Malawi Medical Journal最新文献

{"title":"Trends and patterns of stunted only and stunted-underweight children in Malawi: A confirmation for child nutrition practitioners to continue focusing on stunting.","authors":"Lana Clara Chikhungu","doi":"10.4314/mmj.v34i2.6","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.6","url":null,"abstract":"<p><strong>Aim: </strong>To analyse the trends and patterns of stunted only and stunted-underweight children in Malawi between the 2000 and 2015.</p><p><strong>Methods: </strong>The study used the 2000 and 2015 Malawi Demographic and Health Survey data and employed bivariate and multivariate statistical analysis techniques to explore the difference in the levels of stunted only and stunted-underweight children and key socio-economic factors between 2000 and 2015 and identify key attributes of being stunted only and being stunted-underweight.</p><p><strong>Results: </strong>The percentage of stunted only was 37.2% in 2000 and 26.8% in 2015 and the stunted-underweight percentage was 14.5% in 2000 and 8.8% in 2015. Out of the 6.9% children classified as wasted, 2.4% were also underweight and stunted, 2.4% were underweight and 2.1% did not have any other forms of undernutrition. The analysis did not identify any children that were both stunted and wasted. Only 0.7% in 2000 and 0.4% in 2015 were underweight and free of any other forms of undernutrition. There were improvements in mother education level and mother weight during this time-period which may explain the improvements in child nutritional status.</p><p><strong>Conclusion: </strong>The most common form of undernutrition is stunting and nearly all children that are underweight are also stunted. Child nutrition practitioners and health professionals should consider focusing on tackling child stunting.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"111-117"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/b3/MMJ3402-0111.PMC9356518.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629711","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":"Exploring the cultural appropriateness of a psychosocial intervention, the Thinking Healthy Programme-Peer delivered (THPP), for perinatal depression in Lilongwe, Malawi.","authors":"Mwawi Ng'oma, Najia Atif, Samantha Meltzer-Brody, Robert C Stewart, Ellen Chirwa","doi":"10.4314/mmj.v34i2.3","DOIUrl":"10.4314/mmj.v34i2.3","url":null,"abstract":"<p><strong>Background: </strong>Perinatal depression is a common and disabling mental health problem in Malawi and other Low- and middle-income countries. There is evidence for effective psychosocial interventions for perinatal depression, but no such intervention has been developed for use in Malawi. The broad aim of this study was to explore the cultural appropriateness of a psychosocial intervention for perinatal depression called the Thinking Healthy Programme-Peer delivered for adaptation and use in Lilongwe, Malawi.</p><p><strong>Methods: </strong>A qualitative exploratory design was used. Data were collected through conducting five Focus Group Discussions, involving thirty-eight purposefully selected participants including pregnant women, community volunteers and their supervisors, the Health Surveillance Assistants and maternal health care workers at implementation and policy level following observations of video recorded role plays of the Thinking Healthy Programme-Peer delivered sessions in theatre testing. A content analysis approach was used to analyse data.</p><p><strong>Results: </strong>Six main themes were generated regarding the appropriateness of the content and delivery of the Thinking Healthy Programme-Peer delivered intervention, including: 1) Focus of the intervention; 2) Cultural appropriateness of the content; 3) Language used; 4) Context; 5) Provider of the intervention; and 6) Flexibility in the delivery of the intervention. The Thinking Healthy Programme-Peer delivered intervention was deemed appropriate for the target population, though with recommendations to: review illustrations to enhance clarity, use culturally appropriate stories and idioms, use daily spoken language, and adapt the number and duration of sessions to meet the needs of individual clients.</p><p><strong>Conclusions: </strong>These findings highlight important areas to inform adaptation of the Thinking Healthy Programme-Peer delivered and add to the growing evidence of cultural adaptation of psychosocial interventions for perinatal depression.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"34 2","pages":"87-94"},"PeriodicalIF":1.2,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/e6/MMJ3402-0087.PMC9356516.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10663362","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":"Management of sigmoid volvulus during labor : a challenging situation.","authors":"El Habib Belhaddad,&nbsp;Sara Ait Souabni","doi":"10.4314/mmj.v34i2.12","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.12","url":null,"abstract":"<p><p>Acute intestinal obstruction is rare during pregnancy. Its diagnosis is difficult because the symptoms can be minimal and mimic signs of a regular pregnancy. Sigmoid volvulus is a common cause of these obstructions. The management is challenging because it depends on many factors, and affects maternal-fetal outcomes. We report a case of a 32-year-old woman with sigmoid volvulus associated with fetal demise that came during labor and we discuss the management options.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"151-153"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/10/MMJ3402-0151.PMC9356521.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40628230","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":"Sufficient informed consent to medical treatment of adults: legal and ethical perspectives from Malawi.","authors":"Eva Maria Mfutso Bengo,&nbsp;Adamson Muula,&nbsp;Joseph Mfutso Bengo","doi":"10.4314/mmj.v34i2.11","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.11","url":null,"abstract":"<p><p>This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of <i>Montgomery</i>) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"34 2","pages":"143-150"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/51/MMJ3402-0143.PMC9356522.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10604177","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":"Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China.","authors":"Hui Li,&nbsp;Nawsherwan,&nbsp;Ghulam Nabi,&nbsp;Rahmat Gul,&nbsp;Zahoor Ahmed,&nbsp;Cuifang Fan","doi":"10.4314/mmj.v34i2.8","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.8","url":null,"abstract":"<p><strong>Background: </strong>Neonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China.</p><p><strong>Methods: </strong>A total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and term twins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis.</p><p><strong>Results: </strong>Women with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p<0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p<0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p<0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p<0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p<0.05) associated with twins' neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p<0.05) associated with only twins' neonatal birth weight.</p><p><strong>Conclusion: </strong>In term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"123-131"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/b5/MMJ3402-0123.PMC9356519.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629706","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":"Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study.","authors":"Uchenna C Nnajekwu,&nbsp;Chukwubike O Nnajekwu,&nbsp;Vivian O Onukwuli,&nbsp;Bartholomew F Chukwu,&nbsp;Anthony N Ikefuna,&nbsp;Ifeoma J Emodi","doi":"10.4314/mmj.v34i2.9","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.9","url":null,"abstract":"<p><strong>Introduction: </strong>Folic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis.</p><p><strong>Aim: </strong>To determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype.</p><p><strong>Method: </strong>This study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment.</p><p><strong>Results: </strong>The median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001).</p><p><strong>Conclusion: </strong>Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"132-137"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/25/MMJ3402-0132.PMC9356529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40714654","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":"Does the \"world\" still need to keep live samples of the smallpox virus?","authors":"Adamson S Muula","doi":"10.4314/mmj.v34i2.1","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.1","url":null,"abstract":"Earlier this year (2022), the world witnessed sporadic outbreaks of monkeypox disease in countries other than those in which the disease is endemic. For instance, as of June 10, the United Kingdom had witnessed as least 7 cases of the disease; the first case having been reported on the 7th May 2022 and thought to have been brought into the country by a traveller returning from Nigeria.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"72"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/ab/MMJ3402-0072.PMC9356526.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40628228","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":"Epidemiology of Open Tibia fractures presenting to a tertiary referral centre in Southern Malawi: a retrospective study.","authors":"Kaweme Mwafulirwa,&nbsp;Remedy Munthali,&nbsp;Ian Ghosten,&nbsp;Alexander Schade","doi":"10.4314/mmj.v34i2.7","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.7","url":null,"abstract":"<p><strong>Background: </strong>Road traffic accidents in Malawi have increased in recent years resulting in a high incidence of trauma seen in the hospitals as well as a high prevalence of musculoskeletal impairment in the community. Open fractures are a common consequence of road traffic accidents and the tibia is the most common long bone open fracture.</p><p><strong>Objective: </strong>Epidemiology of open tibia fractures at the largest tertiary level hospital in Malawi and incidence of infections of open fractures managed at the institution.</p><p><strong>Methodology: </strong>This was a retrospective study of consecutive open tibia fracture patients seen and admitted to Queen Elizabeth Central Hospital's (QECH) orthopedic department from 1st January 2019 to 31st December 2019. Patients with life-threatening head, chest, or abdominal injuries were excluded as management takes priority over any limb-threatening injury.</p><p><strong>Results: </strong>There were 72 open tibia fractures screened, and 60 of these met our entry criteria; 6 patients did not, while 6 patient files were missing. The median age of patients was 36 years, IQR (27-44.75) with Males making up 82%(n=49) of open fractures. Most of the open tibia fractures were caused by road traffic accidents 63%(n=38), followed by assaults 18%(n=11), falls 17%(n=10), and industrial accidents 2%(n=1). 26.7% (n=16) of open tibia fractures developed an infection. We found that patients' average length of stay was 16. 9(IQR 9.5-31.25) days. Most of the injuries (68.3%, n=41) were moderate to high energy injuries being Gustilo et al. grade II and III open tibia fractures.</p><p><strong>Conclusion: </strong>This study identified that open tibia fractures were common in our hospital and that were often high energy injuries requiring an extended hospital stay to manage. The infection rate noted was higher than that reported on average in lower- and middle-income countries. There is a need to do more robust prospective studies in the area to gather more information.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"118-122"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/89/MMJ3402-0118.PMC9356523.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629708","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":"Reversal of Roe VS Wade - Implications on Women's Health in Malawi.","authors":"Chisale Mhango","doi":"10.4314/mmj.v34i2.14","DOIUrl":"https://doi.org/10.4314/mmj.v34i2.14","url":null,"abstract":"The United States Supreme Court in on 24th June, 2022 reversed the Abortion Law enacted in 1973 which made safe abortion available to women in that country. It now depends on the individual States to decide which way to go. Almost immediately, 22 of the 50 States reversed the law and outlawed abortion. The argument for the reversal is largely religious describing abortion as egregiously wrong.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":" ","pages":"157-158"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/c7/MMJ3402-0157.PMC9356524.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40714655","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":"Systematic assessment of complications after laparoscopic colorectal surgery for advanced colorectal cancer: A retrospective study using Clavien-Dindo classification, 5-year experience.","authors":"Mahmut Said Degerli,&nbsp;Alp Omer Canturk,&nbsp;Hilmi Bozkurt,&nbsp;Orcun Alpay,&nbsp;Muzaffer Akinci,&nbsp;Yusuf Emre Altundal,&nbsp;Turgay Yildiz,&nbsp;Dogan Yildirim","doi":"10.4314/mmj.v34i1.9","DOIUrl":"https://doi.org/10.4314/mmj.v34i1.9","url":null,"abstract":"<p><strong>Aim: </strong>The presence and frequency of surgical complications indicate the quality of the surgery performed. However, a standard classification system should specify, describe, and compare complications. Clavien Dindo classification is an easily applicable classification in the evaluation of complications. Our study aimed to reveal the severity of complications and the factors affecting them by using the Clavien Dindo classification in patients undergoing laparoscopic colorectal surgery.</p><p><strong>Methods: </strong>Between January 2015 and December 2020, we retrospectively collected the laparoscopic colorectal surgery complications using Clavien Dindo grading in patients in our colorectal surgery unit in the database. The outcome variables studied were age, gender, BMI, ASA score, postoperative length of hospital stay, operation procedure, cancer size, postoperative mortality.</p><p><strong>Results: </strong>There were 53 males and 17 female patients, with a mean age of 56,9±13,4.(19-81). Seventy patients, 32 (45%), had at least one postoperative complication. About complications; 58.6% were rated as Clavien I, 22.9% as Clavien II, 8.6% as Clavien IIIa, 4.3% as Clavien IIIb, 2.9% as Clavien IVa, and 2.9% as Clavien V. There was no Clavien grade IVb complication in any of the patients. Length of hospital stays was significantly higher in patients with had major complex surgery and had higher scores. Clavien Dindo classification was positively statistically significantly related to the day of hospitalization in male and female sex (p<0.001 for all). In addition, positively significantly related to Clavien Dindo classation and tumor diameter in the female sex (p=0.014) detected.</p><p><strong>Conclusions: </strong>In laparoscopic colorectal surgery, the Clavien-Dindo classification can be easily applied and used safely to determine complication rates. The reason for this statistical difference that we detected in our study and that occurs in women may be due to anatomical differences or the surgeon's experience.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"34 1","pages":"49-52"},"PeriodicalIF":0.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/10/MMJ3401-0049.PMC10230576.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9591614","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}