Prevalence of HIV-1 and oral lesions in pregnant women in rural Malawi.

OBJECTIVE: Whether oral lesions were associated with human immunodeficiency virus-type 1 (HIV-1) status in a cohort of pregnant Malawian women was studied. STUDY DESIGN: Six hundred thirty-eight women participated in a randomized prospective study at 3 prenatal clinics in a rural area of southern Malawi. Oral examinations, followed by collection of oral fluid specimens with an HIV-1 oral specimen collection device, were performed. The specimens were tested for antibodies against HIV-1. RESULTS: Sixty-one oral lesions were found in 60 participants. While traditional HIV-1 associated lesions were rare, benign migratory glossitis was unexpectedly common (6%). Oral hairy leukoplakia was significantly more common among women who were HIV-1 positive than among women who were HIV-1 negative. An HIV-1 prevalence rate of 21.8% was estimated among the women, with the highest rate of HIV-1 infection (34.1%) among women aged 25 to 29 years. CONCLUSION: Stratifying lesions showed a small number of oral hairy leukoplakia to be markers for HIV-1. A high seroprevalence was found in this rural cohort, but there were unexpectedly few oral lesions. The relatively few oral lesions diagnosed may indicate a recent infection with HIV.

Pain as a mutual experience for patients, nurses and families: a perspective from Lilongwe, Malawi.

The data for this study were collected in the Republic of Malawi (formerly Nyasaland), a small country in South Central Africa. Data were collected by registered nurses who were senior students in the first class of registered nurse midwives enrolled in a baccalaureate completion program who had completed a research course taught by the CUNY investigator. Fourteen women participated in the study; all were accompanied by a female relative or friend. Because of cultural norms and taboos, paternal attendance in labor settings rarely occurs and women in labor receive support from mothers, aunts and mothers-in-law. In summary, accurate estimation of patient pain among nurses and families occurred less than 25% of the time.

Risk factors for perinatal asphyxia at Queen Elizabeth Central Hospital, Malawi.

The aim of the study was to identify maternal risk factors for perinatal asphyxia in Malawi. Records of 100 mothers who delivered neonates with Apgar scores less than 6 at 5 minutes of birth during March to September 1998 were analyzed. The majority of the mothers were primigravidas (79%) and were within the normal childbearing ages of 20 to 34 years (61.2%). Sixty-one percent of the mothers started antenatal care at 20 to 28 weeks' gestation. Sixty-five percent of the mothers developed obstetric and medical problems that contributed to perinatal asphyxia, and of these, 12 mothers (18.5%) had more than one problem. The problems were premature labor and delivery (21%), preeclampsia (10%), cephalopelvic disproportion (8%), breech presentation (12%), prolonged second stage (11%), fetal distress (7%), cord prolapse (4%), antepartum hemorrhage (2%), prolonged rupture of membranes (1%), and malaria (1%). Forty-six percent had assisted deliveries, and these were cesarean section (18%), vacuum extraction (14%), breech delivery (12%), and forceps delivery (2%). Eighty-one percent of the neonates were admitted to the neonatal nursery, and of these, 56 neonates (67.1%) developed complications; the most common was hypoxic ischemic encephalopathy (38 neonates; 67.9%). Thirty-three percent of the neonates died within 6 days postdelivery. Morbidity and mortality related to perinatal asphyxia can be reduced if staff are knowledgeable and skilled in basic neonatal resuscitation and necessary equipment is available. Mothers should be encouraged to report early for antepartum and intrapartum care for adequate surveillance. The quality of neonatal care, with a focus on thermoregulation and infection prevention, needs to be improved.

Childbearing in Malawi, Africa.

Malawi is a small, landlocked country in South Eastern Africa that faces many challenges in providing health care to childbearing women. Through a partnership between the faculty of the University of Pennsylvania, School of Nursing, faculty of the Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population, an ongoing collaboration has led to research and demonstration projects designed to improve the health of women and children in Malawi. To underscore the cultural context within which childbearing occurs, care of the childbearing family in Malawi is described, as is research that has documented some of the similarities and differences between childbearing in Malawi and the United States.

PIP: An ongoing partnership between the University of Pennsylvania (US) School of Nursing, Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population has led to research and demonstration projects intended to improve the health of women and children in Malawi. Essential to this collaboration has been an understanding of the similarities and differences between childbearing in Malawi and the US. Malawi has a maternal mortality rate of 620/100,000 live births and a child mortality rate of 234/1000 live births, largely as a result of socioeconomic factors. This article details the cultural context of pregnancy and childbirth in Malawi. It also describes the results of a survey conducted in 15 villages in Malawi in 1996 to evaluate the efficacy of an educational program aimed at empowering women to make safe choices during the childbearing process. The survey indicated a need for information about taking iron and antimalarials during pregnancy, the importance of seeking help as soon as problems develop during pregnancy, and the role of postpartum care. A train-the-trainer program is being conducted so local women leaders can provide health education to childbearing women in their villages.

Bridging the gap between hospital and home for premature infants in Malawi.

In Malawi low-birthweight infants born prematurely risk developing health-related problems during the first four years of life and thus require intensive care. However, limited human and material resources place a heavy burden on nurse-midwives. Below some guidelines for improving the discharge planning process for premature infants, particularly in developing countries.