Sufficient informed consent to medical treatment of adults legal and ethical perspectives from Malawi

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity

Prevalence and correlates of common mental disorders among children and adolescents in Blantyre-Urban, Malawi

The high global prevalence of mental disorders justifies the need to quantify their burden in the sub-Saharan Africa where there is a dearth of information. These mental disorders are linked to different socio-demographic factors. Objective To determine the prevalence of, and factors associated with mental disorders among children and adolescents in Blantyre City, Malawi. Methods: Children and adolescents aged 6 to 17 years were interviewed to determine their socio-demographic characteristics and assess their mental health status using the Strengths and Difficulties Questionnaire (SDQ) and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Associations between mental disorders and socio-demographic characteristics were tested using Chi-square and logistic regression analysis. Results The prevalence of symptoms of psychopathology on the SDQ was 7.3% (95%CI 4.8-10.5%) while for the K-SADS was 5.9% (95% CI 3.7%-8.9%). The prevalence of mental disorders across the age ranges of 6 to 12 years and 13 to 17 years was 5.4% and 7.9 % respectively. Males had a higher prevalence (7.1%) compared to females (4.7%). Conduct disorder was most prevalent (3.4%), followed by either type of ADHD- Attention Deficit Hyperactive Disorders (2.0%). Having a single parent (p<0.001), staying with a nonbiological guardian (p<0.030), engaging in paid work (p<0.039), not attending school (p<0.019) and having teacher difficulties(p<0.028) were positively associated with a mental disorder. Conclusion The socio-demographic factors associated with the risk of developing mental disorders may be important targets for mental health intervention programs

Quality of life among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: a cross-sectional double-center study

Introduction: Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi. Methods: The study was conducted among 398 cancer patients using semi-structured questionnaire. Quality of life was measured using EQ-5D-3L instrument. Results: Mean age was 45 years ± 12.77. Pain (44%) was the most prevalent problem experienced by cancer patients. About 23% had worst imaginable health status on the subjective visual analogues scale. Attending cancer services at QECH (AOR= 0.29, 95% CI: 0.17-0.54, p<0.001) and having normal weight (AOR=0.25, 95% CI: 0.08-0.74, p = 0.012), were associated with improved quality of life. A history of ever taken alcohol (AOR= 2.36, 95% CI: 1.02-5.44, p = 0.045) and multiple disease comorbidities (AOR= 3.78, 95% CI: 1.08-13.12, p = 0.037) were associated with poor quality of life. Conclusion: Loss of earning, pain, marital strife, sexual dysfunction, were among the common psychosocial challenges experienced. History of ever taken alcohol and multiple comorbidities were associated with poor quality of life. There is need to integrate psychosocial solutions for cancer patients to improve their quality of life and outcomes

Implementing the Family-Led Care model for preterm and low birth weight newborns in Malawi: experience of healthcare workers

Background: Every Preemie­SCALE developed and piloted the Family-Led Care model, an innovative, locally developed model of care for preterm and low birth weight babies receiving kangaroo mother care. Aim: The aim of this study was to describe healthcare workers' experience using Family-Led Care. Setting: This study was conducted in five health facilities and their catchment areas in Balaka district, Malawi. Methods: The mixed-methods design, with two data collection periods, included record reviews, observations and questionnaires for facility staff and qualitative interviews with health workers of these facilities and their catchment areas. The total convenience sample comprised 123 health professionals, support staff and non-professional community health workers. Results: Facility-based staff generally had positive perceptions of Family-Led Care (83%). Knowledge and application-of-knowledge scores were 69% and 52%, respectively. A major change between the first and the second data periods was improvement in client record-keeping. Documentation of newborn vital signs increased from 62% to 92%. Themes emerging from the qualitative interview analysis were the following: benefits of Family-Led Care; activities supporting the implementation of Family-Led Care; own care practices; and families' reaction to and experience of Family-Led Care. Conclusion: This article reports improved quality of care through better documentation and better follow-up of preterm and low birth weight babies receiving kangaroo mother care according to the Family-Led Care model. Overall, health workers were positive about their involvement, and they reported positive reactions from families. Lessons learned have been incorporated into a universal Family-Led Care package that is available for adaptation by other countries

Prevalence, correlates of and perceptions toward cigarette smoking among adolescents in South Korea.

Objective. To estimate the prevalence of current smoking, correlates of smoking and assess exposure to and perceptions towards smoking by gender. Methods. We used data from the South Korea Global Youth Tobacco Survey (GYTS). Frequencies of selected characteristics and their 95% confidence were obtained. Current cigarette smoking was defined as having smoked, even a single puff, within the last 30 days. Logistic regression analysis was conducted to assess the factors that were considered to be associated with current cigarette smoking in bivariate and multivariate analyses. Results. Of the 5615 respondents, 7.4% males and 5.0% females reported being current smokers (p = 0.003). Having smoked friends who was strongly associated with smoking after controlling for age, gender, parental smoking status, exposure to anti-smoking media messages, and perception of risks of smoking (OR=69.92; 95% CI [41.24, 118.57] for most friends and OR=11.86; 95% CI [7.26, 19.36] for some friends). Male gender and having one or both smoking parents were associated with smoking (OR=1.43; 95% CI [1.09, 1.89] and OR=1.29; 95% CI [1.00-, 1.71] respectively). Exposure to antismoking media messages was negatively associated with smoking (OR=0.52; 95% CI [0.36, 0.77]. Conclusion. Prevalence of smoking among adolescents in South Korea is lower than in many other Asian countries. There is however, need to strengthen anti-tobacco messages especially among adolescents.

Association between bullying victimization and physical fighting among Filipino adolescents: results from the Global School-Based Health Survey.

OBJECTIVE: Interpersonal violence is an important, but neglected public health issue in low and middle-income countries. Adolescent physical fighting not only results in injury, disability and death, but is also associated with other potentially harmful behaviors such substance use and premarital sex. The study aims at dose-response association to prevent adolescent problem behaviors. METHODS: We used data from the 2003-2004 Global School-Based Health Survey conducted among school adolescents in the Philippines. We estimated the prevalence of bullying victimization and physical fighting. We also conducted logistic regression analysis to assess the association between a selected list of explanatory variables and physical fighting. We hypothesized that there would be a dose-response relationship between physical fighting and number of times the adolescent reported being bullied in the past 30 days. RESULTS: Of the 7,338 respondents, 35.5% (34.7% males and 36.1% females) were bullied and 50.0% (51.6% males and 48.8% females) reported having been in a physical fight in the past 12 months. There was a dose-response relationship between bullying victimization and physical fighting (p-trend <0.001). Compared to subjects who were not bullied, those who reported being bullied were more likely to engage in physical fighting after controlling for age, gender, substance use (smoking, alcohol drinking or drug use), and parental supervision (OR=2.38; 95% CI [1.99, 2.86] for 1-2 days of bullying victimization per month, OR=3.55; 95% CI [2.61, 4.83]) for 3-5 days/month per month, OR=4.45; 95% CI [2.61, 7.60]) for 6-9 days/ month, OR=1.91; 95% CI [1.17, 3.13]) for 10-30 days/month.) CONCLUSION: The dose-response relationship between physical fighting and the number of times an adolescent had been a victim of bullying deserves further study. If causal relationship exists, preventing bullying, even if not totally eliminated, may have significant results in preventing physical fighting.

Prevalence and correlates of physical fighting among school-going adolescents in Santiago, Chile / Prevalencia e correlaciones de la lucha física entre adolescentes escolares en Santiago de Chile, Chile

OBJECTIVE: There is a growing interest in injury as a public health issue across the world. There is paucity of data on the prevalence and social correlates of non-fatal interpersonal violence in low- and middle-income income nations. The objective of this study was to estimate the prevalence of, and associated factors for physical fighting among school-going adolescents in Santiago, Chile. METHOD: We conducted a secondary analysis of the Chilean Global School-Based Health Survey conducted in 2004 in Santiago. We aimed to assess the prevalence and social correlates of having been involved in a physical fight in the prior 12 months. RESULTS: Of the 2111 respondents, 40.7 percent (54.3 percent males and 26.6 percent females) reported having been in a physical fight in the prior 12 months. Males were more likely to have been in a physical fight than females [OR = 3.89, 95 percent CI (3.11, 4.85)]. Substance use (cigarette smoking, drinking alcohol, and using drugs) and bullying victimization were positively associated with fighting [OR = 3.05, 95 percent CI (2.40, 3.87) for substance use, and OR = 1.65, 95 percent CI (1.32, 2.05) for bullying]. Parental supervision was negatively associated with physical fighting [OR = 0.62, 95 percent CI (0.50, 0.78)]. CONCLUSION: We have estimated the prevalence of having engaged in a physical fight among in-school adolescents in Santiago, Chile. We have found that the prevalence is similar to what has been reported in diverse settings in Africa, Europe and North America.

OBJETIVO: Existe un creciente interés en el daño como un asunto de salud pública a través del mundo. Hay escasez de datos en la prevalencia y correlaciones sociales de violencia interpersonal no fatal, en naciones con bajos y medianos ingresos. El objetivo de este estudio fue estimar la prevalencia y el factor asociado a lucha física entre estudiantes adolescentes en Santiago, Chile. MÉTODO: Hemos conducido un análisis secundario de la Encuesta Global Chilena de Salud Basada en Escuelas, realizada en el 2004 en Santiago. Nuestro objetivo fue determinar la prevalencia y correlaciones sociales de haber estado involucrado en agresión física en los pasados 12 meses. RESULTADOS: De los 2111 respondedores, 40.7 por ciento (54.3 por ciento masculinos y 26.6 por ciento femeninos) reportaron haber estado en una agresión física en los pasados 12 meses. Los varones tuvieron más probabilidad de haber estado en una agresión física que las mujeres [OR = 3.89, 95 por ciento CI (3.11, 4.85)]. El uso de substancias (fumar cigarros, beber alcohol y usar drogas) e intimidaciones violentas estuvieron positivamente asociados con agresión [OR = 3.05, 95 por ciento CI (2.40, 3.87)] La supervisión parental estuvo asociada negativamente con agresión física [OR = 0.62, 95 por ciento CI (0.50, 0.78)]. CONCLUSIÓN: Hemos estimado la prevalencia de haber estado involucrado en una agresión física entre adolescentes escolares en Santiago, Chile. Encontramos que la prevalencia es similar a la que ha sido reportada en diversos lugares en Africa, Europa y Norteamérica.

Prevalence and correlates of environmental tobacco smoke exposure among adolescents in Mongolia.

OBJECTIVE: To estimate the prevalence and identify correlates of environmental tobacco exposure (ETS) among adolescents in Mongolia. METHODS: A cross-sectional study was carried out in 2003 in Mongolia within the framework of the Global Youth Tobacco Survey. Information was obtained on exposure to Environmental tobacco smoke (ETS) in the home and outside home, parental and peer smoking. Demographic characteristics such as age and sex were also obtained. Data were analyzed to obtain frequencies of characteristics. Logistic regression analysis was conducted to assess the association between ETS and relevant predictor variables. RESULTS: 73.9% (71.6%-76.1%) males and 71.7% (69.7%-73.7%) females reported being exposed to ETS either in the home or elsewhere. The odds of exposure were 5.85 (3.83-8.92) if both parents were smokers, 3.65(3.10-4.30) if only father smoked and 6.54 (3.48-12.32) if only mother smoked. Older adolescents were more likely to be exposed to ETS than younger adolescents. Prevalence of exposure to ETS within the home was similar between males and females but males had a higher prevalence of exposure outside of the home than females (50.7% and 42.4% respectively (p < 0.001). Overall proportion of adolescents exposed to ETS in the home was higher than those exposed outside suggesting that domestic exposure was the main form of ETS among adolescents in Mongolia. CONCLUSION: Exposure to environmental tobacco smoke is high among school going adolescents in Mongolia. Public health interventions aimed to reduce morbidity from tobacco among adolescents should also accord particular attention toward environmental tobacco smoke.

Cigarette Smoking Prevalence among School-Going Adolescents in Two African Capital Cities: Kampala Uganda and Lilongwe Malawi

Background: Non communicable diseases are a growing public health concern. Globally tobacco-related deaths surpass malaria deaths and yet developing countries' data are lacking. Objectives:To compare prevalence of tobacco use and exposure to tobacco and tobacco-related issues among adolescents in Kampala; Uganda and Lilongwe; Malawi. Methods: Cross sectional data from the Global Youth Tobacco Survey (GYTS) w used. Data were collected in 2001 in Lilongwe and in 2002 in Uganda using a standardized questionnaire tool.The study was aimed to enrolled schoolchildren aged 13-17 years. Results:The prevalence of tobacco smoking in Kampala and Lilongwe among adolescents was 5.6and 6.2(p 0.05) respectively. However; adolescents in Lilongwe were statistically significantly more likely to have ever smoked; use other tobacco products and perceived themselves as likely to initiate smoking in the coming year. Exposure to tobacco-related advertisements through billboards; newspapers and magazines was high in both settings. Conclu-sions : Adolescents are increasingly being exposed to tobacco and tobacco-related advertisements in Lilongwe; Malawi and Kampala; Uganda.There is need to enhance tobac-co prevention efforts in developing nations

School children's accessibility to insecticide-treated bednets in peri-urban Blantyre; Malawi

Malaria is a major cause of childhood morbidity and mortality in Malawi. Use of insecticide treated bed nets (ITNs) could reduce the burden of malaria. The objective of the study was to determine the general health status, and factors that influence reported access to ITNs among school children in a peri-urban area of Blantyre, Malawi. 454 school children participated in the study of which 253 (55.7%) were males and 201 (44.3%) females. Their mean age and range were 14 years (std. deviation, 1.4 years) and 10-19 years respectively. When asked about general health status questions, 263 (57.9%) reported ever having fallen ill while at school, 41.2% having ever came to school knowing they were unwell, and 40.7% of those that reported having fallen ill at school, categorized their illness as malaria. Regarding illness in the month preceding the study, 41.0% indicated that they had been ill. 40 (8.8%) participants reported that they were not allowed by their religious denominations to use medications when ill. 165 (36.3%) participants reported using bed nets themselves, 159 (35.0%) had a household member (other than parent) using nets and 254 (55.9%) had parent(s) sleeping under an ITN. Having someone in the household who uses an ITN was positively associated with ITN use while age of the participants was inversely associated with ITN access in the home. While more females (37.3%) reported using nets than males (35.6%), the difference was not statistically significant (p=0.7). It was concluded that many of the school children experience ill health in Ndirande, Malawi and malaria is perceived to be a common illness. While younger children seem to have higher access to ITNs, there seems to be no statistically significant gender differences in accessibility

Condom and sexual abstinence talk in the Malawi National Assembly

Background: Correct and consistent use of condoms has been reported as effective in the prevention of transmission of HIV.There have been many studies reporting on attitudes (perceptions) of communities on condoms and other aspects of HIV and AIDS and yet there is paucity of data on the perception towards condoms and abstinence by law makers. Objective:To determine perceptions of Members of Parliament in Malawi towards condoms. Methods: A qualitative study utilising parliamentary Hansards to describe the discussions about condoms and abstinence in the National Assembly 1999-2004. Content and discourse analyses were used. Results: In general; Members of Parliament had negative attitudes towards extra- and/or pre-marital sexual intercourse; condom promotion and use. Sexual abstinence amongst non-married persons was preferred as opposed to condom use. Condom use was not perceived as an effective way of controlling the spread of HIV. Some MPs though called for a change in mind-set so as to allow use of condoms in prisons; in order to prevent transmission of infection from prisoners to the general community once the prisoners were released. Conclusion:This study confirms that health interventions such as condoms are not perceived neutrally and may be construed as the enemy of society