Knowledge and practice of radiographers regarding infection control in radiology department in Malawi

Infection control is an essential cornerstone of clinical care at all healthcare settings. The changing pattern of infections emphasises the need for all healthcare workers, including radiographers, to implement and strictly adhere to standard infection control precautions (SICP) that will protect both patients and healthcare workers from healthcare associated infections (HAIs). However, implementing SICP can be difficult, especially if radiographers do not have adequate knowledge, and skilled practices, in infection control. As a practicing radiographer and a health educator, the researcher observed that there were discrepancies regarding implementation of SICP by radiographers in Malawi. No study has been conducted to explore and describe the knowledge and practices of radiographers regarding infection control in radiology departments in Malawi. There are also no infection control guidelines. These gaps led to this study being conducted. The aim of the study was to explore, and describe, knowledge and practices of radiographers regarding infection control in radiology departments in government referral hospitals in Malawi in order to develop a draft guideline for infection control to facilitate sound knowledge and practices of radiographers regarding infection control in these departments. The study took place in four government referral hospitals and followed a quantitative, exploratory, and descriptive design that was contextual in nature. The study was conducted in two phases. In the first one a self-administered questionnaire was used to explore and describe the knowledge and practices of radiographers regarding infection control in government referral hospitals in Malawi. The second one included the development of a draft guideline for infection control in order to facilitate sound knowledge and practices of radiographers regarding infection control in government referral hospitals in Malawi. In phase one, the research population consisted of 80 permanently employed radiographers. A census sampling method was used to select 62 respondents. The data were collected by means of a self-administered questionnaire that was developed based on a literature review. Some questions were adapted from an existing questionnaire. The questionnaire consisted of questions and statements. It had four parts: demographic information (Part A), knowledge regarding infection control (Part B), practices regarding infection control (Part C), and additional relevant information (Part D). Descriptive and inferential statistics, with the help of a statistician, were used to analyse the data. The results of the study revealed that radiographers had average knowledge and practice in terms of infection control. The results revealed a significant association between age and knowledge (P<0.05). In phase two, a draft guideline was developed. The guideline’s content is based on 20 gaps identified in phase one of the study, as well as literature. The draft guideline consists of seven sets of recommendations: hand hygiene, personal hygiene, personal protective equipment (PPE), safe handling of sharps and sharp containers, decontamination and cleaning, housekeeping, and routine infection control practices. Reliability and validity were ensured. Ethical considerations were considered throughout the study. Respect for persons, beneficence and justice were adhered to. The study is the first in the field of radiography in Malawi. Results of this study should contribute to the body of knowledge of radiography practice. The results are to be used to inform practicing radiographers, heads of departments, the Ministry of Health and Population, and other health practitioners about the current practices and knowledge of radiographers in government referral hospitals in Malawi. The draft guideline should facilitate sound knowledge and practices regarding infection control among practicing radiographers in these departments. Recommendations include further development and implementation of the draft guideline, and radiography education and development of further research on infection control in the radiography profession, specifically in the African context

CSF Levels of Elongation Factor Tu Is Associated With Increased Mortality in Malawian Adults With Streptococcus pneumoniae Meningitis

Background: Mortality from bacterial meningitis, predominately caused by Streptococcus pneumoniae, exceeds 50% in sub-Saharan African countries with high HIV prevalence. Underlying causes of high mortality are poorly understood. We examined the host and pathogen proteome in the CSF of adults with proven pneumococcal meningitis (PM), testing if there was an association between differentially expressed proteins and outcome. Materials/Methods: CSF proteomes were analyzed by quantitative Mass-Spectrometry. Spectra were identified using the Swissprot human and TIGR4 pneumococcal protein libraries. Proteins were quantitated and analyzed against mortality. Unique proteins in PM were identified against published normal CSF proteome. Random-Forest models were used to test for protein signatures discriminating outcome. Proteins of interest were tested for their effects on growth and neutrophil opsonophagocytic killing of S. pneumoniae. Results: CSF proteomes were available for 57 Adults with PM (median age 32 years, 60% male, 70% HIV-1 co-infected, mortality 63%). Three hundred sixty individual human and 23 pneumococcal proteins were identified. Of the human protein hits, 30% were not expressed in normal CSF, and these were strongly associated with inflammation and primarily related to neutrophil activity. No human protein signature predicted outcome. However, expression of the essential S. pneumoniae protein Elongation Factor Tu (EF-Tu) was significantly increased in CSF of non-survivors [False Discovery Rate (q) <0.001]. Expression of EF-Tu was negatively co-correlated against expression of Neutrophil defensin (r 0.4 p p < 0.002), but not against complement proteins C3 or Factor H. In vitro, addition of EF-Tu protein impaired S. pneumoniae neutrophil killing in CSF. Conclusions: Excessive S. pneumoniae EF-Tu protein in CSF was associated with reduced survival in meningitis in a high HIV prevalence population. We show EF-Tu may inhibit neutrophil mediated killing of S. pneumoniae in CSF. Further mechanistic work is required to better understand how S. pneumoniae avoids essential innate immune responses during PM through production of excess EF-Tu

Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa

Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Prediction of outcome from adult bacterial meningitis in a high-HIV-seroprevalence, resource-poor setting using the Malawi Adult Meningitis Score (MAMS)

Acute bacterial meningitis (ABM) in adults residing in resource-poor countries is associated with mortality rates >50%. To improve outcome, interventional trials and standardized clinical algorithms are urgently required. To optimize these processes, we developed and validated an outcome prediction tool to identify ABM patients at greatest risk of death.We derived a nomogram using mortality predictors derived from a logistic regression model of a discovery database of adult Malawian patients with ABM (n = 523 [65%] cerebrospinal fluid [CSF] culture positive). We validated the nomogram internally using a bootstrap procedure and subsequently used the nomogram scores to further interpret the effects of adjunctive dexamethasone and glycerol using clinical trial data from Malawi.ABM mortality at 6-week follow-up was 54%. Five of 15 variables tested were strongly associated with poor outcome (CSF culture positivity, CSF white blood cell count, hemoglobin, Glasgow Coma Scale, and pulse rate), and were used in the derivation of the Malawi Adult Meningitis Score (MAMS) nomogram. The C-index (area under the curve) was 0.76 (95% confidence interval, .71-.80) and calibration was good (Hosmer-Lemeshow C-statistic = 5.48, df = 8, P = .705). Harmful effects of adjunctive glycerol were observed in groups with relatively low predicted risk of poor outcome (25%-50% risk): Case Fatality Rate of 21% in the placebo group and 52% in the glycerol group (P < .001). This effect was not seen with adjunctive dexamethasone.MAMS provides a novel tool for predicting prognosis and improving interpretation of ABM clinical trials by risk stratification in resource-poor settings. Whether MAMS can be applied to non-HIV-endemic countries requires further evaluation

Prediction of outcome from adult bacterial meningitis in ta high-HIV-seroprevalence, resource-poor setting using the Malawi adult meningitis score (MAMS)

BACKGROUND: Acute bacterial meningitis (ABM) in adults residing in resource-poor countries is associated with mortality rates >50%. To improve outcome, interventional trials and standardized clinical algorithms are urgently required. To optimize these processes, we developed and validated an outcome prediction tool to identify ABM patients at greatest risk of death. METHODS: We derived a nomogram using mortality predictors derived from a logistic regression model of a discovery database of adult Malawian patients with ABM (n = 523 [65%] cerebrospinal fluid [CSF] culture positive). We validated the nomogram internally using a bootstrap procedure and subsequently used the nomogram scores to further interpret the effects of adjunctive dexamethasone and glycerol using clinical trial data from Malawi. RESULTS: ABM mortality at 6-week follow-up was 54%. Five of 15 variables tested were strongly associated with poor outcome (CSF culture positivity, CSF white blood cell count, hemoglobin, Glasgow Coma Scale, and pulse rate), and were used in the derivation of the Malawi Adult Meningitis Score (MAMS) nomogram. The C-index (area under the curve) was 0.76 (95% confidence interval, .71–.80) and calibration was good (Hosmer-Lemeshow C-statistic = 5.48, df = 8, P = .705). Harmful effects of adjunctive glycerol were observed in groups with relatively low predicted risk of poor outcome (25%–50% risk): Case Fatality Rate of 21% in the placebo group and 52% in the glycerol group (P < .001). This effect was not seen with adjunctive dexamethasone. CONCLUSIONS: MAMS provides a novel tool for predicting prognosis and improving interpretation of ABM clinical trials by risk stratification in resource-poor settings. Whether MAMS can be applied to non-HIV-endemic countries requires further evaluation