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S I Watson, E B Wroe, E L Dunbar, J Mukherjee, S B Squire, L Nazimera, L Dullie, R J Lilford
BACKGROUND: User fees have generally fallen out of favor across Africa, and they have been associated with reductions in access to healthcare. We examined the effects of the introduction and removal of user fees on outpatient attendances and new diagnoses of HIV, malaria, and tuberculosis in Neno District, Malawi where user fees were re-instated at three of 13 health centres in 2013 and subsequently removed at one of these in 2015. METHODS: We conducted two analyses...
October 20, 2016: BMC Health Services Research
Paul C Knox, Ian J C MacCormick, Emme Mbale, Macpherson Malewa, Gabriela Czanner, Simon P Harding
Paediatric cerebral malaria is the most serious complication of Plasmodium falciparum infection. While the majority recover, long-term cognitive impairment has been highlighted as a significant and neglected problem. Persistent or serious deficits in processes such as attention or behavioural inhibition should be manifest in changes to performance on oculomotor tasks. Therefore we investigated the impact of cerebral malaria on the development of reflexive pro-saccades and antisaccades. In a longitudinal study, 47 children previously admitted with retinopathy-confirmed cerebral malaria (mean age at admission 54 months), were compared with 37 local healthy controls (mean ages at first study visit 117 and 110 months respectively)...
2016: PloS One
Chikondi A Mwendera, Christiaan de Jager, Herbert Longwe, Kamija Phiri, Charles Hongoro, Clifford M Mutero
BACKGROUND: Research on various determinants of health is key in providing evidence for policy development, thereby leading to successful interventions. Utilization of research is an intricate process requiring an understanding of contextual factors. The study was conducted to assess enhancing factors and barriers of research utilization for malaria policy development in Malawi. METHODS: Qualitative research approach was used through in-depth interviews with 39 key informants that included malaria researchers, policy makers, programme managers, and key stakeholders...
October 19, 2016: Malaria Journal
Amelia Rock, Clare Barrington, Sara Abdoulayi, Maxton Tsoka, Peter Mvula, Sudhanshu Handa
Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys...
October 8, 2016: Social Science & Medicine
Collins O F Zamawe, Kanan Nakamura, Akira Shibanuma, Masamine Jimba
BACKGROUND: Although the universal coverage campaign of insecticide-treated mosquito bed nets (ITNs) has been associated with improved malaria outcomes, recent reports indicate that the campaign is losing its sparkle in some countries. In Malawi, the universal coverage campaign was implemented in 2012, but its impacts are yet to be ascertained. Thus, this study examined the effects of the campaign on malaria morbidity among children in Malawi. METHODS: This is a repeated cross-sectional study...
October 18, 2016: Malaria Journal
Hannah H Leslie, Günther Fink, Humphreys Nsona, Margaret E Kruk
BACKGROUND: Ending preventable newborn deaths is a global health priority, but efforts to improve coverage of maternal and newborn care have not yielded expected gains in infant survival in many settings. One possible explanation is poor quality of clinical care. We assess facility quality and estimate the association of facility quality with neonatal mortality in Malawi. METHODS AND FINDINGS: Data on facility infrastructure as well as processes of routine and basic emergency obstetric care for all facilities in the country were obtained from 2013 Malawi Service Provision Assessment...
October 2016: PLoS Medicine
Brian S Barnett, Macjellings Mulenga, Michelle M Kiser, Anthony G Charles
OBJECTIVE: While psychological care, including supportive group therapy, is a mainstay of burn treatment in the developed world, few reports of support groups for burn survivors and their caregivers in the developing world exist. This study records the findings of a support group in Malawi and provides a qualitative analysis of thematic content discussed by burn survivors and caregivers. MATERIALS AND METHODS: We established a support group for burn survivors and caregivers from February-May 2012 in the burn unit at Kamuzu Central Hospital in Lilongwe, Malawi...
October 12, 2016: Burns: Journal of the International Society for Burn Injuries
Angela M Bengtson, Dawn Kopp, Jennifer H Tang, Ennet Chipungu, Margaret Moyo, Jeffrey Wilkinson
OBJECTIVE: To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. METHODS: We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with a high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, human immunodeficiency virus status, body mass index, previous repair surgery at an outside facility, revised Goh classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length)...
October 6, 2016: Obstetrics and Gynecology
Akosua Sarpong Boakye-Ansah, Giuliana Ferrero, Maria Rusca, Pieter van der Zaag
Over past decades strategies for improving access to drinking water in cities of the Global South have mainly focused on increasing coverage, while water quality has often been overlooked. This paper focuses on drinking water quality in the centralized water supply network of Lilongwe, the capital of Malawi. It shows how microbial contamination of drinking water is unequally distributed to consumers in low-income (unplanned areas) and higher-income neighbourhoods (planned areas). Microbial contamination and residual disinfectant concentration were measured in 170 water samples collected from in-house taps in high-income areas and from kiosks and water storage facilities in low-income areas between November 2014 and January 2015...
October 2016: Journal of Water and Health
Mitch M Matoga, Mina C Hosseinipour, Evgenia Aga, Heather J Ribaudo, Nagalingeswaran Kumarasamy, John Bartlett, Michael D Hughes
BACKGROUND: Cardiovascular disease (CVD) is an emerging concern for HIV-infected patients. Hyperlipidemia is a risk factor for CVD and a complication of protease-inhibitor-based antiretroviral therapy, but little is known about its incidence and risk factors in treated patients in resource-limited settings (RLS). METHODS: We conducted a secondary analysis of ACTG A5230 trial in which HIV-infected adults from India, Malawi, Tanzania, Thailand and South Africa, with virologic relapse on first line therapy were initiated on lopinavir/ritonavir (LPV/r) monotherapy...
October 14, 2016: Antiviral Therapy
Wenjin Liu, Jeff M Snell, William R Jeck, Katherine A Hoadley, Matthew D Wilkerson, Joel S Parker, Nirali Patel, Yohannie B Mlombe, Gift Mulima, N George Liomba, Lindsey L Wolf, Carol G Shores, Satish Gopal, Norman E Sharpless
Esophageal squamous cell carcinoma (ESCC) is endemic in regions of sub-Saharan Africa (SSA), where it is the third most common cancer. Here, we describe whole-exome tumor/normal sequencing and RNA transcriptomic analysis of 59 patients with ESCC in Malawi. We observed similar genetic aberrations as reported in Asian and North American cohorts, including mutations of TP53, CDKN2A, NFE2L2, CHEK2, NOTCH1, FAT1, and FBXW7. Analyses for nonhuman sequences did not reveal evidence for infection with HPV or other occult pathogens...
October 6, 2016: JCI Insight
Andrew D Jones
BACKGROUND: On-farm crop species richness (CSR) may be important for maintaining the diversity and quality of diets of smallholder farming households. OBJECTIVES: The objectives of this study were to 1) determine the association of CSR with the diversity and quality of household diets in Malawi and 2) assess hypothesized mechanisms for this association via both subsistence- and market-oriented pathways. METHODS: Longitudinal data were assessed from nationally representative household surveys in Malawi between 2010 and 2013 (n = 3000 households)...
October 12, 2016: Journal of Nutrition
Khumbo Kalua, Alvin Chisambi, David Chinyanya, Zachariah Kamwendo, Michael Masika, Rebecca Willis, Rebecca M Flueckiger, Alexandre L Pavluck, Anthony W Solomon
PURPOSE: Following a first phase of trachoma mapping in Malawi with the Global Trachoma Mapping Project, we identified and mapped trachoma districts previously suspected to be non-endemic, although adjacent to districts with estimated trachoma prevalences indicating a public health problem. METHODS: We conducted population-based surveys in eight evaluation units (EUs) comprising eight districts in Malawi (total population 3,230,272). A 2-stage cluster random sampling design allowed us to select 30 households from each of 30 clusters per EU; all residents aged 1 year and older in selected households were examined for evidence of trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT)...
October 11, 2016: Ophthalmic Epidemiology
Anne E Heggen, Anthony W Solomon, Paul Courtright
PURPOSE: Neglected tropical diseases (NTDs) affect people living in the poorest regions of the world and their debilitating effects perpetuate the poverty cycle. Understanding the distribution of NTDs is crucial for effective intervention delivery. In 2012, the Global Trachoma Mapping Project (GTMP) was initiated to map >1800 suspected trachoma endemic districts by March 2015. This research was carried out to better understand the implementation experience and identify lessons which might inform the GTMP and similar initiatives...
October 11, 2016: Ophthalmic Epidemiology
T Nakagomi, L P Do, C A Agbemabiese, M Kaneko, P Gauchan, Y H Doan, K C Jere, A D Steele, M Iturriza-Gomara, O Nakagomi, N A Cunliffe
Rotavirus A strains detected in diarrhoeal children commonly possess any one of the genotypes G1, G2, G3, G4, and G9, with a recent increase in G12 detection globally. G12P[6] strains possessing short RNA (DS-1-like) and long RNA (Wa-like) migration patterns accounted for 27 % of the strains circulating in Blantyre, Malawi, between 2007 and 2008. To understand how the G12P[6] strains with two distinct genetic backgrounds emerged in Malawi, we conducted whole-genome analysis of two long-RNA and two short-RNA strains...
October 7, 2016: Archives of Virology
Kate L Mandeville, Godwin Ulaya, Mylène Lagarde, Adamson S Muula, Titha Dzowela, Kara Hanson
Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi...
September 24, 2016: Social Science & Medicine
D Maman, J Ben-Farhat, B Chilima, C Masiku, L Salumu, N Ford, P Mendiharat, E Szumilin, S Masson, J F Etard
OBJECTIVE: HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. METHOD: Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care...
October 7, 2016: Tropical Medicine & International Health: TM & IH
Alan L Schooley, Pocha Samuel Kamudumuli, Sitaram Vangala, Chi-Hong Tseng, Chifundo Soko, Julie Parent, Khumbo Phiri, Andreas Jahn, Dan Namarika, Risa M Hoffman
Background.  Given the uncertainty about the ability of a single CD4 count to accurately classify a patient as antiretroviral therapy (ART) eligible, we sought to understand the extent to which CD4 variability results in misclassification at a CD4 threshold of 500 cells/mm(3). Methods.  We performed a prospective study of CD4 variability in Malawian human immunodeficiency virus-infected, ART-naive, World Health Organization (WHO) stage 1 or 2, nonpregnant adults. CD4 counts were performed daily for 8 days...
September 2016: Open Forum Infectious Diseases
Sarah J Ivory, Margaret W Blome, John W King, Michael M McGlue, Julia E Cole, Andrew S Cohen
Long paleoecological records are critical for understanding evolutionary responses to environmental forcing and unparalleled tools for elucidating the mechanisms that lead to the development of regions of high biodiversity. We use a 1.2-My record from Lake Malawi, a textbook example of biological diversification, to document how climate and tectonics have driven ecosystem and evolutionary dynamics. Before ∼800 ka, Lake Malawi was much shallower than today, with higher frequency but much lower amplitude water-level and oxygenation changes...
October 3, 2016: Proceedings of the National Academy of Sciences of the United States of America
Harold Sungani, Benjamin P Ngatunga, Stephan Koblmüller, Tuuli Mäkinen, Paul H Skelton, Martin J Genner
It has been proposed that the fish faunas of African rivers assemble through multiple colonisation events, while lake faunas form additionally through intralacustine speciation. While this pattern has been established for many lineages, most notably cichlids, there are opportunities to further investigate the concept using phylogenies of congeneric endemic species within ancient lake catchments. The Lake Malawi catchment contains three river-spawning cyprinids of the genus Opsaridium, two of which are endemic...
September 30, 2016: Molecular Phylogenetics and Evolution
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