A retrospective study on side effects of first-line antiretroviral drugs on HIV patients based on 1A, 2A, and 5A regimen records at Zomba Central Hospital, Malawi.

AIDS is an incurable disease that is common in Africa. Patients with HIV/AIDS having a CD4 count of less than 240 are put on life prolonging ARV drugs. The ARVs have serious side effects on some patients which may be handled by treating them or switching patient's drug to one with no or less serious side effects. However, before doing this, more understanding of the circumstances that lead to a side effect is vital. We use statistical analyses to link side effects of 1A, 2A, and 5A treatment regimens to the patient's social and demographic characteristics based on hospital data records. A retrospective review of patients' master cards (2011-2014) was done to assess adverse effects associated with different ARV regimens. Out of the 901 patients that showed side effects, 65.37% were females aged 31-40 and 34.63% were males. Comparatively, 1A regimen showed more side effects than 2A and 5A regimens. Age, gender and occupation correlated significantly with regimen symptoms (p< 0.05). Unlike men, women had the following extra side effects; cough, peripheral neuropathy and leg pains as compared to lipodystrophy. Our results show that old people (50years+) are less likely to get skin rash and other symptoms compared to lipodystrophy (RRR=0.973). Further, the probability of either having cough (0.0021, p< 0.05), or skin rash (0.0021, p< 0.05), as a side effect, on average, decreases as age increases with the same sex and weight. The probability of having peripheral neuropathy (0.0042, p< 0.01), however, increases with age. Knowledge of HIV patient's socio-demographics and the patient's regimen side effects can be utilised to appropriately manage severe ARV side effects. A therapy consideration that takes into account chemicals in ARV regimen responsible for specific side effects can be directed to patients with compatible socio-demographic characteristics.

Influence on sensitivity to insecticides: a case study of a settled area and a game park in Liwonde.

The close proximity of Liwonde National Park to Liwonde town creates a unique situation of a large human population adjacent to a natural undisturbed animal reserve. The closeness of the two ecosystems has an impact on biology of mosquitoes of the area, such as susceptibility to insecticides. Susceptibility to insecticide was determined using knockdown bioassays. The mosquito, Anopheles gambiae, was exposed to 0.05% deltamethrin and 0.75% permethrin giving LT 50 and LT 90. The LT50 values for A. gambiae from the town was 17.23 minutes and those from the park, 14.7 minutes (p < 0.05). The calculated LT 90 values were 32.8 and 28.3 minutes respectively. These results suggest that human settlements using insecticides in mosquito control reduce susceptibility of mosquitoes to regularly used insecticides such as deltamethrin and permethrin in this study.

Applications of Bayesian approach in modelling risk of malaria-related hospital mortality.

BACKGROUND: Malaria is a major public health problem in Malawi, however, quantifying its burden in a population is a challenge. Routine hospital data provide a proxy for measuring the incidence of severe malaria and for crudely estimating morbidity rates. Using such data, this paper proposes a method to describe trends, patterns and factors associated with in-hospital mortality attributed to the disease. METHODS: We develop semiparametric regression models which allow joint analysis of nonlinear effects of calendar time and continuous covariates, spatially structured variation, unstructured heterogeneity, and other fixed covariates. Modelling and inference use the fully Bayesian approach via Markov Chain Monte Carlo (MCMC) simulation techniques. The methodology is applied to analyse data arising from paediatric wards in Zomba district, Malawi, between 2002 and 2003. RESULTS AND CONCLUSION: We observe that the risk of dying in hospital is lower in the dry season, and for children who travel a distance of less than 5 kms to the hospital, but increases for those who are referred to the hospital. The results also indicate significant differences in both structured and unstructured spatial effects, and the health facility effects reveal considerable differences by type of facility or practice. More importantly, our approach shows non-linearities in the effect of metrical covariates on the probability of dying in hospital. The study emphasizes that the methodological framework used provides a useful tool for analysing the data at hand and of similar structure.

Comparison of deltamethrin as indoor residual spray or on insecticide treated nets for mosquito control in Lake Chilwa.

We conducted a study on the control of mosquitos on Chisi Island in Lake Chilwa from August to November, 2006. The aim was to compare the cost and efficacy of deltamethrin, a pyrethroid based insecticide, when used in insecticide treated nets (ITN) and when used in indoor residual spray (IRS). Thirty village huts were enrolled in the study. Fifteen were systematically selected in a stratified manner and sprayed with deltamethrin following manufacturers' standard application procedures of 0.02g/m2. The remaining fifteen were provided with ITNs. In both groups deltamethrin KO tabs were used. Pyrethroid knockdown (PKD) spray was used for indoor rest captures in the houses monthly for three months. Houses treated with IRS had significantly reduced number of mosquitoes resting indoors than houses provided with nets (p<0.05). Based on the prevailing market price of MK550 each, the cost of five nets was calculated as MK2750.00 per house hold of five compared to five 20 g knock-out tablets costing MK300.00 using IRS. The cost of IRS is 10 times cheaper than ITN. These results suggest that it is cheaper and more effective to use deltamethrin in IRS than in ITN.

A Bayesian multinomial model to analyse spatial patterns of childhood co-morbidity in Malawi.

Children in less developed countries die from relatively small number of infectious disease, some of which epidemiologically overlap. Using self-reported illness data from the 2000 Malawi Demographic and Health Survey, we applied a random effects multinomial model to assess risk factors of childhood co-morbidity of fever, diarrhoea and pneumonia, and quantify area-specific spatial effects. The spatial structure was modelled using the conditional autoregressive prior. Various models were fitted and compared using deviance information criterion. Inference was Bayesian and was based on Markov Chain Monte Carlo simulation techniques. We found spatial variation in childhood co-morbidity and determinants of each outcome category differed. Specifically, risk factors associated with child co-morbidity included age of the child, place of residence, undernutrition, bednet use and Vitamin A. Higher residual risk levels were identified in the central and southern-eastern regions, particularly for fever, diarrhoea and pneumonia; fever and pneumonia; and fever and diarrhoea combinations. This linkage between childhood health and geographical location warrants further research to assess local causes of these clusters. More generally, although each disease has its own mechanism, overlapping risk factors suggest that integrated disease control approach may be cost-effective and should be employed.