Malawi Medical Journal最新文献

{"title":"Repeated Ultrasound-Guided Lumbar Sympathetic Block for Refractory Painful Diabetic Peripheral Neuropathy: The First Case from Mzuzu Central Hospital, Malawi.","authors":"Junyi Ren, Francis Masoo, Yingpu Zhu","doi":"10.4314/mmj.v38i2.12","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.12","url":null,"abstract":"<p><strong>Background: </strong>Painful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus characterized by chronic neuropathic pain, sleep disturbance, and impaired quality of life. Although pharmacological therapies remain the cornerstone of treatment, many patients experience inadequate symptom control. Access to advanced interventional pain management techniques, including radiofrequency ablation and neuromodulation, remains limited in many healthcare settings. We report the first case of ultrasound-guided lumbar sympathetic block (LSB) performed for refractory PDPN at Mzuzu Central Hospital, Malawi.</p><p><strong>Case presentation: </strong>A 19-year-old woman with a 9-year history of type 1 diabetes mellitus presented with bilateral lower-limb neuropathic pain that had persisted for 6 years and progressively worsened over the preceding 3 years. Symptoms were more severe in the right lower limb, with a baseline Numerical Rating Scale (NRS) score of 8/10. Clinical features included burning pain, stabbing pain, numbness, allodynia, sleep disturbance, and impaired mobility. The Douleur Neuropathique 4 (DN4) score was 8/10. Previous treatment with amitriptyline, gabapentin, vitamin B supplementation, diclofenac, and tramadol failed to provide satisfactory symptom relief.The patient underwent four ultrasound-guided right lumbar sympathetic blocks using 10 mL of 1% lidocaine between May 15 and May 25, 2026. Pain intensity decreased from an NRS score of 8 to 4 immediately after the first procedure and from 5 to 1 after the second procedure. Complete pain relief was achieved before the third procedure and was maintained throughout the two-week follow-up period. Skin temperature increased by approximately 0.9-1.0°C after each block. No procedure-related complications were observed.</p><p><strong>Conclusion: </strong>Repeated ultrasound-guided lumbar sympathetic block provided substantial and sustained pain relief in refractory PDPN. This minimally invasive, low-cost, and reproducible technique may represent a practical therapeutic option for selected patients with refractory neuropathic pain and may be particularly valuable in settings where access to advanced pain interventions is limited.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"140-145"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian cancer presentation and management in sub-Saharan Africa: a scooping review protocal.","authors":"Alex Thawani, Dzinkambani Kambalame, Jim Mtambo, Patrick Mapulanga, Vincent S Phiri, Fanuel Lampiao, Adamson Sinjani Muula","doi":"10.4314/mmj.v38i2.15","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.15","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Ovarian cancer is a leading gynecological malignancy mortality globally. Clinical outcomes in sub-Saharan Africa (SSA) are poor, largely due to late-stage presentation and limited accessing to effective treatment options. Referral pathways also delay diagnosis and compromise delivery of guideline-concordant care. A comprehensive mapping of evidence on ovarian cancer presentation and management across SSA is needed to characterize what is known, where evidence is concentrated, and where critical gaps persist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;This protocol describes a systematic scoping review of literature on ovarian cancer presentation and management in SSA. The review will be conducted in accordance with the Arksey and O'Malley methodological framework and reported using PRISMA-ScR guidance. The Population Concept Context (PCC) framework will guide eligibility and data charting (Population: individuals diagnosed with ovarian cancer, including epithelial ovarian cancer and, where specified, fallopian tube or primary peritoneal cancer; Concept: presentation from symptom onset to diagnosis and management across the care pathway; Context: SSA). We will search PubMed, Embase, Scopus, Web of Science, CINAHL, and the Cochrane Library, alongside relevant grey literature sources (organizational websites, conference proceedings, dissertations/theses). Searches will be limited to English-language evidence published between January 2000 and June 2026. Two reviewers will independently screen titles/abstracts and full texts, with disagreements resolved by consensus or a third reviewer. Data will be charted using a standardized extraction form capturing study characteristics, presentation indicators (symptoms, stage at diagnosis, delays), diagnostic/staging approaches, management modalities (surgery, systemic therapy, radiotherapy, supportive/palliative care), and barriers/facilitators. Results will be synthesized using descriptive mapping and narrative/thematic synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;Ethics approval is not required as this review will use de-identified publicly available data. Findings will be disseminated through peer-reviewed publications, conference presentations, and stakeholder engagement to inform policy, service delivery, and research priorities for improving ovarian cancer outcomes in SSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations of this study: &lt;/strong&gt;This review will provide a comprehensive evidence map across the ovarian cancer care pathway in sub-Saharan Africa, drawing on both published and grey literature to characterize the scope, distribution, and nature of available evidence. Rigor and transparency will be strengthened through dual independent screening of titles/abstracts and full texts. However, restricting inclusion to English-language evidence published between 2020 and June 2026 may result in the omission of relevant studies from earlier periods or those p","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"154-159"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Descriptive Assessment of Healthcare Workers' Preparedness for Digital Health Systems in Malawi.","authors":"Mayamiko Nkoloma, Harry Gombachika, Chomora Mikeka, Alfred Maluwa","doi":"10.4314/mmj.v38i2.2","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.2","url":null,"abstract":"<p><strong>Introduction: </strong>Although Malawi has expanded various digital health initiatives under its National Digital Health Strategy, there is still limited research on how prepared frontline healthcare workers really are to adopt and use Digital Health Systems (DHS). Most previous studies have focused on system level improvements in data reporting rather than on the experiences and preparedness of the users themselves. This is a major gap as healthcare workers' level of preparedness directly influences system performance, and data quality. This study assessed healthcare workers' preparedness to adopt DHS in Malawi.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a structured questionnaire administered to 615 healthcare workers in selected districts across the three regions of Malawi. Key TAM constructs were analysed using descriptive statistics and binary logistic regression.</p><p><strong>Results: </strong>Overall preparedness levels among healthcare workers for DHS adoption were high. Behavioural intention (94.3%), job relevance (94.1%), and subjective norms (92.1%) recorded the highest scores. Significant predictors of adoption were behavioural intention (OR = 2.67, p < 0.001), job relevance (OR = 2.12, p < 0.001), perceived usefulness (OR = 1.85, p = 0.002), and subjective norms (OR = 1.58, p = 0.014). Majority of respondents from the Southern region reported having attended DHS training compared to those from the Northern region (OR = 2.337, 95% CI:1.549-3.097, p < 0.001), while no significant difference was observed for the Central region (p = 0.330). A higher proportion of male respondents reported having previously attended digital health training compared to female respondents (OR = 1.496, p = 0.019).</p><p><strong>Conclusion: </strong>Motivational and social factors are the main predictors of DHS adoption in Malawi, while technical capacity remains a challenge. To ensure successful implementation and scale-up of digital health initiatives in Malawi, policymakers and health managers should focus on strengthening and improving user training, improving access to computers and reliable internet within health facilities, and promoting a supportive organisational culture.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"61-68"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topographic and Morphometric Assessment of Facial Foramina in Maxilla, Mandible, and Zygomatic Bones: Anatomical and Clinical Relevance.","authors":"Betul Sevindik, Ayse Gamze Ozcan, Busra Pirinc, Nadire Unver Dogan","doi":"10.4314/mmj.v38i2.10","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.10","url":null,"abstract":"<p><strong>Background: </strong>The anatomy of the zygomatic bone, maxilla, periorbital, and mental regions is important because important vessels and nerves pass through these regions. The zygomaticofacial nerve can be injured during facial surgeries, especially during zygomatic implant surgeries. Infraorbital and mental nerves are among the nerves blocked during local anesthesia in dentistry.</p><p><strong>Objective: </strong>To evaluate the topographic and morphometric characteristics of the zygomaticofacial, infraorbital, and mental foramina, and to determine their anatomical variations and clinical significance in order to provide guidance for maxillofacial surgical procedures and regional anesthesia applications.</p><p><strong>Methods: </strong>30 dry human skull bones (60 sides) were examined. The distance of the zygomaticofacial foramen to the edge of the orbit, the distance to the lower end of the zygomaticomaxillary suture, the distance to the upper end of the zygomaticotemporal suture, and the distance to the infraorbital foramen were measured. The distance of the infraorbital foramen to the edge of the orbit and the lower end of the suture zygomaticomaxillaris was measured. Morphometric measurements of the mental foramen variations were examined.</p><p><strong>Results: </strong>Distance between infraorbital foramen and zygomaticomaxillary suture found 24.42 mm on the right; 25.21 mm on the left. It was statistically significant (p = 0.030). The location of the zygomaticofacial foramen was evaluated in four regions (A, B, C, and D), and the most frequent location was region A.</p><p><strong>Conclusion: </strong>Determining the area where the zygomaticofacial foramen is most commonly located will serve as a guide to help prevent nerve injury during facial surgery. It is important that there is no significant difference in the distances between the foramina on the right and left sides to facilitate surgical interventions.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"123-129"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Country readiness in responding to COVID-19 Vaccine-Related Events (VREs) in Malawi.","authors":"Save Kumwenda, Mphatso Nyamasauka, Davis Makupe, Sandra Machiri, Nenani Chisema, Mavuto Thomas, Rhoda Chado, Alvin Phiri, Atupele Kapito","doi":"10.4314/mmj.v38i2.3","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.3","url":null,"abstract":"<p><strong>Introduction: </strong>The Malawi Ministry of Health (MMoH) and partners developed a comprehensive Coronavirus Disease 2019 (COVID-19) Vaccine Related Events (VREs) response plan in 2022. A VRE is any anticipated threat that could erode the public's trust in vaccines or vaccination delivery. We explored the MMoH's readiness to implement the plan by assessing the availability of VRE-related documents describing the overall process of identifying, reporting, investigating, and coordinating a VRE response; and by assessing the strengths and weaknesses of the current system.</p><p><strong>Methods: </strong>We conducted a cross-sectional assessment among MMoH staff involved in VRE response at national, district, and health facility level using a survey and a semi-structured interview guide in ten districts in Malawi in 2023. Ten VRE-related documents were assessed and their availability visually confirmed. We assessed each of the survey findings by district and zone. Ten key themes pertaining to VRE identification, reporting, investigation, and response were explored in 109 Key Informant Interviews (KIIs) and six Focus Group Discussions (FGDs).</p><p><strong>Results: </strong>More than 60% of respondents reported having access to VRE-related documentation, but less than 10% reported access to non-Adverse Events Following Immunisation (non-AEFIs)-related guidance. Participants identified existing processes for AEFIs, but noted the lack of training, coordination, and budgetary support for both AEFI and non-AEFI activities. Health facilities with VRE response teams or committees had implemented aspects of the response plan, emphasizing the need to formulate teams or committees in all health facilities.</p><p><strong>Conclusion: </strong>Adequate implementation of Malawi's VRE response plan will require expanded training opportunities, sustained funding, and improved coordination across all levels of the health system.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"69-80"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric Analysis of Pulmonary Fibrosis Imaging Research: Knowledge Graph Construction Based on the Web of Science Core Database.","authors":"Shuo Yu, Zhiyue Li, Yuting Zhang, Yaqi Yan, Min Tian, Yuhan Bian, Pardis Bahadori, Chenwang Jin","doi":"10.4314/mmj.v38i2.9","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.9","url":null,"abstract":"<p><strong>Aim: </strong>To quantify publication trends, map international collaboration networks, and identify dominant and emerging research themes in Pulmonary fibrosis(PF) imaging (2015-2024).</p><p><strong>Methods: </strong>A structured Web of Science search combining PF- and imaging-related terms yielded 1,159 English-language original research articles. Analyses employed CiteSpace, VOSviewer, and Scimago Graphica for trend assessment, keyword co-occurrence, citation burst detection, and collaboration network visualization.</p><p><strong>Results: </strong>Annual publication volume showed sustained linear growth (R² = 0.867). Researchers from 64 countries contributed; the United States led in output (332 publications) and citation impact (9,821 citations), while China ranked second in volume (224 publications) with lower proportional citation impact. The Western Europe-North America axis showed the densest collaborative ties. Keyword co-occurrence revealed close thematic links among idiopathic pulmonary fibrosis, high-resolution computed tomography (HRCT), usual interstitial pneumonia (UIP), survival, and mortality. Citation burst analysis identified \"deep learning\" as the strongest and most sustained burst (2021-2024), by which point it had shifted from exploratory method to established domain. Three overlapping research phases emerged: diagnostic framework consolidation (2015-2018), computational computed tomography (CT)-based phenotyping (2016-2022), and therapeutic expansion toward antifibrotics and progressive fibrosing interstitial lung disease (2019-2024).</p><p><strong>Conclusion: </strong>PF imaging research has shifted from diagnostic consensus toward quantitative CT biomarkers and artificial intelligence(AI)-driven phenotyping, driven by the need to reduce interobserver variability and enable individualized risk stratification. Geographic fragmentation and limited multicenter validation remain key barriers to AI generalizability. Future priorities include standardized imaging protocols, prospective multicenter validation cohorts, and integration of AI-driven CT phenotyping with multi-omics and circulating biomarkers for prognostic precision.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"116-122"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"miR-146a-5p mitigates ethanol-induced neuroinflammation by targeting Btg2-dependent microglial activation.","authors":"Bo Cheng, Yan Wang, Ping Huang, Zikuo Dong, Junya Zhou, Guoqing Kang, Chengzhu Wang, Zhenkun Yan","doi":"10.4314/mmj.v38i2.11","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.11","url":null,"abstract":"<p><strong>Background: </strong>Chronic alcohol exposure leads to progressive neurodegeneration, primarily driven by sustained neuroinflammation and microglial activation. While microRNAs are key regulators of neuroimmune responses, the specific role of miR-146a-5p and its downstream targets in ethyl alcohol (EtOH)-induced neuroinflammatory injury remain poorly understood.</p><p><strong>Methods: </strong>A chronic EtOH exposure model was established in C57BL/6 mice and BV-2 microglial cells. Neuroinflammatory damage was assessed using behavioral tests (Morris water maze), apoptosis assays, cytokine quantification, and immunostaining. The regulatory relationship between miR-146a-5p and its target gene Btg2 was investigated using luciferase reporter and RNA pull-down assays, combined with gain-of-function approaches.</p><p><strong>Results: </strong>EtOH exposure significantly downregulated miR-146a-5p expression in both mouse hippocampal tissue and BV-2 cells. Overexpression of miR-146a-5p in vivo improved spatial learning and memory, reduced neuronal apoptosis, and attenuated microglial activation and pro-inflammatory cytokine (IL-1β, IL-6, TNF-α) production. Mechanistically, Btg2 was identified as a direct target of miR-146a-5p. EtOH-induced Btg2 upregulation was reversed by miR-146a-5p overexpression in vitro. Importantly, restoring Btg2 expression abolished the anti-inflammatory and anti-apoptotic effects of miR-146a-5p in EtOH-treated BV-2 cells.</p><p><strong>Conclusion: </strong>This study identifies the miR-146a-5p/Btg2 axis as a critical regulator of EtOH-induced microglial activation and neuroinflammation. Targeting this pathway may offer a promising therapeutic strategy for alcohol-related neurodegeneration.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"130-139"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Health and Climate Change- Malawi Clinicians' Current and Next Frontiers in lung adenocarcinoma.","authors":"Adamson S Muula, Dzinkambani Kambalame","doi":"10.4314/mmj.v38i2.14","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.14","url":null,"abstract":"","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"151-153"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Angiotensin Receptor-Neprilysin Inhibition Combined with Enteral Nutritional Therapy on Cardiac Performance and Inflammatory Burden in Hemodialysis-Associated Heart Failure: Clinical and Experimental Evidence.","authors":"Xiangying Liu, Tao Lu, Qiangyan Hu, Chengyi Yang","doi":"10.4314/mmj.v38i2.6","DOIUrl":"10.4314/mmj.v38i2.6","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular complications remain the leading cause of mortality in patients undergoing maintenance hemodialysis (MHD), with heart failure (HF) representing a major clinical challenge. Beyond neurohormonal dysregulation, malnutrition and chronic microinflammation contribute significantly to disease progression. This study investigated whether angiotensin receptor-neprilysin inhibition combined with enteral nutritional support could provide additive benefits in this high-risk population.</p><p><strong>Methods: </strong>A randomized controlled clinical study was conducted involving 60 MHD patients with HF, allocated to standard therapy or combined intervention groups. The intervention consisted of sacubitril/valsartan administration together with structured enteral nutrition support. Cardiac structure and function, inflammatory markers, nutritional indices, immune parameters, and quality-of-life scores were evaluated over 6 months. In parallel, a rat model of post-infarction HF was established to validate mechanistic and physiological changes, including echocardiographic measurements and serum biomarker assessment.</p><p><strong>Results: </strong>Patients receiving the combined regimen demonstrated superior improvement in left ventricular systolic performance, with greater reductions in LV dimensions and circulating BNP levels compared with conventional treatment. Inflammatory mediators including IL-1β, IL-6, and CRP were significantly attenuated, while serum albumin, total protein, hemoglobin, and immunoglobulin levels increased more prominently. Quality-of-life scores improved without excess adverse events. Experimental findings mirrored clinical observations: treated rats exhibited improved LVEF, reduced ventricular remodeling indices, and decreased BNP and pro-inflammatory cytokines relative to untreated HF controls.</p><p><strong>Conclusion: </strong>The integration of sacubitril/valsartan therapy with enteral nutritional supplementation exerts synergistic effects on cardiac remodeling, inflammatory modulation, and metabolic recovery in MHD-associated HF. These findings support a multidimensional therapeutic strategy targeting both neurohormonal activation and nutritional-inflammatory imbalance.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"94-101"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties and validation of the Malawian Cerebral Palsy Quality of Life-child (CP QoL-Child) questionnaire for primary caregivers.","authors":"Bente van der Meijden, Alinafe Chisulanda Kusate, Alpheus Njewa, Wieger Voskuij","doi":"10.4314/mmj.v38i2.5","DOIUrl":"https://doi.org/10.4314/mmj.v38i2.5","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) is the leading cause of childhood disability worldwide, with a significantly higher burden in low- and middle-income countries (LMIC). In Malawi, children with CP often face limited access to rehabilitation services, social exclusion, and poor health outcomes, all of which negatively affect their quality of life (QoL). Although the CP QoL-Child is a validated instrument for assessing QoL in children with CP, no culturally adapted or translated version existed for Malawi.</p><p><strong>Aim: </strong>This study aimed to translate, culturally adapt, and validate the CP QoL-Child primary caregiver version into Chichewa for use in Malawi.</p><p><strong>Methods: </strong>This cross-sectional study involved 62 caregivers of children with CP in Malawi. The CP QoL-Child for Primary Caregivers was translated into Chichewa following standard guidelines. Internal consistency was assessed with Cronbach's alpha and test-retest reliability with intraclass correlation (ICC). ANOVA was used to explore associations with GMFCS levels.</p><p><strong>Results: </strong>The Chichewa CP QoL-Child showed excellent internal consistency (α = 0.96 overall; domain α = 0.65-0.96). Test-retest reliability was strong, with ICCs ranging from 0.84 to 0.96. The Access to Services domain had the lowest internal consistency (α = 0.65), while the highest temporal stability was found in Feelings about Functioning and Emotional Well-being (ICC = 0.96).</p><p><strong>Conclusion: </strong>The Chichewa version of the CP QoL-Child for Primary Caregivers shows strong reliability and offers a valuable tool for understanding and improving the quality of life of children with CP in Malawi, with potential to inform interventions and policy.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"38 2","pages":"87-93"},"PeriodicalIF":0.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}