Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards.

SETTING: Rapid scale-up of antiretroviral therapy (ART) has challenged the health system in Malawi to monitor large numbers of patients effectively. OBJECTIVE: To compare two methods of determining retention on treatment: quarterly ART clinic data aggregation vs. pharmacy stock cards. DESIGN: Between October 2010 and March 2011, data on ART outcomes were extracted from monitoring tools at five facilities. Pharmacy data on ART consumption were extracted. Workload for each method was observed and timed. We used intraclass correlation and Bland-Altman plots to compare the agreeability of both methods to determine treatment retention. RESULTS: There is wide variability between ART clinic cohort data and pharmacy data to determine treatment retention due to divergence in data at sites with large numbers of patients. However, there is a non-significant trend towards agreeability between the two methods (intraclass correlation coefficient > 0.9; P > 0.05). Pharmacy stock card monitoring is more time-efficient than quarterly ART data aggregation (81 min vs. 573 min). CONCLUSION: In low-resource settings, pharmacy records could be used to improve drug forecasting and estimate ART retention in a more time-efficient manner than quarterly data aggregation; however, a necessary precondition would be capacity building around pharmacy data management, particularly for large-sized cohorts.

Surgery in Malawi--the training of clinical officers.

Doctors are scarce in Malawi and, therefore, a considerable amount of work is carried out by paramedical clinical officers (COs). Although their training is limited, they take care of the majority of patients in the country. The CO project started in the Southern region of Malawi in 2005 in order to improve the number of surgical and gynaecological operations and skills of COs. Nine district hospitals and eight Christian Health Organisation of Malawi (CHAM) hospitals were visited and all surgical registers from 2004 and 2007 were analysed and COs were interviewed. The interviewed COs felt at ease when performing operations; in 2004 they performed 61% and in 2007 87% of the surgical and gynaecological procedures itemised in the questionnaire. In 2004 a total of 18,524 operations were registered in the 17 hospitals in the Southern region of Malawi and there were 19,644 in 2007. Certified COs performed significantly more surgical than gynaecological operations. In 2004, 8.4% of their performed operations consisted of major surgical operations and 17.7% in 2007. A two-year postgraduate training in surgery is being developed for them but, in the meantime, it will be necessary to ensure a continuation of the CO project in the central and northern regions of Malawi.