Factors affecting the utilisation of electronic medical records system in Malawian central hospitals

Background In Malawi, paper-based medical record-keeping has been observed to exacerbate challenges related to accessing patient records and patient tracking. Despite the introduction of electronic medical record (EMR) systems in 2001, paper-based records continue to be in use. Some health workers prefer paper-based records to EMRs. This study assessed factors that affect the use of EMRs in Malawi, particularly at Queen Elizabeth and Kamuzu Central Hospitals. It further investigated the reasons why paper-based records are still in use despite the numerous associated disadvantages. The extent to which EMRs contribute to patient care was also analysed.Methods In this cross-sectional study, 111 randomly selected health workers were interviewed, using a semistructured questionnaire, at the 2 largest central hospitals in Malawi, where EMRs were first introduced in the country. Focus group discussions were conducted to gather further information on factors identified during the individual interviews.Results and conclusions Differences in age, gender, and previous computer experience were not associated with differences in EMR usage. However, education and employment levels has a positive association with EMR usage. Hardware and connectivity problems, as well as lack of training and managerial support negatively affected the use of EMRs. EMRs were found to improve data quality and efficiency in patient management

The Tiyeni Deep-Bed Farming System: a Field Manual

This field manual has been developed as a resource for farmers and technical staff who have an interest in adopting Tiyeni’s deep-bed farming system as a means of increasing crop production in a sustainable manner. The aim is to provide the user with a background and context to the Tiyeni method, as well as detailed step-by-step guidelines for its field implementation

Phytochemical composition of four selected vegetable spices commonly consumed in Malawi

Spices, regardless of source, play an important role in enhancing or improving flavor of foods or dishes. In this study, determination of phytochemical composition with respect to total phenolic compounds, antioxidant capacity and vitamin C was conducted in four selected vegetable spices consumed in Malawi, namely Allium cepa L, Allium sativum L, green bell pepper (Capsicum annum L.) and Zingiber officinale. Results showed that total phenolic composition, in mg GAE/100 g, was highest in Zingiber officinale rhizomes (326.5±0.39) followed by Allium cepa L. (169.7±0.00), green bell pepper (124.9±0.20) and Allium sativum L. (72.72±0.39), respectively. Results further showed that Zingiber officinale had the highest antioxidant capacity and reducing power and the lowest vitamin C content, in the range of 21.78±0.21 mg AAE/100 g, 24.35±2.24 mg AAE/g and 3.61±0.23 mg AAE/100 g, respectively compared to the other vegetable spices. On the other hand, vitamin C content was highest in Allium sativum L followed by red Allium cepa L registering values of 455.0±2.12 and 443.4±2.50 mg AAE/100 g, respectively. The reducing power (in mg AAE/g) of the vegetable spices was highest in green bell pepper (Capsicum annum L.) with the value of 17.11±1.549 followed by red Allium cepa L. (9.519±0.860) and Allium sativum L. (5.922±0.778), respectively. Total tannins content, in mg TAE/g, was highest in Allium sativum L, which registered the value of 159.56±4.84 followed by Zingiber officinale (91.53±0.33), bell  pepper (79.94±0.21) and Allium cepa L (49.36±1.98). Furthermore, phytic acid and oxalic acid contents were highest in Zingiber officinale registering values of 5.504±0.822 mg/kg and 37.25±2.83 mg/g, respectively. Red Allium cepa L. was found to contain 20.53±0.916 mg/g oxalic acid but had the lowest phytic acid content registering the value of 2.057±0.095 mg/kg. It can be concluded that the high phytochemical composition in the four vegetable spices, with low antinutrients like phytic and oxalic acids, can play an important role in improving human nutrition and health of consumers.&nbsp

Reducing child undernutrition through dietary diversification, reduced aflatoxin exposure, and improved hygiene practices: the immediate impacts in central Tanzania

Open Access Article; Published online: 28 Nov 2019The study aimed to quantify the immediate effects of dietary diversification, food safety, and hygiene interventions on child undernutrition in four rural villages in Kongwa district of central Tanzania. One hundred mothers with their children of less than 24 months old were recruited for this study. The difference-in-difference (DID) method was used to assess the effects of intensive intervention through a learning-by-doing process on the topic of aflatoxin free diversified food utilization and improved hygiene practices. Periodic anthropometric measurements were conducted on the 0th, 7th, 14th, and 21st days, and DID estimator showed the significant and positive average marginal effects of the intervention on Z-Scores being 0.459, 0.252, and 0.493 for wasting, stunting, and underweight, respectively. Notably, at the end of the study, the mean aflatoxin M1 level in urine samples decreased by 64% in the intervention group, while it decreased by 11% in the control group. The study provides quantitative evidence on intensive 21-day training for mothers incorporating integrated technologies yielded positive impacts on their children’s nutritional outcomes

A Simple Chelex Protocol for DNA Extraction From Anopheles Spp

Endemic countries are increasingly adopting molecular tools for efficient typing, identification and surveillance against malaria parasites and vector mosquitoes, as an integral part of their control programs. For sustainable establishment of these accurate approaches in operations research to strengthen malaria control and elimination efforts, simple and affordable methods, with parsimonious reagent and equipment requirements are essential. Here we present a simple Chelex-based technique for extracting malaria parasite and vector DNA from field collected mosquito specimens. We morphologically identified 72 Anopheles gambiae sl. from 156 mosquitoes captured by pyrethrum spray catches in sleeping rooms of households within a 2,000 km(2) vicinity of the Malaria Institute at Macha. After dissection to separate the head and thorax from the abdomen for all 72 Anopheles gambiae sl. mosquitoes, the two sections were individually placed in 1.5 ml microcentrifuge tubes and submerged in 20 μl of deionized water. Using a sterile pipette tip, each mosquito section was separately homogenized to a uniform suspension in the deionized water. Of the ensuing homogenate from each mosquito section, 10 μl was retained while the other 10 μl was transferred to a separate autoclaved 1.5 ml tube. The separate aliquots were subjected to DNA extraction by either the simplified Chelex or the standard salting out extraction protocol(9,10). The salting out protocol is so-called and widely used because it employs high salt concentrations in lieu of hazardous organic solvents (such as phenol and chloroform) for the protein precipitation step during DNA extraction(9). Extracts were used as templates for PCR amplification using primers targeting arthropod mitochondrial nicotinamide adenine dinucleotide dehydrogenase (NADH) subunit 4 gene (ND4) to check DNA quality, a PCR for identification of Anopheles gambiae sibling species(10) and a nested PCR for typing of Plasmodium falciparum infection. Comparison using DNA quality (ND4) PCR showed 93% sensitivity and 82% specificity for the Chelex approach relative to the established salting out protocol. Corresponding values of sensitivity and specificity were 100% and 78%, respectively, using sibling species identification PCR and 92% and 80%, respectively for P. falciparum detection PCR. There were no significant differences in proportion of samples giving amplicon signal with the Chelex or the regular salting out protocol across all three PCR applications. The Chelex approach required three simple reagents and 37 min to complete, while the salting out protocol entailed 10 different reagents and 2 hr and 47 min\u27 processing time, including an overnight step. Our results show that the Chelex method is comparable to the existing salting out extraction and can be substituted as a simple and sustainable approach in resource-limited settings where a constant reagent supply chain is often difficult to maintain

Informing targeted HIV self-testing: a protocol for discrete choice experiments in Malawi, Zambia and Zimbabwe

Introduction HIV self-testing (HIVST) is a new approach to HIV testing where a person collects his or her own specimen, performs an HIV test and interprets the result, either alone or with someone he or she trusts. It is becoming increasingly relevant as a complement to standard-of-care HIV testing and is now recommended by the World Health Organization. Few studies have explored user preferences around HIVST service delivery and optimal models for increasing uptake and linkage to care, particularly among hard-to-reach populations. This paper describes an ongoing study that uses discrete choice experiments (DCE) to identify key HIVST service characteristics that drive people’s willingness to self-test for HIV and link to care, measure the relative strength of user preferences, and explore preference heterogeneity in Southern Africa. Method and Analysis Two DCEs – one on HIVST delivery and one on linkage to care after a positive self-test – are being administered in Malawi, Zambia and Zimbabwe. The designs in each country were informed by a qualitative study, which identified key HIVST service characteristics that influence user decision-making and refined scenario presentations and illustrations. Following data collection, DCE data will be analysed using a multinomial logit model as well as latent class, nested logit and generalised mixed models to examine heterogeneity in preferences by sociodemographic background, HIV testing experience and sexual behaviour. Ethics and dissemination The study has been approved by the College of Medicine Research Ethics Committee in Malawi, the Biomedical Ethics Committee of the University of Zambia, the Medical Research Council of Zimbabwe and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings from the study will be presented at international conferences and in peer-reviewed journals. The results will help inform the HIVST implementation strategy in Southern Africa, particularly among populations underserved by standard-of-care services, such as men and young women

Reducing Child Undernutrition through Dietary Diversification, Reduced Aflatoxin Exposure, and Improved Hygiene Practices: The Immediate Impacts in Central Tanzania

The study aimed to quantify the immediate effects of dietary diversification, food safety, and hygiene interventions on child undernutrition in four rural villages in Kongwa district of central Tanzania. One hundred mothers with their children of less than 24 months old were recruited for this study. The difference-in-difference (DID) method was used to assess the effects of intensive intervention through a learning-by-doing process on the topic of aflatoxin free diversified food utilization and improved hygiene practices. Periodic anthropometric measurements were conducted on the 0th, 7th, 14th, and 21st days, and DID estimator showed the significant and positive average marginal effects of the intervention on Z-Scores being 0.459, 0.252, and 0.493 for wasting, stunting, and underweight, respectively. Notably, at the end of the study, the mean aflatoxin M1 level in urine samples decreased by 64% in the intervention group, while it decreased by 11% in the control group. The study provides quantitative evidence on intensive 21-day training for mothers incorporating integrated technologies yielded positive impacts on their children’s nutritional outcomes

Evolving water point mapping to strategic decision making in rural Malawi

There is a need to evolve from the simple mapping of water points, now often numerous, to effective decision making using these data. This paper outlines new developments of mWater as the preferred online Management Information System (MIS) tool to analyse significant volumes of water and sanitation data in Malawi. mWater exemplifies an evolving strategic decision-making tool used to formulate rural water supply investment strategies. A time series of 25,000 water points have been mapped since 2011 to build a complete asset register of water infrastructure to support government endeavours to reach Sustainable Development Goal 6. This comprehensive live database allows real-time analysis of over sixty variables, including linkage to concurrent mWater sanitation and waste data. This paper briefly illustrates several emergent uses of the facility to exemplify its potential in strategic decision making using Big Data. It is currently being rolled out across the entire country

Intermittent Intravaginal Antibiotic Treatment of Bacterial Vaginosis in HIV-Uninfected and -Infected Women: A Randomized Clinical Trial

OBJECTIVE: Assess efficacy of intermittent intravaginal metronidazole gel treatment in reducing frequency of bacterial vaginosis (BV). DESIGN: Randomized, double-masked, placebo-controlled phase 3 trial. SETTING: Postnatal and family planning clinics of the Queen Elizabeth Central Hospital and two health centers in Blantyre, Malawi. PARTICIPANTS: Nonpregnant HIV-uninfected and -infected women. INTERVENTION: Intravaginal metronidazole treatment and placebo gels provided at baseline and every 3 mo for 1 y. OUTCOME MEASURES: Primary: Cross-sectional and longitudinal comparisons of BV frequency at baseline, 1 mo after product dispensation (post-treatment evaluation [PTE]), and every quarterly visit. Secondary: Effect of treatment on BV clearance and recurrence. RESULTS: Baseline: 842 HIV-uninfected and 844 HIV-infected women were enrolled. The frequency of BV at baseline in treatment and placebo arms, respectively, was 45.9% and 46.8% among HIV-uninfected women, and 60.5% and 56.9% among HIV-infected women. Primary outcomes: At the PTEs the prevalence of BV was consistently lower in treatment than placebo arms irrespective of HIV status. The differences were statistically significant mainly in HIV-uninfected women. Prevalence of BV was also reduced over time in both treatment and placebo arms. In a multivariable analysis that controlled for other covariates, the effect of intravaginal metronidazole treatment gel compared with placebo was not substantial: adjusted relative risk (RR) 0.90, 95% confidence interval (CI) 0.83–0.97 in HIV-uninfected women and adjusted RR 0.95, 95% CI 0.89–1.01 in HIV-infected women. Secondary outcomes: Intravaginal metronidazole treatment gel significantly increased BV clearance (adjusted hazard ratio [HR] 1.34, 95% CI 1.07–1.67 among HIV-uninfected women and adjusted HR 1.29, 95% CI 1.06–1.58 among HIV-infected women) but was not associated with decreased BV recurrence. Safety: No serious adverse events were related to use of intravaginal gels. CONCLUSION: Intermittent microbicide treatment with intravaginal gels is an innovative approach that can reduce the frequency of vaginal infections such as BV

Two strategies for partner notification and partner HIV self-testing reveal no evident predictors of male partner HIV testing in antenatal settings: A secondary analysis

BackgroundTo meet global targets for the elimination of mother-to-child HIV transmission, tailored approaches to HIV testing strategies need prioritizing. Herein, we sought to identify individual-level factors associated with male partner HIV testing.MethodsWe conducted a secondary analysis of data from two parallel randomized trials of pregnant women living with HIV and those HIV-negative in Lusaka, Zambia. Across both trials, control groups received partner notification services only, while intervention groups received partner notification services plus HIV self-test kits for their partners. Associations between baseline factors and male partner testing were estimated using a probability difference. The outcome of interest was uptake of male partner HIV testing of any kind within 30 days of randomization.ResultsThe parent study enrolled 326 participants. Among the 151 women in the control groups, no clear associations were noted between maternal or male partner characteristics and reported uptake of male partner HIV testing. There were positive trends favouring partner testing among women who completed primary school education, had larger households (>2 members), and whose partners were circumcised. Likewise, no clear predictors of male partner testing were identified among the 149 women in the intervention groups. However, negative trends favouring no testing were noted among older, multiparous women from larger households.ConclusionNo consistent predictors for male partner HIV testing across two compared strategies were observed. Our findings suggest that differentiated strategies for male partner HIV testing may not be necessary. Instead, consideration should be given to universal approaches when bringing such services to scale