Knowledge and perceptions of antenatal women towards prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi

A CAJM medical article.Objectives: To determine antenatal attendees’ knowledge and perceptions towards selected aspects of prevention of mother to child transmission of HIV. Setting: Five rural and six urban public health centers in Blantyre District, Malawi. Subjects: 126 consecutive pregnant women attending antenatal clinics. Design: Cross sectional qualitative study utilizing focus group discussions (FGDs). Analysis was based on content analysis. Results: Knowledge about HIV/AIDS especially regarding causative agents of AIDS, transmission and prevention was generally high in all FGDs. One individual though, suggested that HIV was transmitted by mosquito bites and another that HIV was transmitted by being exposed to persistent coughing. The majority of 126 women identified HIV testing of pregnant women as of potential benefit and necessary for the prevention and control of HIV/AIDS. In most cases, the benefit mentioned for HIV testing was that it was good to know about one ’ s HIV status rather than being ignorant. Other suggested benefits of HIV testing of pregnant women were: future family planning, as an incentive to reduce the number of sexual partners and to know the cause of the problem in case a child is failing to thrive rather than blame witchcraft. Male spouses were identified as both potential supporters and limiting agents towards pregnant women’s acceptability of HIV testing. Conclusion: HIV testing among pregnant women to ensure prevention of mother to child transmission of HIV is a complex issue. Women consider various factors before making decisions. Programme planners and implementing agencies need to be aware of these issues and work together with women and other stakeholders in order to overcome such limitations

Specialisation patterns of medical graduates, University of Malawi College of Medicine, Blantyre

A CAJM journal article.Objective: To describe specialization patterns of medical graduates of the University of Malawi College of Medicine. Design: Cross sectional study. Subjects: Medical graduates of the University of Malawi College of Medicine. Setting: University of Malawi College of Medicine. Main Outcome Measures: Specialty choices, sources of funding for training, employer at time of graduate studies and country where specialist training obtained. Results: Between 1991 and 2000,60 (35.5%) of the 169 graduates of the College of Medicine of the University of Malawi have obtained or are in specialist training, 38/60 (63.3%) with training institutions either in the United States or the United Kingdom, 10 (16.7%) had gone to South Africa, 8% Kenya, 5% to the Republic of China (Taiwan) and 3.3% to Uganda. Other countries are; Uganda, Australia and Finland. The preferred specialties were; Public Health 17 (28.8%), Internal Medicine 12 (20%) and Paediatrics 10 (16.7%). Most of the funding was provided by agencies/institutions in the USA and UK. At the time of their training fellowship, 33 (55%) of the candidates were employed by the College of Medicine, 24 (40%) by the public service and the rest, three (5%) by other institutions. Conclusions: Most Malawian medical graduates are obtaining their specialty training overseas funded mostly by institutions/agencies in the UK and USA. There is need to explore ways on how training could be provided regionally. Malawi and her neighbors must develop post graduate specialty training locally and regionally

Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors

This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries

Factors affecting job satisfaction and commitment among medical interns in Malawi: a cross-sectional study

Introduction: The University of Malawi's College of Medicine produces almost all of the medical interns working at Malawi's two largest public hospitals: Queen Elizabeth Central Hospital in Blantyre, and Kamuzu Central Hospital in Lilongwe. To earn full medical council registration, new graduates must complete an 18-month internship at either site. This study attempted to determine general levels of job satisfaction and commitment among Malawian medical interns, and to rank categorical factors according to impact on intern job satisfaction and commitment. These factors were also examined in terms of influence on bringing about an intern strike in late 2010, early 2011. Methods: Sixty-one of 70 interns working during the study period completed a job satisfaction survey. Questionnaire items addressed ten "factors": (1) hours and pay, (2) work content, (3) working conditions, (4) relationships with senior staff, (5) workplace relationships with peers, (6) educational environment, (7) internal factors, (8) quality of life, (9) autonomy and self-worth, and (10) future career prospects. Analysis for this cross-sectional study included quantification and comparisons of overall and category-specific satisfaction levels, using ANOVA and Student's t-test. Results: Sixty-nine percent then 57% of interns identified themselves as satisfied at the beginning and end of the questionnaire, respectively; 97% of the interns indicated job commitment at both instances of asking. Factors influencing job satisfaction most strongly were those that participants were least satisfied with. Conclusion: Future research and interventions aimed at improving intern job satisfaction in Malawi should focus on assessing and improving remuneration, working hours, and physical working conditions

Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population

A CAJM journal article.Objectives: To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity. Design: Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity. Setting: Blantyre Adventist Hospital Outpatient Clinic. Subjects: Non-emergency patients over 18 years old attending during consulting hours. Interventions: All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout. Main Outcome Measures: Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity. Results: 490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one. The sample was highly knowledgeable about HIV. Reading an information sheet had no impact on HIV knowledge (p=0.736 to 0.788) or desire for testing (p=0.387). However, age (OR=0.97,95%CI (0.95,0.99)) and gender (OR=1.85, 95%CI (1.06, 3.23)) significantly correlated with testing propensity. Conclusions: A large percentage of patients who have never been offered HIV testing desire testing. More frequent HIV test offering by clinicians could improve testing rates. Clinician education programmes should be developed to increase test offering. Furthermore, written health information in a setting of high HIV/AIDS knowledge may not change behaviour. Alternative methods should be employed to encourage HIV testing uptake

Study protocol for evaluating the effectiveness of depression management on gylcaemic control in non-communicable diseases clinics in Malawi

Introduction Depression is associated with negative patient outcomes for chronic diseases and likely affects consistent physical non-communicable diseases (NCDs) care management in relation to clinic attendance and medication adherence. We found no published studies on the integration of depression management in physical NCD clinics in Malawi and assessing its effects on patient and service outcomes. Therefore, the aim of this study is to evaluate the effectiveness of integrating depression screening and management in physical NCD routine care on patient and service outcomes in Malawi. We will also determine the sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) in the detection of depression in NCD clinics. Methods and analysis The study will have two phases. Phase I will involve the validation of the PHQ-9 screening tool for depression, using a cross-sectional study design involving 323 participants, in two specialised physical NCD clinics in one of the 28 districts of Malawi. Using a quasi-experimental study design in four districts of Malawi not involved in the phase I study, the phase II study will evaluate the effectiveness of integrating depression screening (using PHQ-9) and management (based on a specially designed toolkit). Outcomes will be measured at 3 months and 6 months among patients with comorbid diabetes (poorly controlled) and depression attending physical NCD clinics in Malawi. Ethics and dissemination Ethical approval was obtained from the University of Malawi, College of Medicine Research and Ethics Committee (COMREC) on 31 August 2017 (reference P.07/17/2218). The findings will be disseminated through presentations at journal clubs, senior management of the Ministry of Health, national and international conferences as well as submission to peer-reviewed publications. Policy briefs will also be created. Trial registration number PACTR201807135104799

Specialisation patterns of medical graduates, University of Malawi College of Medicine, Blantyre

Objective: To describe specialization patterns of medical graduates of the University of Malawi College of Medicine. Design: Cross sectional study. Subjects: Medical graduates of the University of Malawi College of Medicine. Setting: University of Malawi College of Medicine. Main Outcome Measures: Specialty choices, sources of funding for training, employer at time of graduate studies and country where specialist training obtained. Results: Between 1991 and 2000,60 (35.5%) of the 169 graduates of the College of Medicine of the University of Malawi have obtained or are in specialist training, 38/60 (63.3%) with training institutions either in the United States or the United Kingdom, 10 (16.7%) had gone to South Africa, 8% Kenya, 5% to the Republic of China (Taiwan) and 3.3% to Uganda. Other countries are; Uganda, Australia and Finland. The preferred specialties were; Public Health 17 (28.8%), Internal Medicine 12 (20%) and Paediatrics 10 (16.7%). Most of the funding was provided by agencies/institutions in the USA and UK. At the time of their training fellowship, 33 (55%) of the candidates were employed by the College of Medicine, 24 (40%) by the public service and the rest, three (5%) by other institutions. Conclusions: Most Malawian medical graduates are obtaining their specialty training overseas funded mostly by institutions/agencies in the UK and USA. There is need to explore ways on how training could be provided regionally. Malawi and her neighbors must develop post graduate specialty training locally and regionally

Ethics and programmatic issues on the 2003 SARS epidemic: are any lessons transferable to the HIV pandemic?

The HIV/AIDS pandemic continues to spread globally but much more so in the less industrialised countries of southern and eastern Africa. Despite the difference in aetiology and modes of spread of the Severe Acute Respiratory Syndrome (SARS), there are certainly some lessons that policy makers can reflect on regarding the global control of the SARS epidemic in 2003. The response to the SARS outbreak garnering the support of every stakeholder than could be mobilized is an example of how emerging infectious diseases could be dealt with. However, the programmatic and ethics issues, although resulting in an effective response were nonetheless controversial in many ways, as the potentially compromised people's rights and autonomy. These issues require further reflection and an assessment as to whether they could be used in the fight against HIV and AIDS. Presented in this paper, are selected HIV and SARS prevention and control activities that can be assessed for potential effectiveness, ethics rating and programmatic challenges. In this article, the similarities in prevention and control are presented, so will the differences

Prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi

Tobacco smoking is a major risk factor for non-communicable diseases such as ischaemic heart disease, stroke, chronic obstructive airways disease and several cancers. There is little data about the prevalence and determinants of smoking among adolescents in southern Africa. This study aimed to determine the prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi. Cross-sectional data were obtained from school-going adolescents in Blantyre in 2001 using the Global Youth Tobacco Survey data collection instrument. Data were analysed to determine prevalence of current and ever cigarette smoking, and predictors of smoking. The prevalence of current smoking and ever smoking were 3.0% and 15.6%, respectively. Predictors of current tobacco smoking included male gender, having friends or parents who smoked, having been exposed to advertisements about tobacco brands on television and having seen a lot of advertisements in newspapers and magazines. School programmes that included being taught about smoking in class and a class discussion on the dangers of tobacco were not associated with reduced current smoking. Intervention programmes aiming to curb tobacco smoking among adolescents should focus on dealing also with parental smoking, peer influence and pay special attention toward male gender. School-based programmes to prevent smoking should be evaluated as some may have little impact in influencing current smoking status

Perspectives of patients towards medical students at the Queen Elizabeth Central Hospital, Blantyre, Malawi

Medical students gaining experience in outpatient's clinics and admission wards are exposed to clinical clerkship as this is an important part of their training. There is paucity of reported patients' experiences and perceptions of medical students in low-income settings. The present study was conducted at the Queen Elizabeth Central Hospital (QECH), Malawi to describe patients' and perceptions of, and experience with medical students being present when patients are seen by a medical doctor or students' individual clerking. Participants mostly felt that medical students were compassionate, enthusiastic and helpful to them. The participants' who had been ever clerked by students felt motivated to be present for student learning for altruistic reasons as well as for mutual benefit between student and patient. Patients attending the QECH in Blantyre, Malawi are generally satisfied with the attention and support they obtain from students. Balancing the need for appropriate supervision of students, and facilitating the retention of this patient-cantered approach to care should be maintained