Why might clinicians in Malawi not offer HIV testing to their patients?

In order to identify reasons clinicians in Malawi might not offer HIV testing to patients, a cross-sectional descriptive postal census with telephone and fax follow-up was conducted. Proportions were calculated for each reason given for not offering HIV testing. Multiple logistic regression was used to determine whether responses differed by demographic characteristics. The response rate was 54.3%. The five most common reasons for not offering HIV testing were: (1) inadequate training in HIV counselling (50.3%); (2) perception that the patient is not ready (49.5%); (3) no indication (35.6%); (4) testing facilities unavailable (35.4%); and (5) insufficient time (28.9%). Differences in reasons for not offering HIV tests amongst clinician groups were few. Thus, development of one general programme based on common reasons identified in this study could be effective in increasing HIV testing rates. Further investigation of the identified reasons should be undertaken to facilitate programme development.

Are public antenatal clinics in Blantyre, Malawi, ready to offer services for the prevention of vertical transmission of HIV?

At least 100% of the adult population in Malawi is infected with HIV and vertical transmission is a major mode of transmission. Currently, there are plans to provide widespread antiretroviral therapy to prevent mother to child transmission of HIV. This study was conducted to describe the perceptions of midwives towards selected issues regarding prevention of mother to child transmission of HIV in eleven public health centres in Blantyre, Malawi. A cross-sectional study using a self-administered questionnaire incorporating both open-ended and closed-ended questions was used. Twenty seven midwives participated in the study. Less than half (40.7%), of them reported working at a baby friendly hospital initiative health facility, while 96.3% reported that they would advise an HIV infected woman to breastfeed her infant. HIV prevention messages were reportedly offered routinely by 77.8% of the respondents, but only 22.2% reported that their clinics offered condoms to pregnant women. Also, only 37.0% reported offering routine STI screening, while 37.0% of the midwives would support antenatal women being accompanied by their male partners Majority (81.2%) said that women who know they are HIV infected should not become pregnant, while 37.0% reported that they would be uncomfortable to assist in the delivery of an HIV infected woman. There was lack of appropriate clinic space and sterile gloves for the proper delivery of maternity services. Midwives in Malawi need training, supervision and other support to provide adequate health care services to antenatal women.

Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi.

OBJECTIVES: To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women's perceptions towards selected potential HIV prevention efforts. DESIGN: Cross sectional, questionnaire-administered study. SETTING: Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. SUBJECTS: A total of 321 pregnant women attending ante-natal clinics. RESULTS: Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse. CONCLUSION: Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.

Access to continued professional education among health workers in Blantyre, Malawi.

OBJECTIVE: To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi. DESIGN: A cross-sectional descriptive study utilizing an interviewer-administered questionnaire. SUBJECTS: Healthcare workers in public health centers in Blantyre District, Malawi. RESULTS: Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for a journal subscription. Current personal and institutional subscription to a journal was low, at 2 (3.5%) each. About 30% had been trained to conduct research and 23 (40.1%) had ever conducted research with only 3 (5.3%) ever written a journal or newsletter article. 47.4% had access to a working phone at work and only 3 (5.3%) had access to internet facilities at all. Only 21% were satisfied with their own knowledge on health matters. CONCLUSIONS: Healthcare professionals in Blantyre's DHO zone are using mostly clinical hand-over meetings, seminars and workshops for their CPD. There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professional in Malawi should seriously consider mandatory CPD credits for re-registration.

Pain management among medical in-patients in Blantyre, Malawi.

BACKGROUND: Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. METHODS: A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. RESULTS: A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. CONCLUSION: Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value.

Physical trauma experience among school children in periurban Blantyre, Malawi.

BACKGROUND: Physical trauma is an important cause of childhood morbidity and mortality in Africa. There are however, few community-based reports on the subject on the continent. The present study was conducted to explore school children's experience of physical trauma in a disadvantaged periurban area of Blantyre, in Malawi. METHODS: A cross sectional questionnaire study was carried out among school children in Ndirande-Blantyre, Malawi in 2004. Data were obtained to describe the following aspects of trauma experience: being a victim or observer of motor vehicular accidents involving pedestrians; history of falls from heights; and knowledge about road safety. Sex differences were determined for some of the variables in order to gain insights as to whether there is a difference in trauma experience between boys and girls. RESULTS: A total of 217 school children, 99 (45.6%) boys and 118 (54.4%) girls participated in the study. Eight of them reported to have ever been hit by a motor vehicle, 87 (40.1%) had witnessed a road accident where a pedestrian had been hit and 83 (38.2%) had witnessed a pedestrian they knew having been hit by a motor vehicle. Of those that reported to have ever been hit by motor vehicle, 2 (25%) reported that they had been hospitalized as a result of injury. With regard to falling from heights, 86 reported to have ever fallen from tree, 44 of these (51.2%) were injured from the fall and 14 (16.3%) were hospitalized as a result of injury sustained from the fall. Girls were more likely to fall from trees and getting injured as compared to males (p = 0.04 for both situations). Just under half (41.9%) of the study participants were able to report the correct procedure of crossing the road despite the fact that the majority (80%) reported having been taught road safety at home or school. CONCLUSION: Many school children in Blantyre, Malawi have been exposed to trauma either involving themselves or someone they observed. Prevention, including education, supervision and management of trauma must receive the necessary attention they deserve in terms of resources, surveillance and impact mitigation.

Socio-demographic characteristics associated with HIV and syphilis seroreactivity among pregnant women in Blantyre, Malawi, 2000-2004.

OBJECTIVES: We aimed to evaluate socio-demographic factors associated with HIV and syphilis seroreactivity in pregnant Malawians presenting for antenatal care in late third trimester of pregnancy. METHODS: Between December 2000 and March 2004 at Queen Elizabeth Central Hospital Blantyre, Malawi, we collected cross-sectional clinical and socioeconomic data from consenting women. HIV-1 status was determined using rapid HIV antibody tests and syphilis seroreactivity was determined using Rapid Plasma Reagin (RPR) and confirmed with Treponema pallidum hemagglutination assay (TPHA). RESULTS: Of 3,824 women screened for HIV, 1156 (30%) were HIV seropositive and 198 (5%) were RPR and TPHA seroreactive. In the multivariate analysis, HIV infection was positively associated with elevated socio-economic status, being formerly married, and age, but not with education level. HIV prevalence was lower in women of Yao ethnicity than in other women (OR: 0.78, 95%CI: 0.64-0.95). Increased maternal education was negatively associated with syphilis seroreactivity. CONCLUSIONS: The seroprevalence of HIV and syphilis among women attending the antenatal ward in Blantyre remains unacceptably high. Demographic correlates of HIV and syphilis infections were different. Our results demonstrate the need for better strategies to prevent HIV and syphilis in women and calls for optimizing antenatal syphilis screening and treatment in Malawi.

Under-reporting of gravidity in a rural Malawian population.

BACKGROUND: Mis-reporting of data by study participants in a questionnaire-based study is an important source of bias in studies. OBJECTIVE: To determine the prevalence and factors influencing mis-reporting of gravidity among rural women in Malawi. MATERIALS AND METHODS: Data from cross sectional study conducted in 2004 were analysed using logistic regression analysis and the logit modeling. RESULTS: 7118 women were in the reproductive age group, 2387(33.5%) had ever attended school, 4556 (64.0%) had never and results for 175 (2.5%) were missing. Of those who attended school, 94.9% (2297) had attained a maximum primary level, 5.04% (122) secondary level and 0.08% (2) tertiary level. 81.6% of the women were aged between 12 and 36 years of age, mean was 26.1 years (SD 10.05 years). The remaining 18.4% were aged between 37 and 49 years of age. The mean number of pregnancies attained was 4.0 (SD 3.4), live births was 3.0 (SD 3.2), mean number of stillbirths was almost zero (SD 0.9) and the mean number of children alive was 2.0 (SD 2.3). The prevalence of mis-reporting of gravidity was 7.9%. Factors influencing the risk of under-reporting gravidity were: previous experience of a still-birth, young age, not being married and having ever attended some level of education. CONCLUSIONS: We suggest that women who perceived that the community expected them, or they expected themselves to have fewer or no pregnancy at all, censured themselves in reporting low number of pregancies. Researchers using questionnaires should keep in mind possibility of mis-reporting of number of pregnancies among women as this may introduce error in research results. Incorporating multiple questions asking the same thing but in a different way has potential to identify biases as these other questions serve as consistency checks.

Attitudes towards premarital testing on human immunodeficiency virus infection among Malawians.

AIM: To determine factors influencing voluntary counseling and premarital testing on human immunodeficiency virus (HIV) in Malawi. METHOD: We analyzed the data collected by the Malawi Demographic and Health Survey (MDHS) 2000 to determine the likelihood of Malawi population to accept HIV testing. The MDHS was a nationwide cross-sectional study where cluster sampling technique and an interviewer-administered questionnaire were used. We applied the Logit model of analysis to determine the HIV testing likelihood according to the following parameters: age, place of residence (urban vs. rural), belief that sexual abstinence protects from HIV infection, knowledge of a location of HIV testing, belief that diagnosis of HIV should be kept secret, and knowledge of anyone with AIDS. RESULTS: Out of 3,092 participants, 23.3% lived in urban and 76.7% in rural areas. Willingness to have premarital HIV counseling and testing was positively associated with increased age, urban residence, and wish to keep one's own HIV testing result confidential. However, knowledge of a person with HIV/AIDS, HIV testing location, and other sexually transmitted infections/diseases, as well as belief that abstinence protects against HIV were inversely related to desire to take an HIV test. CONCLUSION: Not all population groups have an equal likelihood of accepting voluntary HIV counseling and testing. Public health intervention on HIV counseling and testing should be tailored specifically for each population group.

School children's accessibility to insecticide-treated bednets in peri-urban Blantyre, Malawi.

Malaria is a major cause of childhood morbidity and mortality in Malawi. Use of insecticide treated bed nets (ITNs) could reduce the burden of malaria. The objective of the study was to determine the general health status, and factors that influence reported access to ITNs among school children in a peri-urban area of Blantyre, Malawi. 454 school children participated in the study of which 253 (55.7%) were males and 201 (44.3%) females. Their mean age and range were 14 years (std. deviation, 1.4 years) and 10-19 years respectively. When asked about general health status questions, 263 (57.9%) reported ever having fallen ill while at school, 41.2 % having ever came to school knowing they were unwell, and 40.7% of those that reported having fallen ill at school, categorized their illness as malaria. Regarding illness in the month preceding the study, 41.0% indicated that they had been ill. 40 (8.8%) participants reported that they were not allowed by their religious denominations to use medications when ill. 165 (36.3%) participants reported using bed nets themselves, 159 (35.0%) had a household member (other than parent) using nets and 254 (55.9%) had parent(s) sleeping under an ITN. Having someone in the household who uses an ITN was positively associated with ITN use while age of the participants was inversely associated with ITN access in the home. While more females (37.3%) reported using nets than males (35.6%), the difference was not statistically significant (p = 0.7). It was concluded that many of the school children experience ill health in Ndirande, Malawi and malaria is perceived to be a common illness. While younger children seem to have higher access to ITNs, there seems to be no statistically significant gender differences in accessibility.

School children's accessibility to insecticide-treated bednets in peri-urban Blantyre; Malawi

Malaria is a major cause of childhood morbidity and mortality in Malawi. Use of insecticide treated bed nets (ITNs) could reduce the burden of malaria. The objective of the study was to determine the general health status, and factors that influence reported access to ITNs among school children in a peri-urban area of Blantyre, Malawi. 454 school children participated in the study of which 253 (55.7%) were males and 201 (44.3%) females. Their mean age and range were 14 years (std. deviation, 1.4 years) and 10-19 years respectively. When asked about general health status questions, 263 (57.9%) reported ever having fallen ill while at school, 41.2% having ever came to school knowing they were unwell, and 40.7% of those that reported having fallen ill at school, categorized their illness as malaria. Regarding illness in the month preceding the study, 41.0% indicated that they had been ill. 40 (8.8%) participants reported that they were not allowed by their religious denominations to use medications when ill. 165 (36.3%) participants reported using bed nets themselves, 159 (35.0%) had a household member (other than parent) using nets and 254 (55.9%) had parent(s) sleeping under an ITN. Having someone in the household who uses an ITN was positively associated with ITN use while age of the participants was inversely associated with ITN access in the home. While more females (37.3%) reported using nets than males (35.6%), the difference was not statistically significant (p=0.7). It was concluded that many of the school children experience ill health in Ndirande, Malawi and malaria is perceived to be a common illness. While younger children seem to have higher access to ITNs, there seems to be no statistically significant gender differences in accessibility