Prevalence of HIV-1 and oral lesions in pregnant women in rural Malawi.

OBJECTIVE: Whether oral lesions were associated with human immunodeficiency virus-type 1 (HIV-1) status in a cohort of pregnant Malawian women was studied. STUDY DESIGN: Six hundred thirty-eight women participated in a randomized prospective study at 3 prenatal clinics in a rural area of southern Malawi. Oral examinations, followed by collection of oral fluid specimens with an HIV-1 oral specimen collection device, were performed. The specimens were tested for antibodies against HIV-1. RESULTS: Sixty-one oral lesions were found in 60 participants. While traditional HIV-1 associated lesions were rare, benign migratory glossitis was unexpectedly common (6%). Oral hairy leukoplakia was significantly more common among women who were HIV-1 positive than among women who were HIV-1 negative. An HIV-1 prevalence rate of 21.8% was estimated among the women, with the highest rate of HIV-1 infection (34.1%) among women aged 25 to 29 years. CONCLUSION: Stratifying lesions showed a small number of oral hairy leukoplakia to be markers for HIV-1. A high seroprevalence was found in this rural cohort, but there were unexpectedly few oral lesions. The relatively few oral lesions diagnosed may indicate a recent infection with HIV.

Health promotion and risk reduction in Malawi, Africa, village women.

OBJECTIVE: A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. DESIGN: Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. SETTING: Surveys were completed by trained data gatherers in the village setting. PATIENTS/PARTICIPANTS: All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. INTERVENTION: Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. RESULTS: The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. CONCLUSIONS: A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

Faculty preparation: a new solution to an old problem.

Concern regarding adequate faculty preparation has been an issue in nursing for many years. Because of the small number of nurses with educational preparation, expert clinicians rather than educators increasingly have filled faculty positions. Although the clinical expertise of this faculty is extremely valuable, they lack critical educational skills. This creates a dilemma for administrators, senior faculty, and the clinicians themselves. This article presents a new solution to this continuing problem. The development, purpose, and outcomes of the Teacher Education Center at the University of Pennsylvania are described. This center has met with success in preparing a specific group of expert clinicians, nurse practitioners, and nurse midwives for their faculty roles.

Childbearing in Malawi, Africa.

Malawi is a small, landlocked country in South Eastern Africa that faces many challenges in providing health care to childbearing women. Through a partnership between the faculty of the University of Pennsylvania, School of Nursing, faculty of the Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population, an ongoing collaboration has led to research and demonstration projects designed to improve the health of women and children in Malawi. To underscore the cultural context within which childbearing occurs, care of the childbearing family in Malawi is described, as is research that has documented some of the similarities and differences between childbearing in Malawi and the United States.

PIP: An ongoing partnership between the University of Pennsylvania (US) School of Nursing, Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population has led to research and demonstration projects intended to improve the health of women and children in Malawi. Essential to this collaboration has been an understanding of the similarities and differences between childbearing in Malawi and the US. Malawi has a maternal mortality rate of 620/100,000 live births and a child mortality rate of 234/1000 live births, largely as a result of socioeconomic factors. This article details the cultural context of pregnancy and childbirth in Malawi. It also describes the results of a survey conducted in 15 villages in Malawi in 1996 to evaluate the efficacy of an educational program aimed at empowering women to make safe choices during the childbearing process. The survey indicated a need for information about taking iron and antimalarials during pregnancy, the importance of seeking help as soon as problems develop during pregnancy, and the role of postpartum care. A train-the-trainer program is being conducted so local women leaders can provide health education to childbearing women in their villages.