection fraction of 35-40 % with<br>high levels of NT pro-BNP, hs-troponin, and CK-MB in the patient.<br>Covid-19 should be considered in complicated pregnancies. In complicated cases, a chest CT scan upon admission may aid in quickly<br>detecting the presence of infection and preventing nosocomial spread of the virus. Cardiomyopathy could be found in pregnant<br>patients with Covid-19 infection. Since cardiomyopathy can be seen in late pregnancy and early postpartum period, it is difficult to<br>distinguish between viral and postpartum cardiomyopathy in these patients. Recognizing the infection earlier will help to anticipate the<br>complications that might contribute to deterioration of the patients, perioperatively.</p> Ayse Ozcan, Yusuf Harun Iren, Cigdem Kizilay, Yusuf Ustun, Cetin Kaymak, Hulya Basar Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 If AFP is elevated, where is cancer? The case report on hereditary persistence of Alpha-fetoprotein <p>Alpha-fetoprotein (AFP) is expressed by tumors with a high mitotic index such as hepatocellular carcinoma and germ cell tumors, therefore it is used as a tumor biomarker. Interestingly, although there is no underlying cause, elevated AFP has been reported in some genetically predisposed individuals. This is a very rare and benign condition called “hereditary persistence of AFP (HPAFP)” and an inherited in an autosomal dominant manner. To our knowledge, only 28 families have been reported to date. Some of the reported cases received inappropriate treatments such as chemotherapy and surgery. The possibility of HPAFP should be kept in mind in patients with high AFP in the absence of radiological evidence of hepatocellular carcinoma or germ cell tumor to avoid harmful <br>procedures. It can be easily confirmed by analyzing AFP levels in other family members. We report a case of HPAFP with surprisingly higher AFP levels than previously reported cases and this is the first case reported from Turkey.</p> Hatice SARACOGLU, Mevlut BASKOL, Hakan SARACOGLU Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000 Lessons learned from the Global Polio Eradication Initiative: A roadmap for the international COVID-19 vaccination campaign <p>The COVID-19 vaccine is lauded by many as one of the greatest accomplishments in modern medicine, with the potential to definitively contain the deadliest pandemic of the last century. With the vaccine rollout now underway in the developing world, a robust, methodical, and swift global distribution effort is required to ensure that it will be done in an equitable manner. Taking into <br>account the vast geographic, socioeconomic, cultural, and political diversity of countries around the world, global vaccination efforts have historically required multifaceted, time consuming, and labor-intensive approaches to be effective. However, with over 33 years of experience from the Global Polio Eradication Initiative – an international health initiative aimed at eradicating poliomyelitis – the COVID-19 vaccination campaign does not have to be approached blindly. Using lessons learned from the Global Polio Eradication Initiative, this paper aims to identify the supply- and demand-side barriers to the success of the international COVID-19 vaccination effort, and ways each can be overcome. Most notably, health systems shortcomings, political and cultural messaging, and civil unrest and violent conflict serve as daunting obstacles to the success of the COVID-19 vaccination campaign. The Global Polio Eradication Initiative has been able to overcome many of these same obstacles with innovative strategies such as context-specific microplanning, robust health surveillance systems, and community-centered education and advocacy programs. Ultimately, while the Global Polio Eradication Initiative is still fighting the battle of polio eradication, it has provided a roadmap for the COVID-19 vaccination campaign to be executed in a more swift and equitable manner.</p> William B. Belshe, Jared M. Alswang, Alexander M. Uplift- Brown, Luso Chilenga, John Chipolombwe, Vincent Y. Seaman Copyright (c) 2022 MMJ Fri, 16 Dec 2022 00:00:00 +0000