529 research outputs found
Fertility intentions and use of contraception among monogamous couples in northern Malawi in the context of HIV testing: a cross-sectional analysis
No full textContext: knowledge of HIV status may influence fertility desires of married men and women. There is little knowledge about the importance of this influence among monogamously married couples and how knowledge of HIV status influences use of contraception among these couples.Methodology: we carried out a cross-sectional analysis of interview data collected between October 2008 and September 2009 on men aged 15–59 years and women aged 15–49 years who formed 1766 monogamously married couples within the Karonga Prevention Study demographic surveillance study in northern Malawi.Results: 5% of men and 4% of women knew that they were HIV positive at the time of interview and 81% of men and 89% of women knew that they were HIV negative. 73% of men and 83% of women who knew that they were HIV positive stated that they did not want more children, compared to 35% of men and 38% of women who knew they were HIV negative. Concordant HIV positive couples were more likely than concordant negative couples to desire to stop child bearing (odds ratio 11.5, 95%CI 4.3–30.7, after adjusting for other factors) but only slightly more likely to use contraceptives (adjusted odds ratio 1.5 (95%CI 0.8–3.3).Conclusion: knowledge of HIV positive status is associated with an increase in the reported desire to cease childbearing but there was limited evidence that this desire led to higher use of contraception. More efforts directed towards assisting HIV positive couples to access and use reproductive health services and limit HIV transmission among couples are recommende
HIV infection in young adults in Africa: context, risks, and opportunities for prevention
No full textReproductive preferences and contraceptive use: a comparison of monogamous and polygamous couples in northern Malawi
No full textSummary There is now widespread agreement on the importance of men's role in reproductive decision-making. Several studies have argued that fertility preferences and their translation into behaviour differ between polygamous and monogamous unions. Studies investigating the dominance of men's preferences over women's preferences, in cases of couple disagreement, found mixed evidence of the effect of polygamy. However, an often cited limitation of these studies has been the inability to link husband's intention with each of his wives in a polygamous union. By adding fertility-intention questions to an on-going Demographic Surveillance Site in Karonga District in northern Malawi the fertility preferences and contraceptive use of husbands and wives were investigated. An analysis of the relationship between the level of agreement and disagreement between husbands' and wives' fertility preferences was then performed to gain insight into the reproductive decision-making process of polygamous couples
Association between socioeconomic position and tuberculosis in a large population-based study in rural Malawi.
No full textSETTING: There is increasing interest in social structural interventions for tuberculosis. The association between poverty and tuberculosis is well established in many settings, but less clear in rural Africa. In Karonga District, Malawi, we found an association between higher socioeconomic status and tuberculosis from 1986-1996, independent of HIV status and other factors. OBJECTIVE: To investigate the relationship in the same area in 1997-2010. DESIGN: All adults in the district with new laboratory-confirmed tuberculosis were included. They were compared with community controls, selected concurrently and frequency-matched for age, sex and area. RESULTS: 1707 cases and 2678 controls were interviewed (response rates >95%). The odds of TB were increased in those working in the cash compared to subsistence economy (p<0.001), and with better housing (p-trend=0.006), but decreased with increased asset ownership (p-trend=0.003). The associations with occupation and housing were partly mediated by HIV status, but remained significant. CONCLUSION: Different socioeconomic measures capture different pathways of the association between socioeconomic status and tuberculosis. Subsistence farmers may be relatively unexposed whereas those in the cash economy travel more, and may be more likely to come forward for diagnosis. In this setting "better houses" may be less well ventilated and residents may spend more time indoors
Profile: The Karonga Health and Demographic Surveillance System
No full textThe Karonga Health and Demographic Surveillance System (Karonga HDSS) in northern Malawi currently has a population of more than 35?000 individuals under continuous demographic surveillance since completion of a baseline census (2002–2004). The surveillance system collects data on vital events and migration for individuals and for households. It also provides data on cause-specific mortality obtained by verbal autopsy for all age groups, and estimates rates of disease for specific presentations via linkage to clinical facility data. The Karonga HDSS provides a structure for surveys of socio-economic status, HIV sero-prevalence and incidence, sexual behaviour, fertility intentions and a sampling frame for other studies, as well as evaluating the impact of interventions, such as antiretroviral therapy and vaccination programmes. Uniquely, it relies on a network of village informants to report vital events and household moves, and furthermore is linked to an archive of biological samples and data from population surveys and other studies dating back three decades
Estimating the need for antiretroviral treatment and an assessment of a simplified HIV/AIDS case definition in rural Malawi.
No full textBACKGROUND: Surveillance in the era of antiretroviral therapy (ART) requires estimates of HIV prevalence as well as the proportion eligible for ART. We estimated HIV prevalence and assessed field staging of individuals to estimate the burden of HIV disease needing treatment in rural Malawi. METHODS: Adults aged 18-59 years in a demographic surveillance system were interviewed, examined, and HIV counselled and tested. Staging that used a simplified version of the WHO criteria ('field checklist') was compared with staging by a medical assistant using a 'clinic checklist' and to CD4 cell results. RESULTS: A total of 2129 of 2303 eligible adults (92.4%) were traced, and 2047 (96.1%) participated. Of the 1443 participants (70.5%) tested, 11.6% were HIV positive. ART eligibility classification by the field and clinic checklists were concordant in 122 of 133 HIV-positive individuals. Compared with the clinic checklist, the field checklist had a sensitivity of 50% and a specificity of 96%. Including those already known to be on ART, staging by the field and clinic checklists estimated ART eligibility at 16.3 and 17.7% of HIV-positive individuals, respectively. Using CD4 cell count under 250 cells/mul or WHO stage III/IV, the Malawi national programme criteria, 38% of HIV-positive individuals were eligible for ART, compared with 31% based on the 2006 WHO criteria of CD4 cell count under 200 cells/mul or WHO stage IV or CD4 cell count of 200-350 cells/mul and WHO stage III. CONCLUSION: The field checklist was not a suitable tool for individual staging. Criteria for ART eligibility based on clinical staging alone missed two-thirds of those eligible by clinical staging and CD4 cell count
High accuracy of home-based community rapid HIV testing in rural Malawi.
No full textOBJECTIVE: To assess the performance of rapid HIV antibody tests when used as part of a home-based community wide counseling and testing strategy in northern Malawi. DESIGN: A cross-sectional population survey of HIV infection, 2007 to 2008. METHODS: Adults aged 15 years or older in a demographic surveillance area were counseled and then offered an HIV test at their home by government-certified counselors. Two initial rapid tests (Determine and Uni-Gold) were performed on all samples and a third, tie-breaker test (SD Bioline) used to resolve discordant results. All people who wanted to know were posttest-counseled and informed of their results with referral to local clinical services if found to be HIV-positive. Laboratory quality control comprised retesting all positive and every tenth negative venous blood sample collected. RESULTS: A total of 10,819 adults provided venous blood samples for HIV testing, of whom 7.5% (813) were HIV-positive. The accuracy of the parallel testing strategy used was high with 99.6% sensitivity, 100.0% specificity, 99.9% positive predictive value, and 99.9% negative predictive value. CONCLUSION: Face-to-face rapid testing by health personnel with minimum training at the client's home performs well when used on a wide scale in the community setting
Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi.
No full textBACKGROUND: Malawi, which has about 80,000 deaths from AIDS every year, made free antiretroviral therapy available to more than 80 000 patients between 2004 and 2006. We aimed to investigate mortality in a population before and after the introduction of free antiretroviral therapy, and therefore to assess the effects of such programmes on survival at the population level. METHODS: We used a demographic surveillance system to measure mortality in a population of 32,000 in northern Malawi, from August, 2002, when free antiretroviral therapy was not available in the study district, until February, 2006, 8 months after a clinic opened. Causes of death were established through verbal autopsies (retrospective interviews). Patients who registered for antiretroviral therapy at the clinic were identified and linked to the population under surveillance. Trends in mortality were analysed by age, sex, cause of death, and zone of residence. FINDINGS: Before antiretroviral therapy became available in June, 2005, mortality in adults (aged 15-59 years) was 9.8 deaths for 1000 person-years of observation (95% CI 8.9-10.9). The probability of dying between the ages of 15 and 60 years was 43% (39-49) for men and 43% (38-47) for women; 229 of 352 deaths (65.1%) were attributed to AIDS. 8 months after the clinic that provided antiretroviral therapy opened, 107 adults from the study population had accessed treatment, out of an estimated 334 in need of treatment. Overall mortality in adults had decreased by 10% from 10.2 to 8.7 deaths for 1000 person-years of observation (adjusted rate ratio 0.90, 95% CI 0.70-1.14). Mortality was reduced by 35% (adjusted rate ratio 0.65, 0.46-0.92) in adults near the main road, where mortality before antiretroviral therapy was highest (from 13.2 to 8.5 deaths per 1000 person-years of observation before and after antiretroviral therapy). Mortality in adults aged 60 years or older did not change. INTERPRETATION: Our findings of a reduction in mortality in adults aged between 15 and 59 years, with no change in those older than 60 years, suggests that deaths from AIDS were averted by the rapid scale-up of free antiretroviral therapy in rural Malawi, which led to a decline in adult mortality that was detectable at the population level
Chasmogenus gironae Glynn & Short 2021, sp. n.
No full textChasmogenus gironae sp. n. Figures 2C–D, 3B, 5C–D, 6 Type Material. Holotype (male): “VENEZUELA, T.F.Amaz. / Cerro de la Neblina / 1.5 km S Basecamp / 0°50’N, 66°10’W / 250 m., 15 Feb. 1985 ”, “In small ponds full/ of dead leaves;/ rainforest ridge/ P. J. & P. M. Spangler,/ R. Faitoute, W. Steiner ” (MIZA). Paratypes (36): VENEZUELA: Amazonas: Same data as holotype (36 exs., SEMC, USNM). Differential Diagnosis. Among species with the median lobe of the aedeagus and the parameres approximately even in length and a long basal piece, this species is similar in morphology and general form of the aedeagus to C. brownsbergensis Smith & Short, 2020, but may be distinguished by characters of the median lobe and dorsal coloration of the head. The median lobe of C. gironae bears a rounded triangular apex past the position of the gonopore and a constriction located medially, whereas the apex of C. brownsbergensis is acutely triangular with straight sides and the constriction is situated more distally closer to the gonopore. The coloration of the head of C. brownsbergensis has mesal dark patches on the clypeus and the labrum compared to the uniformly colored head of C. gironae. Description. Size and color. Total body length 3.4–3.7 mm. Body form elongate oval. Dorsum of head dark brown to very dark brown posteriorly, clypeus and labrum slightly paler (Fig. 3B). Pronotum and elytra uniformly very dark brown (Fig. 2C). Venter uniformly dark orange-brown to dark brown (Fig. 2D). Head. Ground punctation on head fine. Clypeus with anteromedial emargination, which exposes a broadly rounded gap between the clypeus and labrum (Fig. 3B). Mentum moderately depressed in anterior half with a triangular to rounded anteromedial notch. Maxillary palps long, longer than width of head immediately posterior to eyes. Thorax. Ground punctation on pronotum fine (Fig. 2C). Prosternum very weakly to not at all tectiform. Mesoventrite with moderate elevation forming a thin posteromedial longitudinal carina. Metafemora densely pubescent in basal nine-tenths (Fig. 2D). Aedeagus. Aedeagus (Fig. 5C,D) with median lobe that bears a single medial constriction situated halfway between base and apex, base and position of gonopore of equal width, tapering past position of gonopore narrowing abruptly to form a rounded triangular apex which is even with the apex of the parameres. Sclerite of the median lobe not expanded. Gonopore situated ca. half of one gonopore width below the apex of the median lobe. Parameres symmetrical, with outer margins straight, with apex slightly inwardly curved and bluntly rounded. Basal piece long, ca. half the length of the parameres. Etymology. This species is named in honor of Dr. Jennifer Girón, for her substantial contributions and dedication to the study of the taxonomy and morphology of the subfamily Acidocerinae and for her valuable mentorship of the first author. Distribution. Known only from the type locality near the base of Cerro de la Neblina in southern Venezuela. Biology. Chasmogenus gironae was collected in small ponds full of leaves in lowland rainforest.Published as part of Glynn, Rachel D. & Short, Andrew Edward Z., 2021, New species and records of Chasmogenus Sharp, 1882 from the southwestern margin of the Guiana Shield (Coleoptera: Hydrophilidae: Acidocerinae), pp. 435-443 in Zootaxa 5048 (3) on pages 440-441, DOI: 10.11646/zootaxa.5048.3.8, http://zenodo.org/record/555655
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