Exploring the Feasibility of Engaging Traditional Birth Attendants in a Prevention of Mother to Child HIV Transmission Program in Lilongwe; Malawi

Objective:To investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication. Design 2 focus groups with a total of 17 registered TBAs. Setting Lilongwe; Malawi Methods TBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program. Results TBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation. Conclusions:Given appropriate support and training; TBAs' participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication

Anaemia in schoolchildren in eight countries in Africa and Asia.

OBJECTIVE: To report on the haemoglobin concentrations and prevalence of anaemia in schoolchildren in eight countries in Africa and Asia. DESIGN: Blood samples were collected during surveys of the health of schoolchildren as a part of programmes to develop school-based health services. SETTING: Rural schools in Ghana, Indonesia, Kenya, Malawi, Mali, Mozambique, Tanzania and Vietnam. SUBJECTS: Nearly 14 000 children enrolled in basic education in three age ranges (7-11 years, 12-14 years and > or =15 years) which reflect the new UNICEF/WHO thresholds to define anaemia. RESULTS: Anaemia was found to be a severe public health problem (defined as >40% anaemic) in five African countries for children aged 7-11 years and in four of the same countries for children aged 12-14 years. Anaemia was not a public health problem in the children studied in the two Asian countries. More boys than girls were anaemic, and children who enrolled late in school were more likely to be anaemic than children who enrolled closer to the correct age. The implications of the four new thresholds defining anaemia for school-age children are examined. CONCLUSIONS: Anaemia is a significant problem in schoolchildren in sub-Saharan Africa. School-based health services which provide treatments for simple conditions that cause blood loss, such as worms, followed by multiple micronutrient supplements including iron, have the potential to provide relief from a large burden of anaemia.

The effectiveness of weekly iron supplementation in pregnant women of rural northern Malawi.

A weekly iron/folate supplement was compared with a standard daily iron/folate supplement in pregnant women living in rural Malawi. Women were enrolled as they attended the local antenatal clinic, stratified by grade of anaemia and then randomized to receive either 60 mg iron/0.25 mg folate per day (n = 211) or 120 mg iron/0.50 mg folate once a week (n = 202). Supplementation was continued for a minimum of 8 weeks (10 weeks on average) and was self administered by the women at home. Initial haemoglobin values for the daily (mu = 105.7 g/l) and weekly (mu = 104.4 g/l) groups as well as final haemoglobin values (107.5 g/l and 105.6 g/l, respectively) did not differ significantly between the two groups. Haemoglobin values increased by similar levels in both groups with the subset of anaemic women increasing by an average of 6.3 g/l in the daily group (n = 70) and 5.9 g/l in the weekly group (n = 66) for all women. For compliant, anaemic women, the increases were 7.4 g/l and 6.6 g/l for the daily and weekly groups, respectively. Compliance, as indicated by self reporting and by regular counts of remaining tablets, was significantly higher in the weekly group (76% compared with 60%, P < 0.05), however compliance was identical in both groups when assessed by a stool test for elemental iron. Reported side effects were significantly reduced in the weekly group (6% compared with 17%, P < 0.05). We conclude that a weekly iron supplement given to pregnant women in rural Malawi has similar haematologic effects, and an improved side effect profile, in comparison with a standard daily supplement when administered through an existing primary healthcare programme, although both regimens are relatively unsuccessful in the reduction of anaemia prevalence during pregnancy.

Alternatives to bodyweight for estimating the dose of praziquantel needed to treat schistosomiasis.

Data on age, height and mid upper-arm circumference (MUAC) from nearly 6000 schoolchildren in Ghana, Tanzania and Malawi (not MUAC) were used to examine their power to predict bodyweight and thus the dosage of praziquantel required to treat schistosomiasis. Height was found to provide a simple and reasonably accurate estimate of weight, and about 75% of children would have been given a dosage of praziquantel within the range normally given using bodyweight at a dosage of 40 mg/kg bodyweight. The upper and lower ranges in dosage did not exceed dosages of praziquantel which have been used before or are currently recommended to treat schistosomiasis. A pole marked with the number of tablets could thus be used as a simple way to determine the dose of praziquantel to treat children in school-based health programmes.

Mother-daughter interaction and adherence to diabetes regimens.

This study explores the relationship of mother-daughter interaction to adherence to treatment plans among diabetic adolescents. Fifty mother-daughter dyads discussed conflict issues and feelings, problems, and concerns related to diabetes. Discussions were analyzed using the Hill Interaction Matrix and modified Beavers-Timberlawn Family Evaluation Scales. Interview questionnaires provided information on adherence, feelings, problems and concerns, parental supervision, adjustment, and family life. The less adherent the adolescent, the more emotionally charged the interaction, the more directly confrontive mother and daughter were, and the less efficient they were at negotiating issues. The adolescent's statements about herself confirmed observations that poor adherers, more than good adherers, had difficulty discussing feelings, problems, and concerns with their mothers (r = -0.51, P less than or equal to 0.001). Poor adherers reported believing less strongly that adherence would delay/avoid complications (r = 0.51, P less than or equal to 0.001), became more anxious about seeing a disabled diabetic person (r = -0.29, P less than or equal to 0.29), and worried more about future health (r = -0.27, P = NS). No relationships were found between adherence and adolescent-physician rapport. Many adolescents were not engaging in good self-care behaviors, were quite concerned about future health, perceived mothers to be very concerned, hesitated telling peers about their illness, and did not share deeper illness-related concerns with their closest nondiabetic friends.

Plasma and urinary amino acids in primary gout, with special reference to glutamine.

Measurement of the plasma free amino acids by column chromatography (AutoAnalyzer) in 32 patients with primary gout showed statistically significant increases or decreases in several components when compared with the spectrum in 18 control subjects, but the absolute amounts involved were small and the mean total plasma amino acid concentrations in both groups were the same. In the urine all major amino acid components, notably glutamine, serine, threonine, and leucine, were lower in our gouty than in our nongouty subjects, as were also the corresponding renal clearance ratios. These deficits could be reproduced by restricting dietary protein, so appear to be due largely to the some-what reduced mean dietary protein intake of our gouty subjects. However, the low renal clearance of glutamine, the most striking and consistent of the deficits in urinary amino acids noted, could not be accounted for by dietary or other relevant factors, and is interpreted as indicating increased tubular reabsorption of glutamine in primary gout. This interpretation was supported by the results of glutamine loading. The possible compensatory relationship of the abnormality in renal handling of glutamine to the deficiency in renal production of ammonia previously reported is discussed.