Cyclone Freddy in Malawi: Reflections from a primary care perspectivee.

No abstract available.

Perceived readiness for diabetes and cardiovascular care delivery in Mangochi, Malawi: multicentre study from healthcare providers' perspectives.

BACKGROUND: Despite the expected prevalence rise of 98.1% for diabetes between 2010 and 2030 in sub-Saharan Africa (SSA) and the anticipated rise of both diabetes and cardiovascular diseases (CVDs) in Malawi from their current figures ( 5.6 and 8.9%; respectively), data on the readiness of health facilities to provide diabetes and cardiovascular diseases in Mangochi district is not available. Therefore, this study aimed to assess the readiness of health facilities to provide services for diabetes and cardiovascular diseases. METHODS: An exploratory study was conducted from July to early September 2021 in 34 health facilities in Mangochi, Malawi. Forty-two participants were purposefully selected. They included medical officers, clinical officers, medical assistants, and registered nurses. The study used semi-structured interviews (for qualitative data) with a checklist (for quantitative data) to provide information about the readiness of services (such as guidelines and trained staff, drugs, diagnosis capacity and equipment, essential medicines, community services, and education/counseling).The thematic content analysis and basic descriptive statistics were carried out. RESULTS: The following main theme emerged from the qualitative part: low use of diabetes-cardiovascular disease (CVD) services. This was due to: health facility factors (shortage of drugs and supplies, poor knowledge, few numbers and lack of training of providers, and absent copies of guidelines), patients factors (poor health-seeking behaviour, lack of education and counseling for many), and community factors (very limited community services for diabetes and CVDs, lack of transport policy and high transportation costs). Data from the checklists revealed low readiness scores across domains (below the 75% target) in diabetes and cardiovascular diseases: trained staff and guidelines (26.5% vs. 32.4%); diagnosis capacity and equipment (63.7% vs. 66.2%); essential medicines (33.5% vs. 41.9%), and community services, and education and counseling (37.5% vs. 42.5%). CONCLUSION: There were several noticeable shortfalls identified in the readiness of health facilities to provide diabetes and cardiovascular disease services in Mangochi health facilities. Any future intervention in diabetes-cardiovascular disease care in these areas must include these elements in its basic package.

Salient beliefs about modifiable risk behaviours among patients living with diabetes, hypertension or both: A qualitative formative study.

BACKGROUND: Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. AIM: With a focus on the theory of planned behaviour as a theoretical lens, this study aimed to identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi. Specifically, the objectives were to identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi. SETTING: A hypertension diabetes clinic at Mangochi District Hospital, south-eastern Malawi. METHODS: A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour's elicitation interview guide. Thematic content analysis was used to identify emerging themes. RESULTS: A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change. CONCLUSION: Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension.Contribution: The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.

Brief behaviour change counselling in non-communicable diseases in Mangochi, Southern Malawi: a hypothetical acceptability study.

INTRODUCTION: Brief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) among health providers, policy-makers and patients living with noncommunicable diseases (NCDs) in the Mangochi district located in Malawi. METHODS: An exploratory qualitative cross-sectional study used purposive sampling to select 44 respondents. We conducted group discussions with five focus groups that included patients. We also carried out nine key-informant interviews with healthcare providers and policy-makers. Data were managed and organized with Atlas.ti. cloud and analysed using the thematic framework approach. FINDINGS: Several themes, categories, and their subcategories emerged from the interviews. Participants perceived the introduction and delivery of BBCC + 5As + GS in Mangochi as smooth. However, they predicted a few challenges such as time and space to conduct the intervention, cultural bottlenecks caused by low education level, age differences between healthcare providers and patients, low provider- to- patient ratio and high provider turnover. For this method to be adopted, a simplified format is deemed necessary to improve effectiveness with patients. This technique can only be sustained if training opportunities are provided and if positive testimonies are given by beneficiaries. Incorporation of a continuous quality improvement cycle targeting challenges must be part of the intervention. Participants perceived that BBCC will contribute to developing the listening ability of healthcare providers. This would help in providing personalized and cost-effective care relevant to Mangochi. The participants also perceived that BBCC + 5As + GS will be affordable, credible and useful. CONCLUSION: We found a high acceptability rate of BBCC among stakeholders in NCDs clinics in Mangochi. There are a number of areas where BBCC + 5As + GS could be improved to increase the acceptability. Accordingly, a study of feasibility and preliminary efficacy is warranted to determine other prerequisites for the implementation of a large-scale trial using this BBCC+ 5 As + GS, and to fully understand the implementation requirements of a full trial in Mangochi.

Factors influencing health facility delivery among women of reproductive age in Lilongwe District, Malawi: a cross-section study.

Introduction: utilization of health facility for delivery could save pregnant women from avoidable maternal deaths. However, use of health facility in deliveries remains inconsistent. The main study objective was to identify factors influencing health facility delivery among women of reproductive age in Lilongwe District. Methods: a cross-sectional study using structured questionnaires administered to 210 women of reproductive age was used. Chi-square (or Fischer Exact Test), where appropriate was used to analyze data. Results: the findings of the study revealed that the level of health facility delivery in Lilongwe District is 73.8%. It revealed that 97.1% of the respondents are aware of health facility delivery and most (89.5%) prefer health worker as the best person to assist pregnant women during delivery. There is a significant association between level of knowledge (p = 0.000), the level of education (p=0.000), employment (94.7%) and religious teachings (p=0.000) with delivery in a health facility. The study further shows that more Muslim´s women (91.7%) delivered at health facility compared to their counterparts from others religions and African traditionalists (20%). Conclusion: in conclusion, the level of knowledge, age, level of education and marital status, Occupation, monthly income, and the amount spent during the past delivery, and the religious teachings influence health facility delivery. We recommend the sharing of the findings with different stakeholders in order to find the solutions and the need for dialogue with traditional chiefs and religious leaders on advocating for health facility delivery.

Mentoring upcoming researchers for non-communicable diseases' research and practice in Malawi.

The Malawi College of Medicine and its partners are building non-communicable diseases' (NCDs') research capacity through a grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. Several strategies are being implemented including research mentorship for junior researchers interested to build careers in NCDs' research. In this article, we present the rationale for and our experiences with this mentorship program over its 2 years of implementation. Lessons learned and the challenges are also shared.

Knowledge, attitudes and prevention practices regarding HIV/AIDS among barbers in Ho municipality, Ghana.

Barbering poses risks of HIV transmission if it is not conducted in a hygienic manner. This study assessed the knowledge, attitudes and prevention practices regarding HIV transmission among barbers in the Ho Municipality, Ghana. A cross-sectional design was employed in Ho Municipality, and data were collected from 121 participants and analysed using Stata version 13.0 at the significance level of 0.05. Knowledge was low (63.6%) and was associated with attitude [COR=4.37 (95% CI: 1.98-9.62); p<0.001] and with level of education [COR=4.92 (95% CI: 1.70-14.21); p=0.003]. Attitude was inadequate (58.7%) and was associated with level of education [COR=3.47 (95% CI: 1.18-10.14); p=0.023]. Poor prevention practice was high (87.6%) and was associated with work experience [COR=20.72 (95% CI: 3.86-111.05); p<0.001] and location of operation [COR=4.92 (95% CI: 1.60-15.14); p=0.006]. Programmes aimed at improving knowledge, attitudes and practices should focus on Barbers in urban communities, those without any formal education, and those with less than five years work experience.

Risky sexual behaviours among young people in sub-Saharan Africa: how can parents use the Ottawa Charter for Health Promotion for change?

Despite progress made in the treatment of HIV and AIDS by making available the antiretroviral treatment in Africa, youth are still struggling with inadequate knowledge, a negative attitude towards AIDS and high-risk sexual behaviour. All of these are compounded by a lack of open communication between parents and youths which among others, which impedes on the control of the pandemic in this vulnerable group. Building on 'Ottawa Charter for Health Promotion' as one way of breaking all barriers in this communication, we suggest keys points in five different domains of this framework namely: building healthy public policies, creating a supportive environment, strengthening community action, developing personal skills, and reorienting the health services.

Knowledge, attitudes and practices regarding HIV/AIDS among senior high school students in Sekondi-Takoradi metropolis, Ghana.

BACKGROUND: In Ghana, youths aged 15-24 years constitute the group most vulnerable to HIV infection. Inadequate knowledge, negative attitudes and risky practices are major hindrances to preventing the spread of HIV. AIM: This study sought to investigate the knowledge, attitudes and practices regarding HIV/AIDS among senior high school (SHS) students. SETTING: Sekondi-Takoradi metropolis, Ghana. METHODS: A descriptive, cross-sectional design was adopted, using a validated self-administered questionnaire, to collect data from a stratified sample of 294 senior students selected from three participating high schools in August 2017. The data collected were analysed using Stata version 12. Descriptive and inferential statistics were at a significance level of 0.05. RESULTS: Among the participants, 61.6% had good knowledge about HIV/AIDS, 172 (58.5%) showed positive attitudes towards people living with HIV (PLHIV) and 79.1% reported HIV-related risky practices. We found a significant association between age and attitudes (p < 0.05). Poor knowledge was associated with being Muslim (aOR = 1.51 and 1.93; CI 1.19-1.91; p = 0.00) and being a student from school 'F' senior high school (F SHS) (aOR = 1.93; CI 1.71-2.18; p = 0.00). Bad attitude towards PLHIV and HIV was associated with ages 15-19 years (aOR = 3.20[2.58-3.96]; p = 0.03) p confirmed; and single marital status (aOR = 1.79[1.44-2.23]; p = 0.00). Bad practices were associated with ages 15-19 years (aOR = 1.72[1.41-2.11]; p = 0.08), belonging to the Akans ethnic group (aOR = 1.57[1.26-1.97]; p = 0.00) or being single (aOR = 1.79[1.44-2.23]; p = 0.00). Associations between misconceptions and HIV transmission were found: HIV can be transmitted by a handshake (aOR = 3.45[2.34-5.68]; p = 0.000), HIV can be cured (aOR = 2.01[2.12-5.04]; p = 0.004) and HIV/AIDS can be transmitted by witchcraft (aOR = 3.12[3.21-7.26]; p = 0.001). CONCLUSION: Participants generally had inadequate knowledge regarding HIV/AIDS, manifested negative attitudes towards PLHIV and also engaged in risky practices that might predispose them to HIV transmission. Our findings underscore the need for culturally adapted and age-oriented basic HIV information for youths in the metropolis on misconceptions about HIV transmission, negative attitudes of students towards PLHIV as well as the risky practices of students regarding HIV.

Uptake of HIV testing and counseling among tertiary institution students in the Hohoe Municipality, Ghana.

HIV Testing and Counselling (HTC) is a critical strategy to reduce the rate of new HIV infections and the key entry point to HIV treatment, care and support services. This study aimed to determine the uptake of HTC among students of tertiary institutions in the Hohoe Municipality of Ghana. This was a quantitative cross-sectional study. A structured questionnaire was used to collect data among a proportionate stratified sample of students from tertiary institutions. Chi-square and Logistic regression analyses were performed using Stata version 12.0 at the 0.05 level of significance. Only 30.6% of the total respondents had ever tested for HIV/AIDS of which, only 22.9% tested less than 6 months before the current study. Students above twenty-four years of age were 3 times more likely to go for HTC than those below 20 years [OR=2.56 (95% CI: 1.07-6.11; p=0.034)]; those in the fourth year of study were 3 times more likely get HTC than those in the first year [OR=3.05 (95%CI: 1.10-8.49; p=0.033)]; and those attending THERESCO, the Midwifery training college and UHAS were more than 2 times more likely to get tested for HIV than those attending FRANCO [OR =2.67 (95% CI: 1.14-6.15; p=0.024)], [OR=2.40 (95% CI: 1.04-5.54; p=0.040)] and [OR=2.63 (95% CI: 1.13-6.13; p=0.026)] respectively. The uptake of HTC among tertiary institution students in Hohoe municipality was considerably low. Policymakers should design programs and interventions that would increase uptake of HTC among tertiary students, with focus on those aged less than 20 years, those at the lower level of study and those in the non-health related institutions.

Family medicine training and practice in Malawi: History, progress, and the anticipated role of the family physician in the Malawian health system.

This article analyses the development and implementation of family medicine training and practice in Malawi, with special attention given to its current status and the projected role the trained family physician will be expected to play in the future. The general aim of the paper is to briefly review the role of family physicians in rural areas, as well as to discuss the history of family medicine training in Malawi. The idea of formal family medicine training and practice in Malawi started as early as 2001 but did not come to fruition until 2011, with the start of the undergraduate clerkship in the fourth year of medical school at the University Of Malawi College Of Medicine. This energy was followed by the launch of a postgraduate training programme in early 2015. The challenges encountered in this endeavour are also reviewed. The paper concludes by discussing the expected role a Malawian family physician will play in the local context, considering the key roles that family physicians play elsewhere in Africa.

Prevalence and associated factors of partially/non-immunization of under-five in Goma city, Democratic Republic of Congo: a community-based cross-sectional survey.

INTRODUCTION: At the East part of DRC, anecdotal reports are advancing several causes of unsuccessful campaigns of vaccination by the time going: rumors about use of vaccines for killing purpose, injection of vaccine to decrease the reproductive potential in coming generations, use of vaccines by some rebellions and neighboring countries to kill children indirectly, ineffectiveness of vaccines currently on the market. While those rumors seem to be less reliable, potential beneficiaries are taking them seriously and justifying a reluctance to bring their children or siblings for immunization. Against this above background, our community Primary Health Care team indicates that still, in Goma city in general and even in the referral hospital catchment area, there are children who have never been vaccinated. OBJECTIVES: To determine the prevalence and determinants of non-immunization of under-five children in Goma City. STUDY DESIGN: Cross-sectional community-based survey. METHODS: A sample size of 384 children aged under-five years from the target population was used for the study. The ratio of under-five years of age Goma city to the total population of Goma city for the year 2012 was considered as the study population frame. RESULTS: The prevalence of under-five non-immunized children was 25.7%. There was an association between immunization status of children and their gender, school characteristics, age, sibling, the level of literacy, the marital status of their parents and the age of their mothers. CONCLUSION: For improving the quality of under-five children immunization, the medical authorities must consider these different determinants.

HIV knowledge and sexual risk behavior among street adolescents in rehabilitation centres in Kinshasa; DRC: gender differences.

BACKGROUND: Street children, common in Africa, are increasingly vulnerable to alcohol and drugs of abuse and lack access to both healthcare and knowledge about HIV and AIDS. Hence, this study assessed the level of knowledge about sexually transmitted infections (STIs), including HIV, among street adolescents in the Democratic Republic of the Congo (DRC). METHODS: A random sampling of 200 street children (10-25 years of age) were selected from 17 rehabilitation centres in Kinshasa, and a structured questionnaire was administered to all participants in their respective centres. High knowledge, knowledge or awareness of condom was defined when a participant gave more than 67% of correct responses. Chi square analysis was used to test differences between sexes. RESULTS: The knowledge level of respondents was high. 54.3% of males and 45.7% of girls have heard about HIV), and few participants cited unprotected sex as mode of transmission (42.9% for males and 57.1% for females). A high number of children reported a previous sexual experience. Satisfying a natural bodily need was the main reason for having sex. However, the use of condoms is still low in both genders (26.2 versus 59.3%, p<0.01). Neither gender reported a reason why they are not using a condom. CONCLUSION: This study highlights the high knowledge about HIV, which contrasts with low condom use and high past sexual experiences with the high number of sexual partners and sexual contacts. Policies targeting these findings are warranted to reverse such trends.

Psychosocial implications of tubal ligation in a rural health district: a phenomenological study.

BACKGROUND: Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants. METHODS: This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description. RESULTS: Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains. CONCLUSIONS: Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.

High prevalence of syphilis among demobilized child soldiers in Eastern Congo: a cross-sectional study.

BACKGROUND: Syphilis, a known major public health issue for soldiers during periods of conflict, is exacerbated in the Democratic Republic of Congo due to widespread sexual violence. However, there has been no previous study to determine the extent of this problem. Therefore, we determined the prevalence of syphilis among young demobilized soldiers. METHODS: Screening of syphilis using the rapid plasma reagin test and the Treponema pallidum hemagglutination assay was conducted in three transit sites of soldier reintegration in 2005. The Fisher Exact probability test was used to compare results. RESULTS: The prevalence of syphilis was found to be 3.4%, with almost equal distribution in respect to sex, location. CONCLUSION: Syphilis continues to be highly prevalent in demobilized child soldiers in Eastern Congo. Syphilis screening tests are recommended.