Human African Trypanosomiasis in three Malawian districts

Human African Trypanosomiasis (HAT) is a neglected tropical disease (NTD). Surveillance in many of the endemic areas is often inadequate. Up to date information on the HAT situation in Malawi, where the disease is endemic in some districts, provides opportunity to raise the profile of the disease and interest in prevention and control. A retrospective study was conducted in three Malawian districts: Nkhotakota, Rumphi and Kasungu to describe the prevalence of HAT. Hospital laboratory registers from January 2000 to December 2006 were used. The calculated annual district prevalence of Trypanonosomiasis ranged from 0.29 cases per 100,000 population in 2000, to 0.58 cases per 100,000 population in 2003. Nkhotakota District had the highest case detection rate of trypanonosomiasis of 16.56 cases per 100,000 in 2002 and the lowest rate in 2004 of 5.23 cases per 100,000. From 2004 onwards a decline in cases detected was observed. In Rumphi district the highest number of cases (17.67 cases per 100,000 population) were identified in 2003 and the lowest rate of 1.29 cases per 100,000 in 2001. The rate (17.67 cases per 100,000) found in 2003 represented a 5-fold increase of 2002 (3.02 cases per 100,000). In Kasungu the detection rate ranged from 0 per 100,000 in 2001, 2003 and 2004 to 0.99 cases per 100,000 in 2005. The number of cases in this district has remained low including in 2006, when a detection rate of 0.16 cases per 100,000 was observed.  HAT is endemic in selected districts of Malawi. There is need to explore the feasibility of active disease surveillance and the establishment of permanent preventive and control measures

Providing insecticide treated bed nets in antiretroviral treatment clinics in Malawi: a pilot study

HIV infection and malaria, two of the most common and important health problems in sub-Saharan Africa, have been demonstrated to have interactive pathology. In Malawi, where malaria is endemic, and antiretroviral therapy (ART) delivery is scaling up, we piloted integration of long-lasting insecticide-treated bednets (ITN) provision in three ART clinics. In July 2006, 1,910 ITNs were delivered to pilot sites, and ART clinic staff personnel were briefed on ITN provision and use of a monitoring system. Sites were assessed using a structured questionnaire in December 2006. During the pilot period, 1,282 ITNs were distributed to patients. A large proportion (70%) of ART patients at these sites received pilot study ITNs. Site adherence to the monitoring system was variable. Seventeen patients were interviewed, 14 of whom were ART patients who had received ITNs; 11 of these (79%) had slept under the net the previous night. This pilot demonstrates the feasibility of ITN distribution to patients attending ART clinics in Malawi. Programmatic and policy considerations for national roll-out include the need to: 1) adopt a standardized monitoring system, 2) develop information, education, and communication materials, 3) develop in-service training for ART clinicians, and 4) identify systems for forecasting, procuring and distributing ITNs. Malawi Medical Journal Vol. 19 (3) 2007: pp. 111-11

Oral cholera vaccine in cholera prevention and control, Malawi

Problem With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed. Approach In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and international organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use. Local setting Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s. Relevant changes The government’s application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017–2018. Lessons learnt Augmenting advanced mapping techniques with local information helped us extend priority areas beyond those identified as high-risk based on cholera incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission

Geographical disparities in core population coverage indicators for roll back malaria in Malawi

BACKGROUND: Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes. METHODS: Data for the following responses from the 2000 Malawi Demographic and Health Survey (DHS) were aggregated at subdistrict level: (1) households possessing at least one bednet; (2) children under 5 years who slept under a bednet the night before the survey; (3) bednets retreated with insecticide within past 6-12 months preceding the survey; (4) children under 5 who had fever two weeks before the survey and received treatment within 24 hours from the onset of fever; and (5) women who received intermittent preventive treatment of malaria during their last pregnancy. Each response was geographically smoothed at subdistrict level by applying conditional autoregressive models using Markov Chain Monte Carlo simulation techniques. RESULTS: The underlying geographical patterns of coverage of indicators were more clear in the smoothed maps than in the original unsmoothed maps, with relatively high coverage in urban areas than in rural areas for all indicators. The percentage of households possessing at least one bednet was 19% (95% credible interval (CI): 16-21%), with 9% (95% CI: 7-11%) of children sleeping under a net, while 18% (95% CI: 16-19%) of households had retreated their nets within past 12 months prior to the survey. The northern region and lakeshore areas had high bednet coverage, but low usage and re-treatment rates. Coverage rate of children who received antimalarial treatment within 24 hours after onset of fever was consistently low for most parts of the country, with mean coverage of 4.8% (95% CI: 4.5-5.0%). About 48% (95% CI: 47-50%) of women received antimalarial prophylaxis during their pregnancy, with highest rates in the southern and northern areas. CONCLUSION: The striking geographical patterns, for example between predominantly urban and rural areas, may reflect spatial differences in provider compliance or coverage, and can partly be explained by socio-economic and cultural differences. The wide gap between high bed net coverage and low retreatment rates may reflect variation in perceptions about malaria, which may be addressed by implementing information, education and communication campaigns or introducing long lasting insecticide nets. Our results demonstrate that DHS data, with appropriate methodology, can provide acceptable estimates at sub-national level for monitoring and evaluation of malaria control goals

A retrospective study of Human African Trypanosomiasis in three Malawian districts

Human African Trypanosomiasis (HAT) is a neglected tropical disease (NTD). Surveillance in many of the endemic areas is often inadequate. Up to date information on the HAT situation in Malawi, where the disease is endemic in some districts, provides opportunity to raise the profile of the disease and interest in prevention and control. A retrospective study was conducted in three Malawian districts: Nkhotakota, Rumphi and Kasungu to describe the prevalence of HAT. Hospital laboratory registers from January 2000 to December 2006 were used. The calculated annual district prevalence of Trypanosomiasis ranged from 0.29 cases per 100,000 population in 2000, to 0.58 cases per 100,000 population in 2003. Nkhotakota District had the highest case detection rate of trypanosomiasis of 16.56 cases per 100,000 in 2002 and the lowest rate in 2004 of 5.23 cases per 100,000. From 2004 onwards a decline in cases detected was observed. In Rumphi district the highest number of cases (17.67 cases per 100,000 population) was identified in 2003 and the lowest rate of 1.29 cases per 100,000 in 2001. The rate (17.67 cases per 100,000) found in 2003 represented a 5-fold increase of 2002 (3.02 cases per 100,000). In Kasungu the detection rate ranged from 0 per 100,000 in 2001, 2003 and 2004 to 0.99 cases per 100,000 in 2005. The number of cases in this district has remained low including in 2006, when a detection rate of 0.16 cases per 100,000 was observed. HAT is endemic in selected districts of Malawi. There is need to explore the feasibility of active disease surveillance and the establishment of permanent preventive and control measures

Providing insecticide treated bed nets in antiretroviral treatment clinics in Malawi: a pilot study

HIV infection and malaria, two of the most common and important health problems in sub-Saharan Africa, have been demonstrated to have interactive pathology. In Malawi, where malaria is endemic, and antiretroviral therapy (ART) delivery is scaling up, we piloted integration of long-lasting insecticide-treated bednets (ITN) provision in three ART clinics. In July 2006, 1,910 ITNs were delivered to pilot sites, and ART clinic staff personnel were briefed on ITN provision and use of a monitoring system. Sites were assessed using a structured questionnaire in December 2006. During the pilot period, 1,282 ITNs were distributed to patients. A large proportion (70%) of ART patients at these sites received pilot study ITNs. Site adherence to the monitoring system was variable. Seventeen patients were interviewed, 14 of whom were ART patients who had received ITNs; 11 of these (79%) had slept under the net the previous night. This pilot demonstrates the feasibility of ITN distribution to patients attending ART clinics in Malawi. Programmatic and policy considerations for national roll-out include the need to: 1) adopt a standardized monitoring system, 2) develop information, education, and communication materials, 3) develop in-service training for ART clinicians, and 4) identify systems for forecasting, procuring and distributing ITNs

Predictors of uptake and timeliness of newly introduced pneumococcal and rotavirus vaccines, and of measles vaccine in rural malawi: a population cohort study.

Background Malawi introduced pneumococcal conjugate vaccine (PCV13) and monovalent rotavirus vaccine (RV1) in 2011 and 2012 respectively, and is planning the introduction of a second-dose measles vaccine (MV). We assessed predictors of availability, uptake and timeliness of these vaccines in a rural Malawian setting. Methods Commencing on the first date of PCV13 eligibility we conducted a prospective population-based birth cohort study of 2,616 children under demographic surveillance in Karonga District, northern Malawi who were eligible for PCV13, or from the date of RV1 introduction both PCV13 and RV1. Potential predictors of vaccine uptake and timeliness for PCV13, RV1 and MV were analysed respectively using robust Poisson and Cox regression. Results Vaccine coverage was high for all vaccines, ranging from 86.9% for RV1 dose 2 to 95.4% for PCV13 dose 1. Median time delay for PCV13 dose 1 was 17 days (IQR 7–36), 19 days (IQR 8–36) for RV1 dose 1 and 20 days (IQR 3–46) for MV. Infants born to lower educated or farming mothers and those living further away from the road or clinic were at greater risk of being not fully vaccinated and being vaccinated late. Delays in vaccination were also associated with non-facility birth. Vaccine stock-outs resulted in both a delay in vaccine timeliness and in a decrease in completion of schedule. Conclusion Despite high vaccination coverage in this setting, delays in vaccination were common. We identified programmatic and socio-demographic risk factors for uptake and timeliness of vaccination. Understanding who remains most vulnerable to be unvaccinated allows for focussed delivery thereby increasing population coverage and maximising the equitable benefits of universal vaccination programmes

Univariable and multivariable analysis of predictors of pneumococcal vaccine uptake in the catch-up campaign cohort.

<p>Univariable and multivariable analysis of predictors of pneumococcal vaccine uptake in the catch-up campaign cohort.</p

Summary of multivariate analyses on predictors of vaccine non-receipt.

<p>Summary of multivariate analyses on predictors of vaccine non-receipt.</p

Flowchart of eligible children included in vaccination coverage and timeliness analyses.

<p>* There were 35 children for whom written documentation was available for MV but missing for PCV13/RV1.</p