The effect of mother's age, parity and antenatal clinic attendance on infant birth weight

Data from 252 deliveries at a rural hospital during 1988 and 1989 showed that infants born to adolescent mothers had the lowest mean birth weight and highest incidence of low birth weight. Adolescent mothers were, in general, mothers with low parity levels, and the highest incidence of low birth weight was observed in mothers of parity 0 or 1. Average birth weights were higher at parity levels of 4 and 5. Although almost every woman attended the antenatal clinic, women who attended the clinic more than 3 times during pregnancy tended to have higher birth weight infants. More detailed data from 40 of these deliveries suggested that low family socioeconomic status and household food insecurity during pregnancy are also associated with lower birth weight infants

Ward Round - Recurrent anemia and infection in an HIVpositive woman

A 22 year old woman presented to Queen Elizabeth Central Hospital with a three days history of fever, headache and vomiting, with progressive difficulty in swallowin

Early Interferon-γ Production in Human Lymphocyte Subsets in Response to Nontyphoidal Salmonella Demonstrates Inherent Capacity in Innate Cells

Background Nontyphoidal Salmonellae frequently cause life-threatening bacteremia in sub-Saharan Africa. Young children and HIV-infected adults are particularly susceptible. High case-fatality rates and increasing antibiotic resistance require new approaches to the management of this disease. Impaired cellular immunity caused by defects in the T helper 1 pathway lead to intracellular disease with Salmonella that can be countered by IFNγ administration. This report identifies the lymphocyte subsets that produce IFNγ early in Salmonella infection. Methodology Intracellular cytokine staining was used to identify IFNγ production in blood lymphocyte subsets of ten healthy adults with antibodies to Salmonella (as evidence of immunity to Salmonella), in response to stimulation with live and heat-killed preparations of the D23580 invasive African isolate of Salmonella Typhimurium. The absolute number of IFNγ-producing cells in innate, innate-like and adaptive lymphocyte subpopulations was determined. Principal Findings Early IFNγ production was found in the innate/innate-like lymphocyte subsets: γδ-T cells, NK cells and NK-like T cells. Significantly higher percentages of such cells produced IFNγ compared to adaptive αβ-T cells (Student's t test, P<0.001 and ≤0.02 for each innate subset compared, respectively, with CD4+- and CD8+-T cells). The absolute numbers of IFNγ-producing cells showed similar differences. The proportion of IFNγ-producing γδ-T cells, but not other lymphocytes, was significantly higher when stimulated with live compared with heat-killed bacteria (P<0.0001). Conclusion/Significance Our findings indicate an inherent capacity of innate/innate-like lymphocyte subsets to produce IFNγ early in the response to Salmonella infection. This may serve to control intracellular infection and reduce the threat of extracellular spread of disease with bacteremia which becomes life-threatening in the absence of protective antibody. These innate cells may also help mitigate against the effect on IFNγ production of depletion of Salmonella-specific CD4+-T lymphocytes in HIV infection

CHALLENGES OF INCLUSIVE SCHOOLING ON ACADEMIC PERFORMANCE OF STUDENTS WITH VISUAL IMPAIRMENT AT MUNALI BOY’S SECONDARY SCHOOL, ZAMBIA

This manuscript is about challenges of inclusive education on academic performance of students with visual impairment at Munali Boy’s Secondary School. The objectives of the study were to find out the attitude of teachers and sighted students towards the inclusion of students with visual impairment into regular classes. It also sought to examine the academic performance of performance of students with visual impairment in inclusive settings. It further wanted to establish subjects in which students with visual impairment face difficulties. A descriptive survey design was adopted in which 42 participants were purposively selected. The study revealed that, although teachers and sighted students have a fair understanding of inclusive schooling, they give positive attention to students with visual impairment. It also revealed that students with visual impairment face academic challenges at Munali Boys’ which include teachers’ inability to use embossed teaching and learning aids during lesson, lack of individualised attention, mobility challenges, and their pace of teaching does not support the learning of students with visual impairment. The study established that although, inclusive education is fully accepted at Munali Boy’s Secondary School, students with visual impairment are not included in mathematics and sciences related subjects. Article visualizations

Capacity Requirements of Traffic Handling Schemes in Multi-Service Networks

Cataloged from PDF version of article.This paper deals with the impact of traffic handling mechanisms on capacity for different network architectures. Three traffic handling models are considered: per-flow, class-based and best-effort (BE). These models can be used to meet service guarantees, the major differences being in their complexity of implementations and in the quantity of network resources that must be provided. In this study, the performance is fixed and the required capacity determined for various combinations of traffic handling architectures for edge-core networks. This study provides a comparison of different QoS architectures. One key result of this work is that on the basis of capacity requirements, there is no significant difference between semi-aggregate traffic handling and per-flow traffic handling. However, best-effort handling requires significantly more capacity as compared to the other methods. (C) 2004 Elsevier B.V. All rights reserve

Correspondence: Strengthening capacity, collaboration and quality of clinical research in Africa: EDCTP Networks of Excellence

Developing countries bear 90% of the global disease burden, but only access about 10% of globally available health research funding. Weak south–south networking hampers effective use of limited resources,production of critical mass of quality scientists, career opportunities and incentives to retain the few available scientists. The south must urgently act strategically to accelerate generation of talented scientists, createenabling environment and incentives to retain scientists and attract back those in diaspora. The creation of strong networks of excellence for clinical research among southern academic and research institutions is a novelstrategic approach championed by European and Developing Countries Clinical Trials Partnership to achieve the aforementioned goals and mitigate the high disease burden. It will promote strong collaboration, resource sharing and cross-mentorship allowing each partner to grow with complementary capacities that support each other rather than compete negatively. It will enable the south and Africa in particular to participate actively and own the means for solving its own health problems and raise the professional quality and capacity of southern institutions to forge better and equal partnership with northern institutions

Case Report-Right iliac fossa mass in an HIV-positive woman

No Abstrac

Post exposure prophylaxis of HIV transmission after occupational injuries in Queen Elizabeth Central Hospital, Blantyre, Malawi, 2003 – 2008

Health care worker (HCW) in Malawi may acquire HIV infection through occupational injuries, in particular since HIV prevalence among inpatients and incidence of occupational injuries are high. A post exposure prophylaxis (PEP) programme for occupational injuries at QueenElizabeth Central Hospital (QECH) commenced in 2003. We performed an audit of this programme from 2003 through 2008. 203 Occupational injuries were reported. The majority were needle stick injuries (76.3%). Half of the clients were in a training position. A dual ART regimen was most frequently prescribed. Triple therapy use increased over time and wasmore frequent in expatriate students. Many nurses and clinical officers were not fully vaccinated for HBV. Based on previous incidence data, occupational injuries were likely to be underreported. Data on side effects were incomplete, however PEP discontinuation due to side effects occurredonly twice. Follow up visits were poorly attended, therefore the efficacy of PEP could not be evaluated. Prevention efforts for occupational injuries should be increased and specifically target HCWs in training positions.Measures to improve quality of the PEP programme include effective publicity campaigns, compulsory Hepatitis B vaccination and active tracing of HCWs who default follow up after PEP

Loss of Humoral and Cellular Immunity to Invasive Nontyphoidal Salmonella During Current or Convalescent Plasmodium falciparum Infection in Malawian Children.

Invasive nontyphoidal Salmonella (iNTS) infections are commonly associated with Plasmodium falciparum infections, but the immunologic basis for this linkage is poorly understood. We hypothesized that P. falciparum infection compromises the hosts' humoral and cellular immunity to NTS which increases their susceptibility to iNTS infection. We prospectively recruited children aged between 6 and 60 months at a Community Health Centre in Blantyre, Malawi and allocated them to the following groups; febrile with uncomplicated malaria, febrile malaria-negative, non-febrile malaria-negative. S Typhimurium (STm)-specific; serum bactericidal activity (SBA) and blood bactericidal activity (WBBA), complement C3 deposition and neutrophil respiratory burst activity (NRBA) were measured. SBA to STm was reduced in febrile P. falciparum infected (Median -0.201og10, IQR [-1.85, 0.32]) compared to non-febrile malaria-negative (Median -1.42log10, IQR [-2.0, -0.47], p=0.052). In relation to SBA, C3 deposition on STm was significantly reduced in febrile P. falciparum infected (Median 7.5%, IQR [4.1, 15.0]) compared to non-febrile malaria-negative (Median 29%, IQR [11.8, 48.0], p=0.048). WBBA to STm was significantly reduced in febrile P. falciparum infected (Median 0.25log10, IQR [-0.73, 1.13], p=0.0001) compared to non-febrile malaria-negative (Median -1.0log10, IQR [-1.68, -0.16]). In relation to WBBA, STm-specific NRBA was reduced in febrile P. falciparum infected (Median 8.8% IQR [3.7, 20], p=0.0001) compared to non-febrile malaria-negative (Median 40.5% IQR [33, 65.8]). P. falciparum infection impairs humoral and cellular immunity to STm in children during malaria episodes, which may explain the increased risk of iNTS observed in children from malaria endemic settings. The mechanisms underlying humoral immunity impairment are incompletely understood and should be explored further

May measurement month 2018: an analysis of blood pressure screening results from Malawi.

Raised blood pressure (BP) is a growing health care problem in the world leading to over 10 million deaths annually. May Measurement Month (MMM), which aims at raising awareness and screening people for raised BP, is assisting people to know their BP status. In 2018, an opportunistic cross-sectional survey was carried out during May and June in 10 791 volunteers aged 18 years and above following that done in 2017. The screening took place in Lilongwe, Blantyre, Dedza, Kasungu, and Nkhatabay districts mostly in hospitals/clinics, marketplaces, workplaces, and churches/mosques with Kasungu and Nkhatabay in rural areas. After multiple imputation, 2404 (22.3%) had hypertension. Of individuals not receiving antihypertensive treatment, 2101 (20.0%) were found to have raised BP. Only 303 (12.6%) of those with hypertension were receiving antihypertensive treatment, and of these 101 (33.3%) had uncontrolled BP. MMM was the largest BP screening campaign ever undertaken in Malawi. The results identified a large number of individuals with raised BP who were unaware and not on treatment and over one-third of those on treatment were uncontrolled, indicating the need for better management of cases. These results suggest that opportunistic screening can identify significant numbers with raised BP