Falls and other geriatric syndromes in Blantyre, Malawi: A community survey of older adults

Background: The prevalence of geriatric syndromes (falls, immobility,intellectual or memory impairment, and incontinence) is unknown inmany resource-poor countries. With an aging population such knowledgeis essential to develop national policies on the health and social needs ofolder people. The aim of this study was to provide a preliminary surveyto explore the prevalence of falls and other geriatric syndromes and theirassociation with known risk factors in people aged > 60 years in urbanBlantyre, Malawi.Methods: This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on ageassociated syndromes and comorbid problems. The Abbreviated MentalTest (AMT) and Timed Up and Go (TUG) tests were carried out.Results: Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers.Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), selfreportedmemory problems (p=0.004) and AMT score < 7 (p=0.02).Conclusions: Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries

Soil ingestion, nutrition and the seasonality of anthrax in herbivores of Etosha National Park

Abstract. Anthrax, caused by the bacterium Bacillus anthracis, is a seasonally occurring infectious disease affecting primarily herbivorous wildlife and livestock. The seasonality of anthrax outbreaks varies among locations, making it difficult to develop a single consistent ecological description of this disease. Over 44 years of mortality surveillance, most anthrax cases in Etosha National Park, Namibia are observed in the wet season, although elephants have an anthrax mortality peak in the dry season. Focusing on three host species (plains zebra, Equus quagga; African elephant, Loxodonta africana; and springbok, Antidorcas marsupialis) occupying the endemic anthrax area of Etosha National Park, Namibia, we tested two commonly posited causes of anthrax seasonality in herbivores: increased pathogen exposure due to greater soil contact, and increased host susceptibility due to seasonal nutritional stress. These hypotheses were assessed using fecal sampling and measurement of the percentage of fecal silicates as an index of soil ingestion and fecal nitrogen, phosphorus and crude fiber as nutritional indices. Nutritional quality for all three species was higher in wet than dry seasons. Comparing among wet seasons, nutritional indices showed either a decline in nutrition with increasing rainfall or no significant pattern. All three species had greater soil ingestion in the wet season than the dry season. Higher soil contact during the anthrax peak suggests that anthrax seasonality may in part be due to heightened exposure to B. anthracis in wet seasons, for zebra and springbok. Elephant anthrax deaths do not correspond with the season of increased soil ingestion or grazing, suggesting that other behavioral mechanisms may overshadow foraging-based risk factors for this species. Nutritional stress is unlikely the primary causative factor in wet season anthrax systems, although nutritional stress sufficient to reduce resistance is difficult to assess non-invasively in wild herbivores. In contrast, increased soil ingestion may be an important predisposing factor for wet season anthrax outbreaks. Ultimately, the amount of soil ingested and its importance in the transmission of soil-borne pathogens will vary based on foraging behaviors, intake rates, grassland structure and on the likelihood that foraging areas intersect with pathogen aggregations in the environment

The use of focus group discussion methodology: Insights from two decades of application in conservation

This is the final version of the article. Available from Wiley via the DOI in this recordFocus group discussion is frequently used as a qualitative approach to gain an in-depth understanding of social issues. The method aims to obtain data from a purposely selected group of individuals rather than from a statistically representative sample of a broader population. Even though the application of this method in conservation research has been extensive, there are no critical assessment of the application of the technique. In addition, there are no readily available guidelines for conservation researchers. Here, we reviewed the applications of focus group discussion within biodiversity and conservation research between 1996 and April 2017. We begin with a brief explanation of the technique for first-time users. We then discuss in detail the empirical applications of this technique in conservation based on a structured literature review (using Scopus). The screening process resulted in 170 articles, the majority of which (67%, n = 114,) were published between 2011 and 2017. Rarely was the method used as a stand-alone technique. The number of participants per focus group (where reported) ranged from 3 to 21 participants with a median of 10 participants. There were seven (median) focus group meetings per study. Focus group discussion sessions lasted for 90 (median) minutes. Four main themes emerged from the review: understanding of people's perspectives regarding conservation (32%), followed by the assessment of conservation and livelihoods practices (21%), examination of challenges and impacts of resource management interventions (19%) and documenting the value of indigenous knowledge systems (16%). Most of the studies were in Africa (n = 76), followed by Asia (n = 44), and Europe (n = 30). We noted serious gaps in the reporting of the methodological details in the reviewed papers. More than half of the studies (n = 101) did not report the sample size and group size (n = 93), whereas 54 studies did not mention the number of focus group discussion sessions while reporting results. Rarely have the studies provided any information on the rationale for choosing the technique. We have provided guidelines to improve the standard of reporting and future application of the technique for conservation.N.T.O. was funded by Cambridge Overseas Trusts, The Wildlife Conservation Society, Wildlife Conservation Network and WildiZe Foundation. NM was funded by the NERC grant (NE/R006946/1), Fondation Wiener Anspach and the Scriven post doctoral fellowships. K.W. was sup-ported by the Australian Research Council Centre of Excellence for Environmental Decisions (CE11001000104) and Future Fellowship (FT100100413) programs and funded by the Australian Government

Novel arenavirus isolates from Namaqua rock mice, Namibia, Southern Africa

CITATION: Witkowski, P. T. et al. 2015. Novel arenavirus isolates from Namaqua rock mice, Namibia, Southern Africa. Emerging Infectious Diseases, 21(7):1213-1216, doi: 10.3201/eid2107.141341.The original publication is available at http://wwwnc.cdc.gov/eidArenaviruses are feared as agents that cause viral hemorrhagic fevers. We report the identification, isolation, and genetic characterization of 2 novel arenaviruses from Namaqua rock mice in Namibia. These findings extend knowledge of the distribution and diversity of arenaviruses in Africa.http://wwwnc.cdc.gov/eid/article/21/7/14-1341_articlePublishers' versio

Novel Arenavirus Isolates from Namaqua Rock Mice, Namibia, Southern Africa

Arenaviruses are feared as agents that cause viral hemorrhagic fevers. We report the identification, isolation, and genetic characterization of 2 novel arenaviruses from Namaqua rock mice in Namibia. These findings extend knowledge of the distribution and diversity of arenaviruses in Africa

Dynamics of SARS-CoV-2 exposure in Malawian blood donors: a retrospective seroprevalence analysis between January 2020 and February 2021

Background As at end of July 2021, the COVID-19 pandemic has been less severe in sub-Saharan Africa than elsewhere. In Malawi, there have been two subsequent epidemic waves. We therefore aimed to describe the dynamics of SARS-CoV-2 exposure in Malawi. Methods We measured the seroprevalence of anti-SARS-CoV-2 antibodies among randomly selected blood donor sera in Malawi from January 2020 to February 2021. In a subset, we also assesed in vitro neutralisation against the original variant (D614G WT) and the Beta variant. Findings A total of 3586 samples were selected from the blood donor database, of which 2685 (74.9%) were male and 3132 (87.3%) were aged 20-49 years. Of the total, 469 (13.1%) were seropositive. Seropositivity was highest in October 2020 (15.7%) and February 2021 (49.7%) reflecting the two epidemic waves. Unlike the first wave, both urban and rural areas had high seropositivity by February 2021, Balaka (rural, 37.5%), Blantyre (urban, 54.8%), Lilongwe (urban, 54.5%) and Mzuzu (urban, 57.5%). First wave sera showed potent in vitro neutralisation activity against the original variant (78%[7/9]) but not the Beta variant (22% [2/9]). Second wave sera potently neutralised the Beta variant (73% [8/11]). Interpretation The findings confirm extensive SARS-CoV-2 exposure in Malawi over two epidemic waves with likely poor cross-protection to reinfection from the first on the second wave. Since prior exposure augments COVID-19 vaccine immunity, prioritising administration of the first dose in high SARS-CoV-2 exposure settings could maximise the benefit of the limited available vaccines in Malawi and the region. Research in context Evidence before this study We searched PubMed on August 16, 2021, with no language restrictions, for titles and abstracts published between Jan 1, 2020, and August 16, 2021, using the search terms: “SARS-CoV-2 seroprevalence in Africa”[Title/Abstract]) OR “SARS-CoV-2 seroprevalence in blood donors” [Title/Abstract] OR “SARS-CoV-2 seroprevalence in Malawi”, and found 15 records. There are limited SARS-CoV-2 seroprevalence studies in sub Saharan Africa, however the few that are available report high seroprevalence than can be deduced from the respective national reported COVID-19 cases and deaths. Only two published SARS-CoV-2 serosurveys were done on blood donors, from Kenya and Madagascar. Blood donor serosurveys have been recommended by the WHO as an important tool for assessing the spread of SARS-CoV-2 and estimating the burden of COVID-19 pandemic. Added value of this study Unlike previous SARS-CoV-2 blood donor serosurveys in African populations that were conducted for a maximum period of 9 months, our study covers a full year from January 2020 to February 2021, capturing potential introduction of SARS-CoV-2 into Malawi as well as the two epidemic waves. This study provides evidence against the speculation that SARS-CoV-2 had been circulating more widely in sub-Saharan Africa before the first detected cases. It also provides supporting evidence suggesting that the Beta variant was the likely driver of the second wave that resulted in high SARS-CoV-2 seropositivity in January to February 2021 in Malawi. Implications of all the available evidence Our results show extensive community transmission of SARS-CoV-2 in Malawi as reflected in the blood donors serosurvey, with almost half the sample population being seropositive for anti-SARS-CoV-2 antibodies by February 2021. This has implications for COVID-19 vaccination policy in sub-Saharan Africa (SSA), where there are limited available vaccine doses. Considering that prior exposure to SARS-CoV-2 augments COVID-19 vaccine immunity, strategies to maximise administration of the first vaccine dose, while waiting for more vaccines to become available, could maximise the benefits of the limited available vaccines in high SARS-CoV-2 exposure settings in SSA such as Malawi

Consultative meeting that examined alignment and discrepancies between health facility and household survey data in Malawi

Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The frst 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health ofces, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the fndings to programmatic decision-making and strategic plan evaluation were critiqued and discussed

Consultative meeting that examined alignment and discrepancies between health facility and household survey data in Malawi

Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The frst 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health ofces, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the fndings to programmatic decision-making and strategic plan evaluation were critiqued and discussed