Consumption of Sweetened Beverages among School Going Children in a Densely Populated Township in Lilongwe, Malawi

Background: The growing global childhood obesity pandemic has not spared lowincome countries like Malawi, where 8% of children below the age of five years are overweight. Globally, regular consumption of sweetened beverages is implicated among the factors that fuel childhood obesity. Despite the growing problem, there are no local studies on any aspect of sweetened beverage consumption among children in Malawi that could help in guiding interventions and public health nutrition policies.Aim: We aimed to assess sweetened beverage consumption among school-going children in Chilinde, a densely populated township in Lilongwe, the capital city of Malawi.Methods: A total of 60 school-going children whose caregivers gave verbal consent were included, and a structured questionnaire was administered to the caregiver (or other knowledgeable and responsible member of the household) of each eligible child.Results: Our results showed that 50 of the 60 children sampled were consuming a wide-range of sweetened beverages on a regular basis on any day of the week, mostly during meal times (n = 23), before going to school (n = 22), and after school (n = 19). One-third of the children were reportedly consuming up to 300 mL of several sweetened beverages per day.Conclusion: Like in many countries around the world, consumption of sweetened beverages appears to be common among young school-going children in this urban setting in Malawi. As the country builds public health responses to the growing problem of non-communicable diseases, early preventive interventions among children should be given priority

Discriminatory land use planning and flood risk management in Karonga Town, Malawi

This study examines how discriminatory land use planning predisposes the low income residents to flood disaster risks in Karonga town, Malawi. Using a qualitative research design, in-depth interviews were conducted with ten government and non government institutions engaged in land use planning and disaster risk management and traditional leaders. The study showed that theoretical aims of land use planning to improve the living environment remain partial and in certain cases exacerbate risks posed by floods because the planning tool divides the urban landscape into formal and informal spaces. Such separation which coincided with incomes levels forced the marginalised and urban poor to occupy flood-prone areas While literature on flood control promotes an integrated approach to flood risk management, land use planning practice is singled out as a regulatory measure which ironically not only fails to meet the needs, but also increases vulnerability to flood risks, of the urban poor residents. The study further revealed that land use planning has failed to reduce flood disaster risks in informal spaces because it is not compatible with the needs of the urban poor

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi.

In Malawi, maternal mortality remains high. Existing maternal death reviews fail to adequately review most deaths, or capture those that occur outside the health system. We assessed the value of community involvement to improve capture and response to community maternal deaths

Lymphocyte subsets in healthy Malawians: Implications for immunologic assessment of HIV infection in Africa

BackgroundCD4+T lymphocyte measurements are the most important indicator of mortality in HIV-infected individuals in resource-limited settings. There is currently a lack of comprehensive immunophenotyping data from African populations to guide the immunologic assessment of HIV infection.ObjectiveTo quantify variation in absolute and relative lymphocyte subsets with age in healthy Malawians.MethodsLymphocyte subsets in peripheral blood of 539 healthy HIV-uninfected Malawians stratified by age were enumerated by flow cytometry.ResultsB and T–lymphocyte and T-lymphocyte subset absolute concentrations peaked in early childhood then decreased to adult levels, whereas lymphocyte subset proportions demonstrated much less variation with age. Adult lymphocyte subsets were similar to those in developed countries. In contrast, high B-lymphocyte and CD8+T-lymphocyte levels among children under 2 years, relative to those in developed countries, resulted in low CD4+T-lymphocyte percentages that varied little between 0 and 5 years (35% to 39%). The CD4+T-lymphocyte percentages in 35% of healthy children under 1 year and 18% of children age 1 to 3 years were below the World Health Organization threshold defining immunodeficiency in HIV-infected children in resource-limited settings. Thirteen percent of healthy children under 18 months old had a CD4:CD8T-lymphocyte ratio <1.0, which is commonly associated with HIV infection. All immunologic parameters except absolute natural killer lymphocyte concentration varied significantly with age, and percentage and overall absolute CD4+T-lymphocyte counts were higher in females than males.ConclusionAlthough lymphocyte subsets in Malawian adults are similar to those from developed countries, CD4+T-lymphocyte percentages in young children are comparatively low. These findings need to be considered when assessing the severity of HIV-related immunodeficiency in African children under 3 years

Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study

Introduction: Trauma is a leading cause of morbidity and mortality globally, with a disproportionate burden affecting low- and middle-income countries (LMIC). Rapid urbanization and differences in transportation patterns result in unique injury patterns in LMIC. Trauma registries are essential to determine the impact of trauma and the nature of injuries in LMIC to enable hospitals and healthcare systems to optimize care and to allocate resources. Methods: A retrospective database analysis of prospectively collected data in the Kamuzu Central Hospital (KCH) Trauma Registry from 2018 – 2019 was performed. Activity-based costing, a bottom-up cost analysis method to determine the cost per patient registered, was completed after systematically analyzing the standard operating procedures of the KCH trauma registry. Results: During the study period, 12,616 patients were included in the KCH Trauma Registry. Startup costs for the trauma registry are estimated at $3,196.24. This sum includes$1815.84 for personnel cost, $200 for database initiation (REDCap database),$342.50 for initial data clerk training, and $787.90 for registry and office supplies. Recurrent costs occurring in 2018, included personnel, technology, supply, and facility costs. Five data clerks, one data clerk manager, and a registry manager are required for 24/7 data collection, data integrity, and database maintenance, with an estimated cost of$29,697.24 per year. Yearly recurrent data clerk training costs are $137.00. Internet and facility costs for a data clerk office and secure record storage are$1632.60 per year. Supplies for the completion of trauma intake forms (binders, paper, pens) are $1431.80 per year. The total annual cost of the trauma registry at a tertiary hospital in Malawi is$33,361.64, which costs $2.64 per patient registered in the registry in 2018. Conclusion: Trauma registries are necessary for the assessment of the local trauma burden and injury pattern, but require significant financial commitment and time. To fully capture the local burden of trauma in resource-limited settings, acquiring, validating, and analyzing accurate data is crucial. Anticipating the financial burden of a trauma surveillance registry ahead of time is imperative

Dietary change, noncommunicable disease and local knowledge: results of a small-scale study of the views of older Malawians

Interviews were conducted with a small group of Malawians over the age of 60 in rural Karonga district and in Area 25 of the capital, Lilongwe. We asked their views on the changes in diet that had taken place over their lifetimes and also on the causes of 'noncommunicable' diseases, such as Type 2 diabetes and hypertension in their communities. Their answers generally confirmed research showing that dietary diversity is decreasing in Malawi, but many of our interviewees also recalled that hunger was more frequently experienced in the past. Our interviews revealed that though the essential rural diet based on either maize or cassava appears superficially largely unchanged, there have been significant changes in the varieties of crops grown, methods of production and food processing. Many of our interviewees were concerned that the application of chemical fertiliser and pesticides was harming their health

Lactobacillus-deficient vaginal microbiota dominate post-partum women in rural Malawi

The bacterial community found in the vagina is an important determinant of a woman's health and disease. A healthy vaginal microbiota is associated with a lower species richness and high proportions of one of a number of different Lactobacillus spp.. When disrupted the resulting abnormal vaginal microbiota is associated with a number of disease states and poor pregnancy outcomes. Studies up until now have concentrated on relatively small numbers of American and European populations which may not capture the full complexity of the community, nor adequately predict what constitutes a healthy microbiota in all populations. In this study we sampled and characterised the vaginal microbiota from a cohort of 1107 women in rural Malawi found on vaginal swabs taken post-partum. We found a population dominated by Gardnerella vaginalis and devoid of the most common vaginal Lactobacillus species, even if the vagina was sampled over a year post-partum. The Lactobacillus-deficient anaerobic community commonly labelled community state type (CST) 4 could be sub-divided into four further communities. A Lactobacillus iners dominated vaginal microbiota became more common the longer after delivery the vagina was sampled, but G. vaginalis remained the dominant organism. These results outline the difficulty in all-encompassing definitions of what a healthy or abnormal vaginal microbiota is post-partum. Previous identification of community state types and associations between bacterial species, bacterial vaginosis and adverse birth outcomes may not represent the complex heterogeneity of the microbiota present.ImportanceA bacterial community in the vaginal tract that is dominated by small number of bacterial Lactobacillus species and when they are not present, there is a greater incidence of inflammatory conditions and adverse birth outcomes. A switch to a vaginal bacterial community lacking in Lactobacillus species is common after pregnancy. In this study we characterised the vaginal microbiota after delivery of a large group of women from a resource poor, under-sampled population in rural Malawi. The majority of women were found to have a Lactobacillus-deficient community and even after a year after delivery the majority of women still did not have Lactobacillus present in their vaginal microbiota. The effect of becoming pregnant again for those who do not revert to a Lactobacillus dominant community is unknown and could suggest that not all Lactobacillus-deficient community structures are adverse. A better understanding is needed of this complex community state type

Physicochemical, microbial, and aflatoxin analyses of selected high-quality cassava flour (HQCF) from the major markets of Zambia

Open Access Journal; Published online: 13 May 2021Various quality grades of high-quality cassava flour (HQCF) are found in markets due to the rapid increase in its utilization for product development. Therefore, this study assessed the chemical, functional and pasting properties and the microbial and aflatoxin content of HQCF being sold in Lusaka markets. Nine samples of HQCF (coded CM 01 to 09) were collected from supermarkets, one major open market, and one cassava processing centre. The samples were analyzed for chemical, functional and pasting properties and the microbial and aflatoxin content using standard laboratory methods. Samples CM 01, CM 08, and CM 09 had starch content above 60%, while CM 02 to CM 07 had starch slightly above 40%. The mean value of bulk density (BD) was 0.51 ± 25.49 g ml−1, dispersibility 68 ± 2.63%, swelling power (SP) 7.84 ± 0.76%, solubility index 135.80 ± 18.8%, and water absorption capacity (WAC) 6.28 ± 32.49%. The mean value for the peak viscosity was 437.46 ± 94.12 RVU, trough viscosity 217.55 ± 27.41 RVU, breakdown viscosity 219.91 ± 77.94 RVU, final viscosity 284.31 ± 29.96 RVU, and setback viscosity 66.77 ± 5.30 RVU. There was no detection of aflatoxins B1, B2, G1, and G2, especially aflatoxin B1 (AFB1) that belongs to group 1 carcinogens for humans. Bacteria colony counts in samples CM 02, CM 03, CM 07, and CM 09 were higher with CFU mg−1 of 2,280,000, 260,000, 200,000, and 510,000, respectively. The study’s information will guide the quality standard specifications, breeding programs, and end-use of HQCF

Perceptions of Gender Disparities in Access to Surgical Care in Malawi: A Community Based Survey

Background Gender disparities in surgical care exist but have been minimally studied, particularly in low- and middle-income countries. This study explored perceptions and gender differences in health-seeking behavior and attitudes toward surgical care in Malawi among community members.MethodsA survey tool was administered to adults ≥18 years old at a central hospital, district hospital, and two marketplaces in Malawi from June 2018 to December 2018. Responses from men and women were compared using chi-squared tests. Results Four hundred eighty-five adults participated in the survey, 244 (50.3%) men and 241 (49.7%) women. Women were more likely to state that fear of surgery might prevent them from seeking surgical care (29.1% of men, 43.6% of women, P = .0009). Both genders reported long wait times, medicine/physician shortages, and lack of information about when surgery is needed as potential barriers to seeking surgical care. More men stated that medical preference should be given to sons (17.1% of men, 9.3% of women, P = .01). Men were more likely to report that men should have the final word about household decisions (28.7% of men vs 19.5% of women, P < .0001) and were more likely to spend money independently (68.7% of married men, 37.5% of married women, P < .0001). Few participants reported believing gender equality had been achieved (61% of men and 66.8% of women). Conclusions A multi-pronged approach is needed to reduce gender disparities in surgical care in Malawi, including addressing paternalistic societal norms, education, and improving health infrastructure