Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 31
Filter
1.
BMC Public Health ; 22(1): 1430, 2022 07 27.
Article in English | MEDLINE | ID: covidwho-1962804

ABSTRACT

INTRODUCTION: Majority of Malawians have not yet adopted COVID-19 mitigation measures despite having knowledge about its infectivity, morbidity, and fatality. Understanding drivers of hesitancy to adoption of COVID-19 mitigation measures is critical as it can inform prevention programs. This study explores Malawians' COVID-19 risk perception, and the associated constraints in the adoption of mitigation efforts. A Health Belief Model (HBM) approach was used to understand perceived factors that undermine public health COVID-19 messages to reduce the spread of the pandemic in Malawi. METHODS: The study applied rapid appraisal and photovoice qualitative inquiry to comprehend risk perception regarding COVID-19. We purposively selected 52 participants from three major cities in Malawi. Audio and video interviews were transcribed verbatim, and transcripts were coded manually to derive key themes and concepts. RESULTS: The study identified that social factors particularly religious and political beliefs influenced COVID-19 risk perception. Specific religious beliefs pertaining to individuals recognizing signs of the 'Christian apocalypse' were particularly associated with lower risk perceptions. Politically, participants believed COVID-19 lockdown measures were a ploy by the then-ruling party to remain in power. CONCLUSION: The study suggests that religious beliefs and political environment undermine self -perceived risk of contracting COVID-19 among urban dwellers in Malawi. We recommend that diverse actors in Malawi should collaborate to promote the dissemination of accurate COVID-19 discourses and reduce the severity of the pandemic's impact in Malawi.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Humans , Malawi/epidemiology , Perception , Politics , Religion , Urban Population
2.
PLoS One ; 17(5): e0268749, 2022.
Article in English | MEDLINE | ID: covidwho-1933289

ABSTRACT

Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015-19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015-19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98-11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.


Subject(s)
Mycobacterium tuberculosis , Tuberculosis , Adult , Bayes Theorem , Humans , Malawi/epidemiology , Mass Screening/methods , Prevalence , Sputum/microbiology , Tuberculosis/complications , Tuberculosis/diagnosis , Tuberculosis/epidemiology
3.
BMC Public Health ; 22(1): 1072, 2022 05 31.
Article in English | MEDLINE | ID: covidwho-1933111

ABSTRACT

BACKGROUND: Food security, malnutrition, and poverty are some of the challenges that most of the sub-Saharan African countries have been historically facing. With the coming of Covid-19 pandemic, the sustainability of the Village Savings and Loans Association which are formed to counter fight these challenges is questioned. AIM: This study aimed to assess factors associated with the Sustainability of VSLAs amidst Covid-19 and its impacts on households' income levels. METHODS: An online cross-sectional design was conducted from November to January 2021, targeting VSLAs members in Mzuzu. A snowball and respondent-driven sampling technique were used to recruit the needful participants using a referral approach. IBM SPSS version 23 was used to perform descriptive statistics, Chi-Square, and binary logistic regression with unstandardized Beta (ß), Odds Ratios (OR), and 95% Confidence Interval (CI) being taken into account with P-value set at 0.1, 0.05 and 0.01 significance levels. RESULTS: Our study finds that household income declined by 54% for those earnings belonged to ˂ MK5,000, as compared to 38% and 15% for medium (MK5,000 ≥ MK10,000) and higher (> MK10,000) income bands respectively. Our study shows that gender (ß = 0.437, p = 0.094), age-group (ß = 1.317, p = 0.000), education (ß = 2.181, p = 0.047), share contributions (ß = 1.035, p = 0.008), meetings (ß = 0.572, p = 0.021), occupation (ß = -0.453, p = 0.106), and frequency of meeting (ß = -0.507, p = 0.049) were positively and negatively statistically significant predictors. CONCLUSION: According to the findings of this study, households with lower income earners, which is one of the indicators of poverty, are more affected by the pandemic than their counterparts. We urge that the Malawi governments should maintain and, if they haven't already, implement programs that support low-income households, such as transfer payments, which have been shown to uplift people out of income poverty in many developing countries.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Income , Malawi/epidemiology , Pandemics
4.
BMJ Open ; 12(6): e048955, 2022 06 21.
Article in English | MEDLINE | ID: covidwho-1901987

ABSTRACT

OBJECTIVES: To examine indirect impacts of the COVID-19 pandemic on neonatal care in low-income and middle-income countries. DESIGN: Interrupted time series analysis. SETTING: Two tertiary neonatal units in Harare, Zimbabwe and Lilongwe, Malawi. PARTICIPANTS: We included a total of 6800 neonates who were admitted to either neonatal unit from 1 June 2019 to 25 September 2020 (Zimbabwe: 3450; Malawi: 3350). We applied no specific exclusion criteria. INTERVENTIONS: The first cases of COVID-19 in each country (Zimbabwe: 20 March 2020; Malawi: 3 April 2020). PRIMARY OUTCOME MEASURES: Changes in the number of admissions, gestational age and birth weight, source of admission referrals, prevalence of neonatal encephalopathy, and overall mortality before and after the first cases of COVID-19. RESULTS: Admission numbers in Zimbabwe did not initially change after the first case of COVID-19 but fell by 48% during a nurses' strike (relative risk (RR) 0.52, 95% CI 0.41 to 0.66, p<0.001). In Malawi, admissions dropped by 42% soon after the first case of COVID-19 (RR 0.58, 95% CI 0.48 to 0.70, p<0.001). In Malawi, gestational age and birth weight decreased slightly by around 1 week (beta -1.4, 95% CI -1.62 to -0.65, p<0.001) and 300 g (beta -299.9, 95% CI -412.3 to -187.5, p<0.001) and outside referrals dropped by 28% (RR 0.72, 95% CI 0.61 to 0.85, p<0.001). No changes in these outcomes were found in Zimbabwe and no significant changes in the prevalence of neonatal encephalopathy or mortality were found at either site (p>0.05). CONCLUSIONS: The indirect impacts of COVID-19 are context-specific. While our study provides vital evidence to inform health providers and policy-makers, national data are required to ascertain the true impacts of the pandemic on newborn health.


Subject(s)
COVID-19 , Infant Health , Pandemics , COVID-19/epidemiology , Hospital Units , Humans , Infant Health/statistics & numerical data , Infant, Newborn , Interrupted Time Series Analysis , Malawi/epidemiology , Tertiary Care Centers , Zimbabwe/epidemiology
5.
BMJ Open ; 12(6): e051125, 2022 06 10.
Article in English | MEDLINE | ID: covidwho-1886763

ABSTRACT

OBJECTIVE: Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers. SETTING: Primary and maternal healthcare in Blantyre District, Malawi. PARTICIPANTS: We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021. RESULTS: Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19. CONCLUSION: Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care , Health Personnel/psychology , Humans , Malawi/epidemiology , Pandemics/prevention & control
6.
BMC Health Serv Res ; 22(1): 613, 2022 May 07.
Article in English | MEDLINE | ID: covidwho-1822190

ABSTRACT

Sepsis causes 20% of global deaths, particularly among children and vulnerable populations living in developing countries. This study investigated how sepsis is prioritised in Malawi's health system to inform health policy. In this mixed-methods study, twenty multisectoral stakeholders were qualitatively interviewed and asked to quantitatively rate the likelihood of sepsis-related medium-term policy outcomes being realised. Respondents indicated that sepsis is not prioritised in Malawi due to a lack of local sepsis-related evidence and policies. However, they highlighted strong linkages between sepsis and maternal health, antimicrobial resistance and COVID-19, which are already existing national priorities, and offers opportunities for sepsis researchers as policy entrepreneurs. To address the burden of sepsis, we recommend that funding should be channelled to the generation of local evidence, evidence uptake, procurement of resources and treatment of sepsis cases, development of appropriate indicators for sepsis, adherence to infection prevention and control measures, and antimicrobial stewardship.


Subject(s)
COVID-19 , Sepsis , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , Child , Drug Resistance, Bacterial , Female , Global Health , Humans , Malawi/epidemiology , Sepsis/drug therapy , Sepsis/epidemiology
7.
PLoS One ; 17(3): e0265530, 2022.
Article in English | MEDLINE | ID: covidwho-1765535

ABSTRACT

PURPOSE: There is limited knowledge on how to tackle mental health problems among youth in Africa. Literature describing community engagement (CE) approaches in low/middle-income countries (LMICs) health research is sparse. CE with youth from LMICS can help steer and shape culturally relevant interventions for stigmatised topics like mental health, resulting in better healthcare experiences. We share our experience of engaging youth in Malawi through advocacy organisations to inform cultural adaptation of a mental health literacy intervention. METHODS: Young people were recruited using social media from universities and community youth organisations in Malawi to participate in focus group discussions to help culturally adapt content of an existing mental health literacy intervention. Nine online focus groups with 44 individuals were conducted. Discussions involved views and experiences of mental health, including impact of the coronavirus pandemic. Discussions were recorded, transcribed verbatim and analysed using content analysis. RESULTS: Transcript analyses revealed a vicious cycle of poverty and mental health problems for youth in Malawi. Four key themes were identified, 1) poverty-related socioeconomic and health challenges, 2) no one talks about mental health, 3) lacking mental health support and 4) relationship issues. These themes fed into one another within this vicious cycle which perpetually and negatively impacted their lives. The coronavirus pandemic worsened socioeconomic issues, health challenges, mental health and substance use issues, and burden on Malawi's already weak mental health system. CONCLUSION: Findings suggest increasing untreated mental health burden among Malawi's youth. It highlights great need to address mental health literacy using existing community structures like educational settings to minimise burden on a weak health system. Online focus groups are an effective way of acquiring views from various young people in Malawi on mental health. This CE approach has grown our stakeholder network, strengthening potential for future CE activities and broader research dissemination.


Subject(s)
Health Literacy , Mental Health , Adolescent , Focus Groups , Humans , Malawi/epidemiology , Poverty
8.
Bull World Health Organ ; 100(2): 115-126C, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1760156

ABSTRACT

OBJECTIVE: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. METHODS: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. FINDINGS: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. CONCLUSION: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.


Subject(s)
COVID-19 , Child , Haiti/epidemiology , Humans , Immunization , Immunization Programs , Infant , Lesotho/epidemiology , Liberia/epidemiology , Malawi/epidemiology , Pandemics , SARS-CoV-2 , Vaccination
9.
Glob Health Action ; 15(1): 2029335, 2022 12 31.
Article in English | MEDLINE | ID: covidwho-1758547

ABSTRACT

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic's disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women's health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population. Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries - Kenya, Malawi, and Zimbabwe - provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.


Subject(s)
COVID-19 , HIV Infections , Adolescent , Female , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Kenya/epidemiology , Malawi/epidemiology , Zimbabwe/epidemiology
10.
BMC Public Health ; 22(1): 522, 2022 03 17.
Article in English | MEDLINE | ID: covidwho-1745466

ABSTRACT

BACKGROUND: Malawi is at the brink of experiencing food insecurity amidst the COVID-19 pandemic as the vast majority of its population lives in extreme poverty. While measures are being implemented to avert the spread of COVID-19, little is known about how COVID-19 policy measures have impacted food insecurity in urban Malawi. This study addresses this gap by exploring the implications of COVID-19 policy measures on food insecurity in low-income areas of Blantyre in Malawi. METHODS: We used Bronfenbrenner's ecological theory to explore the implications of COVID-19 policy measures on peoples' access to food. In-depth interviews were conducted with fifteen participants comprising of private school teachers, street vendors, sex workers, and minibus drivers. Data were analyzed using thematic analysis in which emerging patterns and themes from the transcripts were identified. RESULTS: The COVID-19 lockdown measures undermined participants' ability to maintain livelihoods. These measures have increased the vulnerability of the residents to food insecurity, forcing them to face severe challenges to accessing adequate food to support their families as a result of low incomes, job loss, and business disruptions. CONCLUSION: Our study underscores the need for the Malawi government to seriously consider the provision of basic necessities such as food to the urban poor. We also suggest that the Malawi government should continue and expand the social cash transfer or relief funding packages by targeting the most vulnerable groups in the city. There is also a need for the government to engage all stakeholders and work collaboratively with people at local level in policymaking decisions in times of crisis.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Food Insecurity , Food Supply , Humans , Malawi/epidemiology , Pandemics/prevention & control , Policy , Urban Population
11.
PLoS One ; 17(2): e0262741, 2022.
Article in English | MEDLINE | ID: covidwho-1705190

ABSTRACT

The ongoing Covid-19 pandemic has generated an immense amount of potentially infectious waste, primarily face masks, which require rapid and sanitary disposal in order to mitigate the spread of the disease. Yet, within Africa, large segments of the population lack access to reliable municipal solid waste management (SWM) services, both complicating the disposal of hazardous waste, and public health efforts. Drawing on extensive qualitative fieldwork, including 96 semi-structured interviews, across four different low-income communities in Blantyre, Malawi and Durban, South Africa, the purpose of this article is to respond to a qualitative gap on mask disposal behaviours, particularly from within low-income and African contexts. Specifically, our purpose was to understand what behaviours have arisen over the past year, across the two disparate national contexts, and how they have been influenced by individual risk perceptions, established traditional practice, state communication, and other media sources. Findings suggest that the wearing of cloth masks simplifies disposal, as cloth masks can (with washing) be reused continuously. However, in communities where disposable masks are more prevalent, primarily within Blantyre, the pit latrine had been adopted as the most common space for 'safe' disposal for a used mask. We argue that this is not a new behaviour, however, and that the pit latrine was already an essential part of many low-income households SWM systems, and that within the Global South, the pit latrine fulfils a valuable and uncounted solid waste management function, in addition to its sanitation role.


Subject(s)
COVID-19/epidemiology , Masks , Medical Waste , Pandemics , Public Health , SARS-CoV-2 , Sanitation , Humans , Malawi/epidemiology , Poverty , South Africa/epidemiology
13.
PLoS Med ; 18(12): e1003552, 2021 12.
Article in English | MEDLINE | ID: covidwho-1627468

ABSTRACT

BACKGROUND: Interpersonal violence has physical, emotional, educational, social, and economic implications. Although there is interest in empowering young people to challenge harmful norms, there is scant research on how individual agency, and, specifically, the "power to" resist or bring about an outcome relates to peer violence perpetration and victimization in early adolescence. This manuscript explores the relationship between individual agency and peer violence perpetration and victimization among very young adolescents (VYAs) living in two urban poor settings in sub-Saharan Africa (Kinshasa, Democratic Republic of Congo (DRC) and Blantyre, Malawi). METHODS AND FINDINGS: The study draws on two cross-sectional surveys including 2,540 adolescents 10 to 14 years from Kinshasa in 2017 (girls = 49.8% and boys = 50.2%) and 1,213 from Blantyre in 2020 (girls = 50.7% and boys = 49.3%). The sample was school based in Malawi but included in-school and out-of-school participants in Kinshasa due to higher levels of early school dropout. Peer violence in the last 6 months (dependent variable) was defined as a four categorical variable: (1) no victimization or perpetration; (2) victimization only; (3) perpetration only; and (4) both victimization and perpetration. Agency was operationalized using 3 scales: freedom of movement, voice, and decision-making, which were further divided into tertiles. Univariate analysis and multivariable multinomial logistic regressions were conducted to evaluate the relationships between each agency indicator and peer violence. The multivariable regression adjusted for individual, family, peer, and community level covariates. All analyses were stratified by gender and site. In both sites, adolescents had greater voice and decision-making power than freedom of movement, and boys had greater freedom of movement than girls. Boys in both settings were more likely to report peer violence in the last six months than girls (40% to 50% versus 32% to 40%, p < 0.001), mostly due to higher rates of a perpetration-victimization overlap (18% to 23% versus 10% to 15%, p < 0.001). Adolescents reporting the greatest freedom of movement (Tertile 3) (with the exception of girls in Kinshasa) had a greater relative risk ratio (RRR) of reporting a perpetrator-victim overlap (boys Kinshasa: RRR = 1.9 (1.2 to 2.8, p = 0.003); boys Blantyre: RRR = 3.8 (1.7 to 8.3, p = 0.001); and girls Blantyre: RRR = 2.4 (1.1 to 5.1, p = 0.03)). Adolescents with the highest decision-making power in Kinshasa also had greater RRR of reporting a perpetrator-victim overlap (boys: RRR = 3.0 (1.8 to 4.8, p < 0.001). Additionally, girls and boys in Kinshasa with intermediate decision-making power (tertile 2 versus 1) had a lower RRR of being victimized (Girls: RRR = 1.7 (1.02 to 2.7, p = 0.04); Boys: RRR = 0.6 (0.4 to 0.9, p = 0.01)). Higher voice among boys in Kinshasa (Tertile 2: RRR = 1.9 (1.2 to 2.9, p = 0.003) and Tertile 3: 1.8 (1.2 to 2.8, p = 0.009)) and girls in Blantyre (Tertile 2: 2.0 (1.01 to 3.9, p = 0.048)) was associated with a perpetrator-victim overlap, and girls with more voice in Blantyre had a greater RRR of being victimized (Tertile 2: RRR = 1.9 (1.1 to 3.1, p = 0.02)). Generally, associations were stronger for boys than girls, and associations often differed when victimization and perpetration occurred in isolation of each other. A main limitation of this study is that the cross-sectional nature of the data does not allow a causal interpretation of the findings, which need further longitudinal exploration to establish temporality. CONCLUSIONS: In this study, we observed that peer violence is a gendered experience that is related to young people's agency. This stresses the importance of addressing interpersonal violence in empowerment programs and of including boys who experience the greatest perpetration-victimization overlap.


Subject(s)
Crime Victims/statistics & numerical data , Peer Influence , Violence/statistics & numerical data , Adolescent , Child , Crime Victims/classification , Crime Victims/psychology , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Female , Humans , Incidence , Malawi/epidemiology , Male , Violence/classification , Violence/psychology
14.
Int J Infect Dis ; 116: 157-165, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1587625

ABSTRACT

BACKGROUND: COVID-19 transmission and disease dynamics in sub-Saharan Africa are not well understood. Our study aims to provide insight into COVID-19 epidemiology in Malawi by estimating SARS-CoV-2 prevalence and immunity after SARS-CoV-2 infection in a hospital-based setting. METHODS: We conducted a hospital-based, convenience sampling, cross-sectional survey for SARS-CoV-2 in Lilongwe, Malawi. Participants answered a questionnaire and were tested for SARS-CoV-2 by enzyme-linked immunosorbent assay and real-time reverse-transcription polymerase chain reaction (RT-PCR). A surrogate virus neutralization test (sVNT) was performed in seropositive samples to estimate immunity. Poisson regression was used to assess SARS-CoV-2 point prevalence association with demographic and behavioral variables. FINDINGS: The study included 930 participants. We found a combined point prevalence of 10.1%. Separately analyzed, RT-PCR positivity was 2.0%, and seropositivity was 9.3%. Of tested seropositive samples, 90.1% were sVNT positive. We found a high rate (45.7%) of asymptomatic SARS-CoV-2 infection. SARS-CoV-2 point prevalence was significantly associated with being a healthcare worker. INTERPRETATION: Our study suggests that official data underestimate COVID-19 transmission. Using sVNTs to estimate immunity in Malawi is feasible and revealed considerable post-infection immunity in our cohort. Subclinical infection and transmission are probably a game-changer in surveillance, mitigation and vaccination strategies.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Cross-Sectional Studies , Hospitals , Humans , Malawi/epidemiology , Prevalence
15.
Lancet Infect Dis ; 21(11): 1590-1597, 2021 11.
Article in English | MEDLINE | ID: covidwho-1561435

ABSTRACT

BACKGROUND: Trials of BCG vaccination to prevent or reduce severity of COVID-19 are taking place in adults, some of whom have been previously vaccinated, but evidence of the beneficial, non-specific effects of BCG come largely from data on mortality in infants and young children, and from in-vitro and animal studies, after a first BCG vaccination. We assess all-cause mortality following a large BCG revaccination trial in Malawi. METHODS: The Karonga Prevention trial was a population-based, double-blind, randomised controlled in Karonga District, northern Malawi, that enrolled participants between January, 1986, and November, 1989. The trial compared BCG (Glaxo-strain) revaccination versus placebo to prevent tuberculosis and leprosy. 46 889 individuals aged 3 months to 75 years were randomly assigned to receive BCG revaccination (n=23 528) or placebo (n=23 361). Here we report mortality since vaccination as recorded during active follow-up in northern areas of the district in 1991-94, and in a demographic surveillance follow-up in the southern area in 2002-18. 7389 individuals who received BCG (n=3746) or placebo (n=3643) lived in the northern follow-up areas, and 5616 individuals who received BCG (n=2798) or placebo (n=2818) lived in the southern area. Year of death or leaving the area were recorded for those not found. We used survival analysis to estimate all-cause mortality. FINDINGS: Follow-up information was available for 3709 (99·0%) BCG recipients and 3612 (99·1%) placebo recipients in the northern areas, and 2449 (87·5%) BCG recipients and 2413 (85·6%) placebo recipients in the southern area. There was no difference in mortality between the BCG and placebo groups in either area, overall or by age group or sex. In the northern area, there were 129 deaths per 19 694 person-years at risk in the BCG group (6·6 deaths per 1000 person-years at risk [95% CI 5·5-7·8]) versus 133 deaths per 19 111 person-years at risk in the placebo group (7·0 deaths per 1000 person-years at risk [95% CI 5·9-8·2]; HR 0·94 [95% CI 0·74-1·20]; p=0·62). In the southern area, there were 241 deaths per 38 399 person-years at risk in the BCG group (6·3 deaths per 1000 person-years at risk [95% CI 5·5-7·1]) versus 230 deaths per 38 676 person-years at risk in the placebo group (5·9 deaths per 1000 person-years at risk [95% CI 5·2-6·8]; HR 1·06 [95% CI 0·88-1·27]; p=0·54). INTERPRETATION: We found little evidence of any beneficial effect of BCG revaccination on all-cause mortality. The high proportion of deaths attributable to non-infectious causes beyond infancy, and the long time interval since BCG for most deaths, might obscure any benefits. FUNDING: British Leprosy Relief Association (LEPRA); Wellcome Trust.


Subject(s)
BCG Vaccine/administration & dosage , Immunization, Secondary/statistics & numerical data , Mortality , Vaccination/methods , Adolescent , Adult , Aged , BCG Vaccine/immunology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , Child , Child, Preschool , Double-Blind Method , Female , Follow-Up Studies , Humans , Immunogenicity, Vaccine , Leprosy/immunology , Leprosy/mortality , Leprosy/prevention & control , Malawi/epidemiology , Male , Middle Aged , Mycobacterium leprae/immunology , SARS-CoV-2/immunology , Treatment Outcome , Tuberculosis/immunology , Tuberculosis/mortality , Tuberculosis/prevention & control , Vaccination/statistics & numerical data , Young Adult
16.
Reprod Health ; 18(1): 222, 2021 Nov 07.
Article in English | MEDLINE | ID: covidwho-1505521

ABSTRACT

The COVID-19 infection control and prevention measures have contributed to the increase in incidence of intimate partner violence (IPV) and negatively impacted access to health and legal systems. The purpose of this commentary is to highlight the legal context in relation to IPV, and impact of COVID-19 on IPV survivors and IPV prevention and response services in Kenya, Malawi, and Sudan. Whereas Kenya and Malawi have ratified the Convention on Elimination of all forms of Discrimination against Women (CEDAW) and have laws against IPV, Sudan has yet to ratify the convention and lacks laws against IPV. Survivors of IPV in Kenya, Malawi and Sudan have limited access to quality health care, legal and psychosocial support services due to COVID-19 infection control and prevention measures. The existence of laws in Kenya and Malawi, which have culminated into establishment of IPV services, allows a sizable portion of the population to access IPV services in the pandemic period albeit sub-optimal. The lack of laws in Sudan means that IPV services are hardly available and as such, a minimal proportion of the population can access services. Civil society's push in Kenya has led to prioritisation of IPV services. Thus, a vibrant civil society, committed governments and favourable IPV laws, can lead to better IPV services during the COVID-19 pandemic period.


Subject(s)
COVID-19 , Intimate Partner Violence , Female , Humans , Kenya/epidemiology , Malawi/epidemiology , Pandemics , SARS-CoV-2 , Sudan/epidemiology
17.
PLoS One ; 16(9): e0256361, 2021.
Article in English | MEDLINE | ID: covidwho-1403300

ABSTRACT

BACKGROUND: Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. METHODS: We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). RESULTS: Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). CONCLUSION: There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Health Services Needs and Demand/statistics & numerical data , Hypotension/epidemiology , Hypoxia/epidemiology , Pandemics , Adult , Aged , Cross-Sectional Studies , Female , Hospitalization , Humans , Malawi/epidemiology , Male , Middle Aged
19.
BMJ Open ; 11(7): e045196, 2021 07 22.
Article in English | MEDLINE | ID: covidwho-1322820

ABSTRACT

BACKGROUND: COVID-19 mitigation strategies have been challenging to implement in resource-limited settings due to the potential for widespread disruption to social and economic well-being. Here we predict the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health system capacity. METHODS: The infection fatality ratios (IFR) were predicted by adjusting reported IFR for China, accounting for demography, the current prevalence of comorbidities and health system capacity. These estimates were input into an age-structured deterministic model, which simulated the epidemic trajectory with non-pharmaceutical interventions and increases in health system capacity. FINDINGS: The predicted population-level IFR in Malawi, adjusted for age and comorbidity prevalence, is lower than that estimated for China (0.26%, 95% uncertainty interval (UI) 0.12%-0.69%, compared with 0.60%, 95% CI 0.4% to 1.3% in China); however, the health system constraints increase the predicted IFR to 0.83%, 95% UI 0.49%-1.39%. The interventions implemented in January 2021 could potentially avert 54 400 deaths (95% UI 26 900-97 300) over the course of the epidemic compared with an unmitigated outbreak. Enhanced shielding of people aged ≥60 years could avert 40 200 further deaths (95% UI 25 300-69 700) and halve intensive care unit admissions at the peak of the outbreak. A novel therapeutic agent which reduces mortality by 0.65 and 0.8 for severe and critical cases, respectively, in combination with increasing hospital capacity, could reduce projected mortality to 2.5 deaths per 1000 population (95% UI 1.9-3.6). CONCLUSION: We find the interventions currently used in Malawi are unlikely to effectively prevent SARS-CoV-2 transmission but will have a significant impact on mortality. Increases in health system capacity and the introduction of novel therapeutics are likely to further reduce the projected numbers of deaths.


Subject(s)
COVID-19 , China/epidemiology , Humans , Malawi/epidemiology , Models, Theoretical , SARS-CoV-2
20.
Emerg Infect Dis ; 27(7): 1831-1839, 2021 07.
Article in English | MEDLINE | ID: covidwho-1278364

ABSTRACT

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.


Subject(s)
COVID-19 , Tuberculosis , Communicable Disease Control , Female , Humans , Malawi/epidemiology , Male , Pandemics , SARS-CoV-2 , Tuberculosis/diagnosis , Tuberculosis/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL