19 research outputs found
Seasonal prediction of summer rainfall in Southern Africa
No full textThis thesis was scanned from the print manuscript for digital preservation and is copyright the author.
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Are They Really Lost? "True" Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi
No full textINTRODUCTION
Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies.
METHODS
We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART.
RESULTS
Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender.
CONCLUSION
The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence
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In order to protect our mothers, we need to prioritize our nurses and midwives
No full textAim: To investigate working conditions and experiences of nurses and midwives in a rural district in southern Malawi, a place where nurse-midwives are at the frontlines of maternal care. Methods: Two focus group interviews were conducted with nurses and midwives (N = 20) in March 2018. Interviews were conducted in person, audio-recorded, and transcribed in Word. Themes were developed during hand-coding by a member of the research team and analyzed in a framework table. All documents were kept on a password protected computer with access limited to the first author and one other member of the team. All participants provided both verbal and written consent prior to the interviews. Results: The major theme that emerged from the group interviews was primarily resource challenges; specifically staffing shortages, poor infrastructure, and lack of essential birthing supplies. Conclusions: The findings suggest that without the tools to do their job in a safe working environment, nurses and midwives may leave nursing and midwifery to pursue alternative careers if they cannot provide safe and comprehensive care. While this problem had been identified in other studies, a dedicated effort to remedy such challenges is necessary at the district and national level
Supplementary information files for "Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and from England"
No full textSupplementary files for article "Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and from England"BackgroundWe investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations.MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011–2015) and four in ELSA (2001−2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength.FindingsLower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline.InterpretationLower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.© The Author(s), CC BY-4.0</p
Author Correction: Community-based active-case finding for tuberculosis: navigating a complex minefield
No full textFollowing publication of the original article it was reported that Kwame Shanaube’s name was misspelt ‘Shaunabe’. The original article has been updated.</p
Flowchart of tracing outcomes for ART patients who run out of ARVs for at least 21 days between January 2006 and December 2010 at Martin Preuss Centre and Lighthouse clinics in Lilongwe, Malawi.
No full text<p>LTFU = Lost to follow-up; Official transfer’ if transfer-out notes were available in the patient’s health book but not at the ART facility; or ‘self-transfer’ if the patient arranged the transfer independently; a patient could appear in more than one category during the study period. ‘Treatment gaps’ if a patient took none or fewer than the prescribed drugs before the interview date.</p
Reasons for collecting ARVs from other ART providers.
No full text<p>Reasons for collecting ARVs from other ART providers.</p
Protective association of 13-valent pneumococcal conjugate vaccination against experimental carriage determined by 1-year post-vaccination re-challenge with Streptococcus pneumoniae serotype 6B in Blantyre, Malawi
No full textBackgroundIn Malawi, childhood pneumococcal conjugate vaccination has not achieved expected herd protection despite more than 10 years since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Vaccine efficacy and longevity of protection are crucial in achieving herd protection. We previously found that PCV13 offers immediate protection from experimental pneumococcal carriage in Malawian adults, but of uncertain duration. Using a pre-specified study protocol, we aimed to determine longevity of protection of PCV13 vaccination against experimental human pneumococcal carriage measured by one-year post-vaccination homotypic Streptococcus pneumoniae serotype 6B re-challenge in healthy Malawian adults.MethodsWe re-recruited all eligible participants available at one-year post-vaccination follow-up from a double-blind, parallel-arm, randomised controlled trial investigating the efficacy of PCV13 or placebo against experimental pneumococcal carriage of Streptococcus pneumoniae serotype 6B (SPN6B, strain BHN418) among healthy adults (aged 18-40 years) in Blantyre, Malawi, one year after vaccination. Participants were re-challenged intranasally with 80,000 colony-forming units (CFUs) of SPN6B per naris. The primary endpoint was experimental pneumococcal carriage, established by culture of nasalwash at 2, 7, and 14 days. Vaccine efficacy was estimated using a log-binomial model adjusting for prior experimental SPN6B carriage, prior natural carriage of any serotype, and prior inoculation dose.FindingsParticipant recruitment started on 10 May 2022 and the final visit was completed on 22 August 2023. 137 participants completed the study protocol after being re-recruited (57 PCV13, 80 placebo). In an adjusted model, there was a 73% protective effect of PCV13 vaccination against experimental pneumococcus serotype 6B carriage following re-challenge (RR 0.27, 95% CI 0.08-0.98, p = 0.047). Prior experimental serotype 6B carriage reduced vaccine protective effect, and even reversed it (RR 2.20, 95% CI 0.85-5.67, p = 0.10). The effect of PCV13 vaccination was reduced within prior serotype 6B carriers (RR 8.95, 95% CI 2.27-35.33, p = 0.002) and prior natural pneumococcal carriers (RR 14.31, 95% CI (1.65, 124.20), p = 0.016). Lastly, in the placebo but not vaccine arm, experimental pneumococcal carriage rate was lower after nasal re-challenge compared to the primary challenge (12 [15.0%] of 80 vs 30 [28.3%] of 106; McNemar’s test p=0.031) indicating an immunising effect of the primary challenge.InterpretationThe study indicates that PCV13 vaccination has a role in preventing pneumococcalcarriage for at least one year, with strong interaction with natural carriage events. This suggests that the inability to achieve herd protection in Malawi is probably due to factors other than the efficacy or duration of protection of the PCV13 vaccine
Protective association of 13-valent pneumococcal conjugate vaccination against experimental carriage determined by 1-year post-vaccination re-challenge with Streptococcus pneumoniae serotype 6B in Blantyre, Malawi
No full textBackgroundIn Malawi, childhood pneumococcal conjugate vaccination has not achieved expected herd protection despite more than 10 years since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Vaccine efficacy and longevity of protection are crucial in achieving herd protection. We previously found that PCV13 offers immediate protection from experimental pneumococcal carriage in Malawian adults, but of uncertain duration. Using a pre-specified study protocol, we aimed to determine longevity of protection of PCV13 vaccination against experimental human pneumococcal carriage measured by one-year post-vaccination homotypic Streptococcus pneumoniae serotype 6B re-challenge in healthy Malawian adults.MethodsWe re-recruited all eligible participants available at one-year post-vaccination follow-up from a double-blind, parallel-arm, randomised controlled trial investigating the efficacy of PCV13 or placebo against experimental pneumococcal carriage of Streptococcus pneumoniae serotype 6B (SPN6B, strain BHN418) among healthy adults (aged 18-40 years) in Blantyre, Malawi, one year after vaccination. Participants were re-challenged intranasally with 80,000 colony-forming units (CFUs) of SPN6B per naris. The primary endpoint was experimental pneumococcal carriage, established by culture of nasalwash at 2, 7, and 14 days. Vaccine efficacy was estimated using a log-binomial model adjusting for prior experimental SPN6B carriage, prior natural carriage of any serotype, and prior inoculation dose.FindingsParticipant recruitment started on 10 May 2022 and the final visit was completed on 22 August 2023. 137 participants completed the study protocol after being re-recruited (57 PCV13, 80 placebo). In an adjusted model, there was a 73% protective effect of PCV13 vaccination against experimental pneumococcus serotype 6B carriage following re-challenge (RR 0.27, 95% CI 0.08-0.98, p = 0.047). Prior experimental serotype 6B carriage reduced vaccine protective effect, and even reversed it (RR 2.20, 95% CI 0.85-5.67, p = 0.10). The effect of PCV13 vaccination was reduced within prior serotype 6B carriers (RR 8.95, 95% CI 2.27-35.33, p = 0.002) and prior natural pneumococcal carriers (RR 14.31, 95% CI (1.65, 124.20), p = 0.016). Lastly, in the placebo but not vaccine arm, experimental pneumococcal carriage rate was lower after nasal re-challenge compared to the primary challenge (12 [15.0%] of 80 vs 30 [28.3%] of 106; McNemar’s test p=0.031) indicating an immunising effect of the primary challenge.InterpretationThe study indicates that PCV13 vaccination has a role in preventing pneumococcalcarriage for at least one year, with strong interaction with natural carriage events. This suggests that the inability to achieve herd protection in Malawi is probably due to factors other than the efficacy or duration of protection of the PCV13 vaccine
Reflections on the first state of the map conference in Malawi
No full textState of the Map (SotM) conferences are important events that enable OpenStreetMap (OSM) contributors and users to present and discuss their work. However, when international SotM conferences are held in the Global North countries, participation by African geospatial scientists is not guaranteed due to various barriers, including travel costs and visa restrictions. Conversely, locally held SotM conferences within Africa mitigate these barriers. Such conferences have been held in different African countries. Malawi hosted its first SotM conference in 2024 at the Malawi University of Business and Applied Sciences (MUBAS), bringing together its local geospatial science community to discuss the landscape of the field in the country. In this paper, we reflect on the conference’s proceedings, positive developments, opportunities, and challenges facing Malawi’s geoscience community. The paper contributes to the broader understanding of how African countries are leveraging geoscience and identifies areas for further growth and collaboration.</p
