Use of an electronic medical record to monitor efficacy of diabetes care in out-patients in a central hospital in Malawi: Patterns of glycaemic control and lessons learned

The Malawian health sector has a strong tradition of systematic data collection for monitoring and evaluation of large-scale services. A highly successful adapted Directly Observed Treatment, Short course “DOTS” framework, based on patient registers and paperbased mastercards was introduced to facilitate the management and monitoring of the scale up of antiretroviral therapy. Subsequently, a simple, touch-screen based electronic medical record system (EMRs) was effectively introduced at high burden ART sites. Based on this model, in 2010, a diabetes specific EMRs was introduced in the diabetes clinic at Queen Elizabeth Central Hospital. In this paper we report on the first 3 years experience with the diabetes EMRs. We highlight the strengths and weaknesses of the diabetes EMRs and present data on glycaemic control recorded in the system

Oxygen saturations of medical inpatients in a Malawian hospital: cross-sectional study of oxygen supply and demand

Oxygen is a World Health Organization listed essential drug, yet provision of oxygen in developing countries often fails to meet demand. The aim of this study was to evaluate the need for supplementary oxygen against oxygen delivery capacity at a large teaching hospital in Malawi. A cross-sectional study of all adult medical inpatients and assessment of oxygen provision over a 24-hour period was conducted. 144 patients were included in the study, 14 of whom met local and international criteria for oxygen therapy (oxygen saturations of <90%). Four were receiving oxygen. Of the 8 oxygen concentrators available, only 4 were functional. In conclusion, we identified a need for oxygen that was greater than the supply

Surveillance Programme of IN-patients and Epidemiology (SPINE): implementation of an electronic data collection tool within a large hospital in Malawi.

Miguel Sanjoaquin and colleagues describe their experience of setting up an electronic patient records system in a large referral hospital in Blantyre, Malawi

Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi

<div><p>Background</p><p>The epidemic of non-communicable diseases (NCDs) in low and middle income countries (LMICs) is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a “double burden” of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi’s largest hospital.</p><p>Methods</p><p>Primary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender.</p><p>Findings</p><p>10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs.</p><p>Interpretation</p><p>Infectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.</p></div

Annual incidence of inpatient admissions per 1000 population, by age and sex, Blantyre District, Malawi 2013–2015.

<p>The grey line represents ‘Male’, the light blue line represents ‘Female’.</p

Predicted probablility (with 95% confidence limits) of a non-communicable disease diagnosis, by age, in adult inpatients, Blantyre, Malawi- 2013 to 2014.

<p>Predicted probablility (with 95% confidence limits) of a non-communicable disease diagnosis, by age, in adult inpatients, Blantyre, Malawi- 2013 to 2014.</p

Mortality and case fatality rate by age and diagnosis (ranked by total mortality burden).

<p>Mortality and case fatality rate by age and diagnosis (ranked by total mortality burden).</p

Predicted probablility (with 95% confidence limits) of a death, by age, in adult inpatients, Blantyre, Malawi- 2013 to 2014.

<p>Predicted probablility (with 95% confidence limits) of a death, by age, in adult inpatients, Blantyre, Malawi- 2013 to 2014.</p

HIV testing and status by age and diagnosis in adult inpatients at QECH, 2013–2014, ranked by total proportion HIV positive.

<p>HIV testing and status by age and diagnosis in adult inpatients at QECH, 2013–2014, ranked by total proportion HIV positive.</p

Demographic and clinical characteristics and risk of death among adult inpatients at QECH 2013–2014.

<p>Demographic and clinical characteristics and risk of death among adult inpatients at QECH 2013–2014.</p