Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in Malawi.

BACKGROUND: The B.1.1.529 (Omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the fourth COVID-19 pandemic wave across the southern African region, including Malawi. The seroprevalence of SARS-CoV-2 antibodies and their association with epidemiological trends of hospitalisations and deaths are needed to aid locally relevant public health policy decisions. METHODS: We conducted a population-based serosurvey from December 27, 2021 to January 17, 2022, in 7 districts across Malawi to determine the seroprevalence of SARS-CoV-2 antibodies. Serum samples were tested for antibodies against SARS-CoV-2 receptor binding domain using WANTAI SARS-CoV-2 Receptor Binding Domain total antibody commercial enzyme-linked immunosorbent assay (ELISA). We also evaluated COVID-19 epidemiologic trends in Malawi, including cases, hospitalisations and deaths from April 1, 2021 through April 30, 2022, collected using the routine national COVID-19 reporting system. A multivariable logistic regression model was developed to investigate the factors associated with SARS-CoV-2 seropositivity. FINDINGS: Serum samples were analysed from 4619 participants (57% female; 60% aged 18-50 years), of whom 878/3794 (23%) of vaccine eligible adults had received a single dose of any COVID-19 vaccine. The overall assay-adjusted seroprevalence was 83.7% (95% confidence interval (CI), 79.3%-93.4%). Seroprevalence was lowest among children <13 years of age (66%) and highest among adults 18-50 years of age (82%). Seroprevalence was higher among vaccinated compared to unvaccinated participants (1 dose, 94% vs. 77%, adjusted odds ratio 4.89 [95% CI, 3.43-7.22]; 2 doses, 97% vs. 77%, aOR 6.62 [95% CI, 4.14-11.3]). Urban residents were more likely to be seropositive than those from rural settings (91% vs. 78%, aOR 2.76 [95% CI, 2.16-3.55]). There was at least a two-fold reduction in the proportion of hospitalisations and deaths among the reported cases in the fourth wave compared to the third wave (hospitalisations, 10.7% (95% CI, 10.2-11.3) vs. 4.86% (95% CI, 4.52-5.23), p < 0.0001; deaths, 3.48% (95% CI, 3.18-3.81) vs. 1.15% (95% CI, 1.00-1.34), p < 0.0001). INTERPRETATION: We report reduction in proportion of hospitalisations and deaths from SARS-CoV-2 infections during the Omicron variant dominated wave in Malawi, in the context of high SARS-CoV-2 seroprevalence and low COVID-19 vaccination coverage. These findings suggest that COVID-19 vaccination policy in high seroprevalence settings may need to be amended from mass campaigns to targeted vaccination of reported at-risk populations. FUNDING: Supported by the Bill and Melinda Gates Foundation (INV-039481)

Accessibility of primary health care services in Alexandra township

M.Cur.The overall aim of the study is to explore and describe the factors that influence the accessibility of PHC services in Alexandra Township. Most of the time the public clinics in Alexandra rely on part-time nursing personnel to render health services. Sometimes there are so few nurses on duty that they cannot manage to perform all the services required in the clinic and the community. There are long queues of patients and they are often turned away because they cannot be attended to. Statistics (Clinic Statistics, Jan 2000-Dec 2000) show that about 100 000 people out of the total population of 350 000 people (Community Statistics, 1999) attend these clinics in a year. This number includes people who come to the clinics three or more times per year for services such as family planning, Tuberculosis and well baby. To achieve the objectives of the study a quantitative, non-experimental, exploratory, descriptive and contextual design as described by Polit and Hungler (1997:166,456 & 466) and Burns and Grove (1997:52) was chosen. A pilot study (Burns and Grove 1997:52) was done in three phases with 12 patients, 10 community members and two professional nurses from the clinics. After that 300 interview schedules were administered to 160 randomly selected patients attending the four public clinics in the area and 140 members of the community. Ten questionnaires were distributed among the remaining 10 professional nurses. The researcher as a participant observer, made observations with the aid of an observation list, which was developed after the three phases of data collection to verify the data, collected. A quantitative descriptive data analysis (Burns & Groove 1997:779) was done with the use of SPSS computer program. Content analysis was done on the open-ended questions and the results of the observations. The demographics of the residents reveal that the community is a vulnerable area (White paper, 1997:14) which should be the focus of the health service providers. Although the iii services are geographically accessible, they are provided in an unacceptable, inefficient, ineffective and inequitable manner. Moreover services are functionally, socially, physica.lly and financially inaccessible. Health education factors add to the inaccessibility of the services to the people. Guidelines to improve these factors were formulated to make public PHC services in the area more accessible. These findings have implications on nursing practice, education and research. A replica of the study in similar and different contexts in SA is recommended

Stakeholders' perceptions of the changing role of traditional birth attendants in the rural areas of central Wets zone, Malawi: a mixed methods study

Introduction: In 2007, the Ministry of Health in Malawi issued a directive banning traditional birth attendants (TBAs) from delivering mothers and ordered all mothers to access skilled birth attendants in health facilities (MoH, 2007b). Anecdotal reports showed that the influx of pregnant mothers to the health facilities resulted in mothers delivering on make shift beds on the floor and sometimes without the assistance of the skilled provider. The badly stretched health care system continues to force mothers to deliver with the assistance of TBAs who have gone underground for fear of being fined. Purpose of the study: The purpose of this study was to explore stakeholders’ perceptions of the changing role of TBAs in order to obtain a greater breadth of understanding of the reasons why home births persist in the rural areas of Central West Zone (CWZ), Malawi. Methods: The study employed a mixed method concurrent triangulation design in which 24 health facilities in the districts of Ntcheu, Dedza, Lilongwe and Mchinji, in CWZ, Malawi were included. A non-probability purposive sampling method was used to select 24 health facilities that provide Basic Emergency Obstetric and Neonatal Care (BEmONC) services in rural areas of CWZ. A randomly selected sample was used to collect quantitative data from mothers, using an interview schedule. These were mothers (n=144) who had come to access maternal and neonatal health care but had previously sought the help of a TBA to deliver. A total of 55 nurse midwives who worked in the 24 health facilities and who were available and willing to participate responded to a structured interview schedule. Quantitative data were analyzed using SPSS version 19. Qualitative data were collected using focus group discussions (FGDs) with TBAs (n=4 FGDs, with 6-7 respondents in each discussion group) who lived in the catchment areas of the selected BEmONC sites. Single in- depth interviews were conducted with TBA trainers (n=10) in the districts and health professionals (n=12) from the Ministry of Health and Nurses and Midwives Council of Malawi. Data were analyzed manually. Findings: The findings showed that the moratorium on TBAs was implemented without consultation with the relevant stakeholders and as a result, many mothers in rural areas continued to seek the services of TBAs. Untrained TBAs took advantage of the opportunity and together with some trained TBAs who were afraid of punishment went underground to practice. Maternal and neonatal health care in BEmONC facilities were deficient as the health care system struggled with challenges such as the lack of adequate and humane accommodation for waiting mothers, critical shortages of staff, drugs and supplies and negative health care worker attitudes. In addition, long distances and the lack of empowerment of rural women prevented mothers from seeking skilled birth attendants. The study concluded that even though the government had issued a moratorium on TBAs, the health care system is not coping. Recommendations: It is recommended that having moved away from the TBAs, there is no need to revert to using them since that would mean perpetuating harmful and substandard care for mothers. In addition, TBA services would undermine the government’s efforts to improve skilled birth attendance. However, the system needs to urgently deal with the challenges that rural mothers encounter in trying to access skilled birth attendance

Knowledge, Attitudes, and Practices on COVID-19 Vaccination among General Adult Population in Malawi: A Countrywide Cross-Sectional Survey

Vaccination is one of the essential measures in reducing transmission, morbidity, and mortality rates of a disease. However, the COVID-19 vaccination is facing hesitancy across the globe, Malawi included. A population-based cross-sectional study was conducted in Malawi to document knowledge, attitudes, and practices on COVID-19 vaccination. The study targeted the general adult population and employed a multi-stage sampling technique. The Census Enumeration Areas within the 16 selected districts served as a primary sampling unit. Among the total 3068 participants, 1947 (63.6%) were female. About 1039 (34.1%) participants had primary education, while only 169 (5.5%) had college education. A total of 2936 (95.7%) participants knew about the COVID-19 vaccine, and 2063 (68.4%) felt that the COVID-19 vaccine was effective. A total of 1180 (38.7%) got vaccinated. Knowledge of the COVID-19 vaccination was significantly associated with participants’ education levels, location, occupation, marital status, household family income, and whether they were suffering from chronic illness or not. Overall, the level of knowledge and attitudes about the COVID-19 vaccination was good. This study has also established that different population groups have statistically different levels of knowledge and attitudes regarding COVID-19 vaccination. This study has also indicated a significant relationship between the rate of vaccination and several factors. Therefore, this calls for stakeholders to continue awareness and group-targeted tailored campaigns so as to increase COVID-19 vaccination

SARS-CoV-2 Prevalence in Malawi Based on Data from Survey of Communities and Health Workers in 5 High-Burden Districts, October 2020.

To determine early COVID-19 burden in Malawi, we conducted a multistage cluster survey in 5 districts. During October-December 2020, we recruited 5,010 community members (median age 32 years, interquartile range 21-43 years) and 1,021 health facility staff (HFS) (median age 35 years, interquartile range 28-43 years). Real-time PCR-confirmed SARS-CoV-2 infection prevalence was 0.3% (95% CI 0.2%-0.5%) among community and 0.5% (95% CI 0.1%-1.2%) among HFS participants; seroprevalence was 7.8% (95% CI 6.3%-9.6%) among community and 9.7% (95% CI 6.4%-14.5%) among HFS participants. Most seropositive community (84.7%) and HFS (76.0%) participants were asymptomatic. Seroprevalence was higher among urban community (12.6% vs. 3.1%) and HFS (14.5% vs. 7.4%) than among rural community participants. Cumulative infection findings 113-fold higher from this survey than national statistics (486,771 vs. 4,319) and predominantly asymptomatic infections highlight a need to identify alternative surveillance approaches and predictors of severe disease to inform national response

Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in MalawiResearch in context

Summary: Background: The B.1.1.529 (Omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the fourth COVID-19 pandemic wave across the southern African region, including Malawi. The seroprevalence of SARS-CoV-2 antibodies and their association with epidemiological trends of hospitalisations and deaths are needed to aid locally relevant public health policy decisions. Methods: We conducted a population-based serosurvey from December 27, 2021 to January 17, 2022, in 7 districts across Malawi to determine the seroprevalence of SARS-CoV-2 antibodies. Serum samples were tested for antibodies against SARS-CoV-2 receptor binding domain using WANTAI SARS-CoV-2 Receptor Binding Domain total antibody commercial enzyme-linked immunosorbent assay (ELISA). We also evaluated COVID-19 epidemiologic trends in Malawi, including cases, hospitalisations and deaths from April 1, 2021 through April 30, 2022, collected using the routine national COVID-19 reporting system. A multivariable logistic regression model was developed to investigate the factors associated with SARS-CoV-2 seropositivity. Findings: Serum samples were analysed from 4619 participants (57% female; 60% aged 18–50 years), of whom 878/3794 (23%) of vaccine eligible adults had received a single dose of any COVID-19 vaccine. The overall assay-adjusted seroprevalence was 83.7% (95% confidence interval (CI), 79.3%–93.4%). Seroprevalence was lowest among children <13 years of age (66%) and highest among adults 18–50 years of age (82%). Seroprevalence was higher among vaccinated compared to unvaccinated participants (1 dose, 94% vs. 77%, adjusted odds ratio 4.89 [95% CI, 3.43–7.22]; 2 doses, 97% vs. 77%, aOR 6.62 [95% CI, 4.14–11.3]). Urban residents were more likely to be seropositive than those from rural settings (91% vs. 78%, aOR 2.76 [95% CI, 2.16–3.55]). There was at least a two-fold reduction in the proportion of hospitalisations and deaths among the reported cases in the fourth wave compared to the third wave (hospitalisations, 10.7% (95% CI, 10.2–11.3) vs. 4.86% (95% CI, 4.52–5.23), p < 0.0001; deaths, 3.48% (95% CI, 3.18–3.81) vs. 1.15% (95% CI, 1.00–1.34), p < 0.0001). Interpretation: We report reduction in proportion of hospitalisations and deaths from SARS-CoV-2 infections during the Omicron variant dominated wave in Malawi, in the context of high SARS-CoV-2 seroprevalence and low COVID-19 vaccination coverage. These findings suggest that COVID-19 vaccination policy in high seroprevalence settings may need to be amended from mass campaigns to targeted vaccination of reported at-risk populations. Funding: Supported by the Bill and Melinda Gates Foundation (INV-039481)

Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in Malawi

No abstract available