Marie Stopes international child spacing clinics in Malawi

No Abstrac

Factors Involved in Selection of a Career in Surgery and Orthopedics for Medical Students in Malawi

AimsThere is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitmentinto Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students’ choice of careers in surgical disciplines.MethodsAn on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format byseveral Malawian Medical Students, and then formal survey testing.ResultsSurgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appearto be a factor in specialty choice (p=0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices.ConclusionsThis is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty

Water quality assessment in Bangwe Township, Blantyre City, Malawi

This study assessed microbial contamination of water in sources (boreholes and open wells) and selected households in four Malawian villages (situated in Bangwe Township, Blantyre city) by analyzing the presence of faecal coliforms using membrane filtration. Additionally, pH, conductivity and temperature of the water sources were also determined. Conductivity ranged from 150.5 to 1575 μS/cm. About 70% of all water sources were above World Health Organization (WHO) and Malawi Bureau of Standards (MBS) limits for conductivity (indicating salty water in the area). Water temperature ranged from 21.5 to 24.7°C and pH from 5.28 to 6.95 with no significant difference (p > 0.05) for these physical parameters among the sampling points. Water pH was within MBS range while 60% of water sources were below WHO range. Faecal coliform levels exceeding WHO and MBS safe standards were observed in 79% of all samples analysed in this study. Mean household faecal coliform levels were as follows (village (mean)); Nalivata (437 CFU/100 mL), Mpingwe 1 (172 CFU/100 mL), Mpingwe (266 CFU/100 mL) and Salvation Army (15 CFU/100 mL). All mean faecal coliform counts were above WHO (0  CFU/100 mL) and MBS (0 CFU/100 mL) safe values. The results suggest that the quality of water in the villages often fails to meet one or more WHO and MBS recommended safe levels as such, poses a potential risk to the health of those individuals living in such villages. Local and National Governments should therefore target the provision of safe water to such populations. The findings of this study also highlight the need for improved dissemination of good hygienic practices amongst such communities.Key words: Boreholes, drinking water, faecal coliforms, health, pollution

Developing the UNICEF Malawi school handwashing program

Diarrhea is one of the major causes of morbidity and mortality among children and immune-compromised individuals in Malawi. Handwashing with soap (HWWS) is one of the most cost-effective health interventions to prevent diarrhea. United Nations Children’s Fund (UNICEF) Malawi has adopted a social marketing approach to achieve large-scale behavioral change for HWWS. The study, commissioned by UNICEF Malawi, was developed by PSI Malawi and Griffith University and conducted by PSI Malawi. Formative research insights using two research studies are presented including observations at 30 primary schools in terms of HWWS behavior. Second, key informant interviews with school administrators and staff members were conducted to understand HWWS motivation, opportunity, and ability factors. This study found less than half of the assessed schools had handwashing facilities. Structural barriers that prevent school children from practicing HWWS were identified including a lack of financial resources to construct permanent handwashing facilities in schools. Many schools also experience a lack of support from the community as citizens are not aware of the benefits of HWWS. Changes to school and community infrastructure are required to facilitate the adoption of the behavior. Supporting activities to encourage school children to practice HWWS and reinforcement strategies to sustain the behavior over time should also be implemented. School children can then become change agents for HWWS by reinforcing the behavior at home thereby contributing to the achievement of the national objectives to reduce diarrhea and leading to improved health and well-being for communities in Malawi

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

Background Noncommunicable diseases, such as surgical conditions have received little attention from public health planners in low income countries (LIC) like Malawi. Though increasingly recognised as a growing global health problem, the burden of surgical pathologies and access to surgical care has not been adequately identified in many LIC. Information on the spectrum and burden of surgical disease in Malawi is important to uncover the unmet need for surgery and for planning of the National Health Service.Methods This was a multistage random cluster sampling national survey. Households were selected from clusters using probability proportional to size method. 1448 households and 2909 interviewees were analysed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used to collect data. This electronic tablet based questionnaire tool included general information and a dual personalised head to toe inquiry on surgical conditions. The general information included number of household members, and inquired on any death within the past twelve months, and if any of the deaths in the family had a suspected surgical condition leading to that death. Data was collected by specially trained third year medical students.Results Out of 1480 selected households, 1448 (98%) agreed to participate, with 2909 interviewed individuals included in the study. The median household size was 6 individuals (range 1 – 47). Median age of interviewed persons was 35 years (range 0.25 – 104 years). 1027 out of 2909 (35%) of the interviewed people reported to be living with a condition requiring surgical consultation or intervention, whereas 146 of 616 (24%) of the total deaths reported to have occurred in the preceding 12 months were reported to have died from a surgically related condition. Most individuals did not seek health care due to lack of funds for transportation to the health facility. Only 3.1% of those that reported a surgical condition had surgical intervention.Conclusions There is a large unmet need for surgical care in Malawi. A third of the population is living with a condition needing surgical consultation or intervention, and a quarter of all deaths are potentially avoidable with surgery. Urgent scale up of surgical services and training are needed to reduce this huge gap in public health planning in the country

Motivation of Community Care Givers in a Peri-urban Area of Blantyre, Malawi

The main objective was to determine motivating factors for community care givers (CCGs), the services they provided to the community, and to identify sources of CCGs\u2019material supplies. A cross sectional qualitative study was done using in-depth key informant interviews with community cares givers and traditional leaders. Analysis was based on themes utilizing content analysis. Most of the CCGs were housewives. Intrinsic motivating factors included feelings of empathy, altruism and religious convictions. Extrinsic motivators were rarely mentioned and these included expected opportunities for loans to start businesses, recognition by the community and eventual employment. The services that CCGs provided in their communities included; offering psycho-spiritual support, providing clothes, food and money to the under-privileged and paying school fees for orphans. In many instances the community care givers were spending from their own personal resources to help the under-privileged, while support from non-governmental organizations could only be sourced erratically. Mobilising resources from the local community through contributions was not seen a viable option. Intrinsic factors are an important motivator for community health volunteer CCGs in the peri-urban area of Blantyre. There is need for community groups to explore the feasibility of tapping from local material and financial resources

Ward Round - Crocodile bites in Malawi: microbiology and surgical management

We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation. Malawi Medical Journal Vol. 21 (1) 2009: pp. 29-3