A comparison of clinical outcomes among people living with HIV of different age groups attending queen Elizabeth central hospital outpatient ART Clinic in Malawi.

Introduction: Adherence to Antiretroviral Treatment (ART) in children and adolescents living with HIV in low-resource settings is not extensively studied in large cohort studies including both adults and pediatric patients. We compared rates of virological suppression, adherence and defaulting among children, adolescents and adults attending a family ART clinic at Queen Elizabeth Central Hospital; a tertiary hospital situated in the southern region of Malawi. Methods: The study was longitudinal and made use of routinely collected data for all 27,229 clinic attendees. Clinical information obtained at routine clinical visits entered electronically since 2008 was extracted in February 2017. This data was used to ascertain differences across the different age groups. Logistic regression and Cox regression models were fitted to compare rates of Virological Suppression (VS), adherence, and defaulting, respectively. Results: Younger and older adolescents (ages 10-14 years and 15-19 years respectively) were less likely to achieve VS compared to adults in the final model AOR 0.4 (0.2-0.9, 95% CI) and AOR 0.2 (0.1-0.4, 95% CI) respectively. Young children (ages 0-4 years), older children (ages 5-9 years) and younger adolescents were less adherent to ART compared to adults AOR 0.1 (0.1-0.2, 95% CI), AOR 0.2 (0.1-0.3, 95% CI), and AOR 0.4 (0.3-0.5, 95% CI) respectively. Young adults and younger children had an increased likelihood of defaulting compared to adults. Conclusion: Poor performance on ART of children and adolescents highlights unaddressed challenges to adherence. Ongoing research to explore these potential barriers and possible interventions needs to be carried out. The adherence assessment methods used and strategies for improving it among children and adolescents need to be revised at the clinic.

Two decades of malaria control in Malawi: Geostatistical Analysis of the changing malaria prevalence from 2000-2022.

Background: Malaria remains a public health problem in Malawi and has a serious socio-economic impact on the population. In the past two decades, available malaria control measures have been substantially scaled up, such as insecticide-treated bed nets, artemisinin-based combination therapies, and, more recently, the introduction of the malaria vaccine, the RTS,S/AS01. In this paper, we describe the epidemiology of malaria for the last two decades to understand the past transmission and set the scene for the elimination agenda. Methods: A collation of parasite prevalence surveys conducted between the years 2000 and 2022 was done. A spatio-temporal geostatistical model was fitted to predict the yearly malaria risk for children aged 2-10 years (PfPR 2-10) at 1×1 km spatial resolutions. Parameter estimation was done using the Monte Carlo maximum likelihood method. District-level prevalence estimates adjusted for population are calculated for the years 2000 to 2022. Results: A total of 2,595 sampled unique locations from 2000 to 2022 were identified through the data collation exercise. This represents 70,565 individuals that were sampled in the period. In general, the PfPR2_10 declined over the 22 years. The mean modelled national PfPR2_10 in 2000 was 43.93 % (95% CI:17.9 to 73.8%) and declined to 19.2% (95%CI 7.49 to 37.0%) in 2022. The smoothened estimates of PfPR2_10 indicate that malaria prevalence is very heterogeneous with hotspot areas concentrated on the southern shores of Lake Malawi and the country's central region. Conclusions: The last two decades are associated with a decline in malaria prevalence, highly likely associated with the scale-up of control interventions. The country should move towards targeted malaria control approaches informed by surveillance data.

In Malawi, malaria continues to be a significant health issue, affecting people's well-being and the economy. Over the past twenty years, efforts to control malaria, such as using bed nets, specific medications, and introducing a malaria vaccine, have increased substantially. This paper explores malaria transmission patterns during this time to better understand the past situation and prepare for future efforts to eliminate the disease. We collected and analyzed data from various surveys conducted between 2000 and 2022, focusing on malaria risk for children aged 2­10 years. We used a detailed statistical model to predict yearly malaria risk. The results show a decline in malaria prevalence over the 22 years. The analysis also reveals variations in malaria prevalence, with hotspot areas particularly concentrated in the southern shores of Lake Malawi and the country's central region. This decline in malaria prevalence is likely linked to the increased implementation of control measures. The findings emphasize the importance of targeted approaches informed by ongoing surveillance data for continued progress in malaria control.

Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight.

BACKGROUND: "Kangaroo mother care," a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain. METHODS: We conducted a randomized, controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania involving infants with a birth weight between 1.0 and 1.799 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in an incubator or a radiant warmer until their condition stabilized and kangaroo mother care thereafter (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life. RESULTS: A total of 3211 infants and their mothers were randomly assigned to the intervention group (1609 infants with their mothers) or the control group (1602 infants with their mothers). The median daily duration of skin-to-skin contact in the neonatal intensive care unit was 16.9 hours (interquartile range, 13.0 to 19.7) in the intervention group and 1.5 hours (interquartile range, 0.3 to 3.3) in the control group. Neonatal death occurred in the first 28 days in 191 infants in the intervention group (12.0%) and in 249 infants in the control group (15.7%) (relative risk of death, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P = 0.001); neonatal death in the first 72 hours of life occurred in 74 infants in the intervention group (4.6%) and in 92 infants in the control group (5.8%) (relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P = 0.09). The trial was stopped early on the recommendation of the data and safety monitoring board owing to the finding of reduced mortality among infants receiving immediate kangaroo mother care. CONCLUSIONS: Among infants with a birth weight between 1.0 and 1.799 kg, those who received immediate kangaroo mother care had lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization; the between-group difference favoring immediate kangaroo mother care at 72 hours was not significant. (Funded by the Bill and Melinda Gates Foundation; Australian New Zealand Clinical Trials Registry number, ACTRN12618001880235; Clinical Trials Registry-India number, CTRI/2018/08/015369.).

Voluntary medical male circumcision and sexual practices among sexually active circumcised men in Mzuzu, Malawi: a cross-sectional study.

BACKGROUND: Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices. METHOD: A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18-49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson's chi square test and logistic regression. RESULTS: Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7-38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n = 187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p < 0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex. CONCLUSION: Risky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.

Seroprevalence and trends in transfusion transmissible infections among voluntary non-remunerated blood donors at the Malawi Blood Transfusion Service-a time trend study.

Introduction: Collecting blood from voluntary non-remunerated blood donors from low risk populations is a key strategy for blood safety. Identifying such populations involves analysis of population and blood donor data to identify risk factors for transfusion transmissible infections (TTIs). There are no recent seroprevalence statistics for blood donors in Malawi. This study fills this gap by describing characteristics of blood donors, trend of annual prevalence of HIV, HBV, HCV and syphilis and factors associated with each TTI. Methods: Retrospective analysis of blood donors' records in the MBTS database from 2011 to 2015 was undertaken. Summary statistics were performed to describe characteristics of the blood donors. Univariable and multivariable logistic regression analyses were performed to determine association between prevalence of infections and socio-demographic factors. Time trend analysis was done to assess changes in prevalence. P-value <0.05 was considered statistically significant. Results: The number of blood donors screened over the 5 year period was 125,893. The mean number of donors donating blood per year was 39, 289; median age was 19 years; 82% were male, 87% single and 72% students and56% were repeat blood donors. Overall prevalence of each TTI decreased. The 2015 prevalence was: 3.6% for HBV; 1.9% for HIV; 2.6% for Syphilis and 1.0% for HCV while the 2011 prevalence was 4.7% for HBV; 3.5% for HIV 3.2% for syphilis and 2.4% for HCV.Repeat blood donors had significantly lower prevalence of TTIs than first time donors. Females were associated with lower risk for HBV, HCV and syphilis. Age ≥25 years and being out of school were associated with HIV. Age ≥25 years was associated with reduced risk for HCV and being self-employed and married were each associated with syphilis. Conclusion: The typical blood donor is a young single male student. Repeat blood donation improves safety of the blood supply.

Parents Mimic and Influence Their Infant's Autonomic State through Dynamic Affective State Matching.

When we see someone experiencing an emotion, and when we experience it ourselves, common neurophysiological activity occurs [1, 2]. But although inter-dyadic synchrony, concurrent and sequential [3], has been identified, its functional significance remains inadequately understood. Specifically, how do influences of partner A on partner B reciprocally influence partner A? For example, if I am experiencing an affective state and someone matches their physiological state to mine, what influence does this have on me-the person experiencing the emotion? Here, we investigated this using infant-parent dyads. We developed miniaturized microphones to record spontaneous vocalizations and wireless autonomic monitors to record heart rate, heart rate variability, and movement in infants and parents concurrently in naturalistic settings. Overall, we found that infant-parent autonomic activity did not covary across the day-but that "high points" of infant arousal led to autonomic changes in the parent and that instances where the adult showed greater autonomic responsivity were associated with faster infant quieting. Parental responsivity was higher following peaks in infant negative affect than in positive affect. Overall, parents responded to increases in their child's arousal by increasing their own. However, when the overall arousal level of the dyad was high, parents responded to elevated child arousal by decreasing their own arousal. Our findings suggest that autonomic state matching has a direct effect on the person experiencing the affective state and that parental co-regulation may involve both connecting and disconnecting their own arousal state from that of the child contingent on context.

Hematuria meter application as a diagnostic tool in the assessment of the degree of hematuria among post-TURP and post- TURBT patients

INTRODUCTION: Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.OBJECTIVE: The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.METHODS: Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.RESULTS: From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).CONCLUSION: The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.

Erythrocyte sedimentation rate as a predictor of success of trial of voiding without catheter after transurethral electrosurgical resection of benign prostatic hyperplasia

INTRODUCTION: Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).OBJECTIVE: The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.METHODS: On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.RESULTS: From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).CONCLUSION: Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.

Hematuria meter application as a diagnostic tool in the assessment of the degree of hematuria among post-TURP and post- TURBT patients

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.<br /><strong>OBJECTIVE:</strong> The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.<br /><strong>METHODS:</strong> Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.<br /><strong>RESULTS:</strong> From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.<br />The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).<br /><strong>CONCLUSION:</strong> The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.</p>

Erythrocyte sedimentation rate as a predictor of success of trial of voiding without catheter after transurethral electrosurgical resection of benign prostatic hyperplasia

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).<br /><strong>OBJECTIVE:</strong> The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.<br /><strong>METHODS:</strong> On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.<br /><strong>RESULTS:</strong> From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).<br /><strong>CONCLUSION:</strong> Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.</p>

A variant pattern of calretinin immunohistochemistry on rectal suction-biopsies is fully specific of short-segment Hirschsprung's disease.

BACKGROUND/PURPOSE: Calretinin immunohistochemistry is now widely used to diagnose Hirschsprung's disease (HD), since loss of calretinin expression within the mucosa and muscularis mucosae of rectal suction-biopsy is pathognomonic of HD. However, a stippled staining may be observed within hypertrophic nerves in the submucosae in some HD patients. The aim of the study was to test the hypothesis that such findings may announce the beginning of the transitional zone. METHODS: We retrieved 44 consecutive patients (10 girls and 34 boys; median age 6.5 days), diagnosed with aganglionosis on rectal suction biopsies, followed by surgery. According to calretinin immunohistochemistry performed on all paraffin-embedded rectal biopsies, we defined two HD groups: P- showing an absence of any staining within mucosa, muscularis mucosae and submucosa et P+ showing an absence of staining within the mucosa and muscularis mucosae, but a positivity of some submucosal hypertrophic nerves. These data were correlated to the length of total pathological segment (aganglionic and transitional zones) obtained from the original surgery reports. RESULTS: 18/44 patients (40.9 %) belonged to the P+ group and 26/44 (59 %) patients were within the P- group. In the P+ group, the maximal length of the aganglionic zone was 9 cm [mean 4 (1-9)] and the total pathological zone never exceeded 14 cm [mean 8 (3.8-14)]. In the P- group, the maximal length of aganglionic zone was 55.5 cm [mean 11.3 (2.5; 55.5)] and the total pathological zone extended to 59.5 cm [mean 17.75 (4.5; 59.5)]. Aganglionic segment was significantly shorter in the P+ group (p < 0.0001). CONCLUSION: Staining of some hypertrophic nerves in the submucosa in suction rectal biopsy of HD patients using calretinin immunohistochemistry is only encountered in short-segment aganglionosis with a pathological zone always restricted to rectal and sigmoid colon. This information could be crucial for the surgeons in the decision to choose a transanal procedure.

Calretinin immunohistochemistry: a simple and efficient tool to diagnose Hirschsprung disease.

Diagnosis of Hirschsprung disease (HD) is quite entirely based on the histopathological analysis of suction rectal biopsies. This hematoxylin and eosin approach has some limitations, despite the help of acetylcholinesterase staining. The aim of this study was to assess the diagnostic value of calretinin immunochemistry as a simple and reliable method in the diagnosis of HD. A total of 131 initial rectal biopsies carried out for suspicion of HD in children were retrieved, and calretinin immunohistochemistry was carried out on paraffin-embedded biopsies. Diagnosis of HD was made when no staining was observed. The results were statistically analyzed in comparison with our standard method (histology and acetylcholinesterase staining). 130 biopsies were accurately diagnosed on the basis of the positivity or negativity of calretinin staining. The senior pathologists diagnosed all cases of HD with no false positives. Furthermore, 12 additional cases initially considered as doubtful for HD using the standard method, were accurately diagnosed using calretinin immunohistochemistry. The false negative was a case of HD with a calretinin-positive biopsy. We also demonstrate the ease of calretinin interpretation compared with acetylcholinesterase for the junior pathologist. Calretinin immunohistochemistry overcomes most of the difficulties encountered using the combination of histology and acetylcholinesterase staining, and detects almost all cases of HD with confidence, with no false positives. Thus, we demonstrate that calretinin is superior to acetylcholinesterase to complete histology and could advantageously substitute for acetylcholinesterase.