Malawi Medical Journal最新文献

{"title":"Mothers' breastfeeding attitudes when lactation overlaps with a new pregnancy.","authors":"Nursan Çınar,&nbsp;Özge Karakaya Suzan,&nbsp;Sümeyra Topal,&nbsp;Sultan Pekşen","doi":"10.4314/mmj.v34i1.10","DOIUrl":"https://doi.org/10.4314/mmj.v34i1.10","url":null,"abstract":"<p><strong>Background and aim: </strong>There is usually a strong cultural taboo when breastfeeding overlaps with pregnancy. A lot of mothers cease breastfeeding their infants when they conceive again due to social pressure, professional advice, or their own beliefs.The present research aimed to reveal the attitudes of mothers who conceived again while breastfeeding their infants and their experiences in this process.</p><p><strong>Methods: </strong>The data of the study, were collected between November 2018 and March 2019 in Sakarya University Education and Research Hospital, Sakarya. The study conducted in 40 women in whom lactation overlapped with pregnancy, and the face-to-face interview technique was employed for data collection. Data were collected using an information form containing information about the participants and a semi-structured interview form. The interviews conducted were then examined using the interpretative phenomenological analysis method, one of the qualitative research methods. The codes and themes were created using the NVIVO 9.0 program. In the report of this study, the Consolidated criteria for reporting qualitative research (COREQ) checklist was utilized as a guide.</p><p><strong>Results: </strong>The mean age of the mothers is 26.70±4.58 (min: 20, max: 36), 62.5% (n=25) of the mothers were in the third trimester. While 5% of the mothers (n=2) continued breastfeeding during pregnancy, 95% (n=38) ceased breastfeeding at certain periods of pregnancy. It was observed that the mothers who conceived again during the lactation period considerably hesitated how to act about breastfeeding, they were significantly influenced by the people in their environment concerning how to overcome this, and they were often misguided.</p><p><strong>Conclusion: </strong>There is obviously an urgent need for evidence-based studies on the subject. Studies to be carried out in this regard will increase the self-confidence of healthcare professionals and will enable them to perform effective training and counseling on the subject.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"34 1","pages":"53-59"},"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/14/57/MMJ3401-0053.PMC10230579.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9594204","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":"The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi.","authors":"Elizabeth C Wetzel, Tapiwa Tembo, Elaine J Abrams, Alick Mazenga, Mike J Chitani, Saeed Ahmed, Xiaoying Yu, Maria H Kim","doi":"10.4314/mmj.v33i4.4","DOIUrl":"10.4314/mmj.v33i4.4","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%).</p><p><strong>Objectives: </strong>We aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes.</p><p><strong>Methods: </strong>This analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV.</p><p><strong>Results: </strong>Thirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count.</p><p><strong>Conclusions: </strong>A large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 4","pages":"242-252"},"PeriodicalIF":1.2,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/46/MMJ3304-0242.PMC8892998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10476212","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":"Effects of cardiac rehabilitation treatment modalities in Sub-Saharan Africa: A systematic review","authors":"Alice Namanja, Ana Usman, Toyin Odunuga","doi":"10.4314/mmj.v33i4.10","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.10","url":null,"abstract":"Purpose Although Cardiac Rehabilitation (CR) implementation models recommend delivery of any CR treatment component, Sub-Saharan Africa (SSA) constitutes only 17% of globally available CR programs. The aims of this review were to assess the benefits of employing any CR treatment modality in SSA, and evaluate if this approach should be encouraged in this resource-constrained region. Methodology Records were identified electronically via CINAHL, MEDLINE, Cochrane library, African journal online, PubMed, Web of science and google scholar, and grey literature was hand-searched. Articles reporting effectiveness of any CR treatment modality were included if participants had any cardiovascular disease and if the study was conducted in SSA. Quality assessment for each enrolled study was done using Downs and Black (1998) checklist and data was extracted using a modified standard tool. Results Searches identified 1666 records, 24 full text articles were examined and 10 were included for the review; 60%, 30% and 10% of the enrolled studies were done in South Africa, Nigeria and Benin respectively. The studies implemented exercise, psychosocial and education treatment modalities of CR, and the approach of delivery was either comprehensive or modified. Comprehensive CR and delivery of combined aerobic and resistance exercises improved physical (13%, p=0.001), social (40%, p=0.001) and mental aspects of quality of life and reduced anxiety (-12%, p<0.05) and depression (-6%, p<0.001) respectively. Comprehensive CR and aerobic training both reduced systolic blood pressure (range of mean reduction [RMR] -6 to -14mmHg), diastolic blood pressure (RMR -4 to -6mmHg) and resting heart rate (RMR -7 to -17bpm). Overall, all types of exercises showed a 1–5ml.kg-1.min-1 increase in peak oxygen consumption. Conclusion The findings support delivery of exercise treatment modality and comprehensive delivery of CR in SSA. However, efficacy of independent implementation of education and psychosocial therapeutic components of CR remains unclear; hence the need for further investigations.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"287 - 296"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46743593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria","authors":"S. Omenai, M. Ajani, J. Nwadiokwu, C. Okolo","doi":"10.4314/mmj.v33i4.9","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.9","url":null,"abstract":"Background Autopsy remains an invaluable resource for medical education and establishing diagnosis of diseases that were missed prior to death. Many patients on admission in hospitals suffer kidney diseases that may contribute to their morbidity and/or mortality. The kidneys from autopsies provide opportunity to diagnose and understand some of these non-neoplastic renal lesions. This study aimed to present the frequency of non-neoplastic renal diseases at autopsy. Methods We conducted a five-year retrospective review of post-mortem records of deceased who had autopsy. Data such as age, sex, cause of death, and kidney lesions were extracted from the post-mortem records and clinical details were gotten from the clinical summaries in the autopsy reports. The kidneys were examined for pathological findings that were then classified into glomerular, tubulointerstitial (tubulointerstitial nephritis and other tubular lesions such as tubular necrosis, casts and fibrosis) and vascular lesions. Results A total of seventy (70) cases met the inclusion criteria with 91.4% having significant non-neoplastic renal lesions. The mean age of the deceased was 57.7years (18years – 91years). Males accounted for 65.7% of the cases. Glomerular lesions were seen in 84.3% of the cases, tubulointerstitial nephritis in 41.6% of cases, vascular lesions were seen in 30% of the cases and other tubular lesions (such as stones, casts and tubular necrosis) were seen in 52.9% of the cases. Cardiovascular diseases and infections were the major causes of death in these patients, accounting for 40% and 27% respectively. Renal diseases were attributed to immediate cause of death in 10% of the cases. Conclusion The kidney at autopsy provides a valuable renal pathology educational tool, as a wide range of medical renal lesions can be seen from kidneys examined at post mortem.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"281 - 286"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47793862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma cytokines quantification among Trypanosoma brucei rhodesiense sleeping sickness cases and controls in Rumphi, Malawi","authors":"K. Kamoto, A. Chiwaya, Peter Nambala, Pricilla Chammudzi, E. Senga, J. Chisi, E. Matovu, J. Musaya","doi":"10.4314/mmj.v33i4.2","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.2","url":null,"abstract":"Introduction Trypanosoma brucei (T.b.) rhodesiense is the cause of the acute form of human African trypanosomiasis (HAT) in eastern and southern African countries, including Malawi. For a long time, untreated HAT infections were believed to be 100% fatal. However, recent studies show that infection by T.b. rhodesiense can result in a wide range of clinical outcomes in its human host. Apart from other factors such as parasite diversity, cytokines have been strongly implicated to play a major role in the outcome of T.b. rhodesiense infections. In this study, we quantify the levels of three cytokines Interleukin-8 (IL-8), Tumor Necrotic Factor alpha (TNF-α) and Interleukin -10 (IL-10) in plasma amongst HAT cases (treated and untreated) and controls recruited during medical survey. Methods Two-hundred and thirty-three plasma samples (HAT cases and controls) from Rumphi, one of the endemic areas in Malawi were used. Blood collected was centrifuged, plasma extracted and stored in cryovials at -80°C until processing. Plasma cytokine concentration was measured using ELISA. Results Plasma samples for 233 individuals, 76 HAT cases and 157 controls were quantified. Among the cases, nine had their plasma collected before treatment (untreated) and the rest were treated before blood for plasma analysis was collected. Controls had significantly higher mean plasmatic levels of TNF-α (94.5 ±474.12 pg/ml) and IL-8 (2258.6 ±5227.4 pg/ml) than cases TNF-α (29.35±181.58 pg/ml) and IL-8 (1191.3±4236.09 pg/ml). Controls and cases had similar mean levels of IL-10 in plasma. Only IL-8 had statistically significant higher median levels in the untreated than treated HAT cases P=0.006. Conclusion Our data suggest that cytokines could be considered as biomarkers of HAT infection and treatment. Further studies with a larger cohort of cases and additional cytokines which are known to be associated with HAT infection outcomes will be required to evaluate these cytokines further.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"230 - 235"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44090412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memoriam: Professor Malcolm Molyneux (1943–2021)","authors":"A. Muula","doi":"10.4314/mmj.v33i4.1","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.1","url":null,"abstract":"We, at the Malawi Medical Journal (www.medcol.mmj.mw) were saddened by the demise of Professor Malcolm Molyneux, former Editor-in-Chief (EIC) of our journal on 17th November 2021. Malcolm passed away in the UK where he had been since 2015 after almost three decades of service to Malawi and our journal. The Malawi Medical Journal started off as the Medical Quarterly for which Prof Molyneux was its EIC from 1980 to 1984.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"229 - 229"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70575455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent pregnancy outcomes at Queen Elizabeth Central Hospital, Malawi: a cross-sectional study.","authors":"Tamala Chaura, Donnie Mategula, Luis Aaron Gadama","doi":"10.4314/mmj.v33i4.6","DOIUrl":"10.4314/mmj.v33i4.6","url":null,"abstract":"<p><p>Malawi has a growing population with a high Maternal Mortality Ratio (MMR) of 439 per 100,000 live births to which adolescents contribute 25%. Current data suggests adolescent pregnancies in low resource settings are at an increased risk of both maternal and neonatal morbidity.</p><p><strong>Objectives: </strong>This study assessed the pregnancy outcomes amongst adolescents while using women from the early adulthood (20 - 24-year-old) and advanced maternal age (35 years old and above) groups as reference.</p><p><strong>Methods: </strong>This was a cross-sectional study, carried out at the Chatinkha maternity (labour) and post-natal wards at QECH, and included all adolescents (10 - 19 years old) and women between 20 - 24 years old (early adulthood) and 35 years old or older (advanced maternal age), presenting in labor, at any gestational age ≥ 28 weeks or with a birth weight of 1000 grams or above.</p><p><strong>Results: </strong>The study found the prevalence of adolescent pregnancy to be 20.4% (N=5035) out of all the deliveries during the recruitment period. Sexually transmitted infections were proportionally higher in the adolescent group, with 12% testing HIV seroreactive and 10% syphilis seroreactive. Neonatal outcomes of birth asphyxia (3.5%), low birth weight (5%), prematurity (4.3%) and early neonatal death (4.3%) were not statistically different from the outcomes of the older age groups. The major causes of maternal morbidity were determined to be a high caesarean section rate of 31.9% and intrapartum diagnosis of urinary tract infection (7.4%), malaria (7.4%) and hypertensive disorders (14.5%).</p><p><strong>Conclusions: </strong>Adolescents are a significant proportion of the pregnant population in Malawi. These adolescents are at increased risk of some pregnancy and peripartum complications when compared to women of older age groups. However, our study determined that these outcomes appear to be more likely related to the peripartum care received and not solely specific to maternal age.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"261-268"},"PeriodicalIF":1.2,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42204984","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":"Striking A Balance Between Prevention Of COVID-19 And The Promotion Of Child And Adolescent Mental Health: A Case Study Of Long Closure Of Schools In Malawi","authors":"Precious Makiyi","doi":"10.4314/mmj.v33i4.11","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.11","url":null,"abstract":"The Corona Virus Disease-2019 (COVID-19) has necessitated the long closure of academic institutions in most countries including Malawi. By the first week of April 2020, 188 countries had closed down their schools, affecting over 1.5 billion young people1. As a way of curbing the spread of the pandemic, the Malawian president ordered an immediate closure of schools on 23rd March, 2020, affecting 5.3 million school-going children2. Schools remained closed up to August, 2020. This may have negative implications on the mental health of school-going children, adolescents and the country’s economy.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"297 - 299"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46535001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare disease with pregnancy: Castleman case report","authors":"Özen Esra Karaman, Çetin Kılıççı, Pelin Özdemir Önder","doi":"10.4314/mmj.v33i4.12","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.12","url":null,"abstract":"Castleman's disease was first described by Castleman et al. in 1956 as a non-lymphoproliferative disease.1 Castleman's disease (CD), or angiofollicular lymphoid hyperplasia, is a rare disease with unknown etiology that can be easily misdiagnosed as lymphoma, neoplasm, or infection. Very few cases of pelvic origin and observed in pregnancy have been reported in the literature and are usually asymptomatic. Preoperative diagnosis is very difficult due to nonspecific imaging findings and rarity; most cases are diagnosed based on postoperative pathological examination. In this paper, a case of a 36-year-old pregnant woman suspected of adnexal origin in the uterine posterolateral, which was detected incidentally by ultrasound, was presented. The patient underwent a successful mass excision. Pathology of mass observed to be in the pelvic retroperitoneum was detected as localized unicentric and hyaline vascular CD. The study was conducted to discuss the diagnostic tools and perioperative management needed to identify the retroperitoneal unicentric Castleman case.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"300 - 302"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44226016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of prelacteal feeding practice in Uganda; a population based cross-sectional study using Uganda demographic and health survey data","authors":"Ibrahim Isa Koire, A. Acikgoz, T. Gunay","doi":"10.4314/mmj.v33i4.7","DOIUrl":"https://doi.org/10.4314/mmj.v33i4.7","url":null,"abstract":"Background Breastfeeding has well-established short-term and long-term health benefits for both the mother and infant. Initiating breastfeeding immediately after birth stimulates breast milk production. Prelacteal feeding (PLF) may result in late initiation of breastfeeding, and thus insufficient production of breast milk. This study aimed to identify the determinants of PLF among children under five years in Uganda. Methods This cross-sectional study was conducted using the data from the database of Uganda Demographic and Health Survey 2011. The data of 4,774 children/mothers were evaluated in this study. Results The prevalence of PLF was 40.3%. The rate of PLF practice was found to be 2.15 times higher in women with moderate economic status and 2.02 times higher in women with high economic status compared to those who have low economic status. The rate of PLF practice was found to be 1.73 times higher in newborns delivered by an unskilled birth attendant and 4.35 times higher in newborns delivered with no birth attendant compared to those infants delivered by a skilled birth attendant. The ratio of PLF practice was found to be 2.49 times higher in multiple births. Mothers who initiated breastfeeding in the first 24 hours after birth had higher odds of PLF. No relationship was found between PLF practice with some sociodemographic characteristics of mother's (age, marital status, educational status, religion, residential location), maternal factors (number of children, antenatal and postnatal care attendance, place of delivery), and characteristics of the newborn infants (sex, type of delivery, birth order number) in the multivariate logistic regression analysis. Conclusions All mothers should be informed about the importance of initiation of breastfeeding immediately after delivery, the risks associated with PLF, the optimal practices for breastfeeding, and the presence of a skilled birth attendant at delivery.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"269 - 275"},"PeriodicalIF":0.8,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46443616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}