Malawi Medical Journal

Mood disorders after COVID-19 infection: a single-center experience

Fatih Uzer — 2024-12-19

Objectives
The present study aimed to examine mood disorders in patients discharged from the hospital due to Coronavirus Disease-19 (COVID-19).
Methods
The study included patients who were admitted to Akdeniz University with the diagnosis of COVID-19. Post-Traumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-5), and Beck Anxiety and Depression Inventories were administered to the patients at least 30 days after discharge.
Results
A total of 215 patients were included. The median age was 56 years, and 60.9%(131) were male. There was no statistically significant difference in mood disorders scale scores between male and female. However, there was a weak negative correlation between age and PCL-5 scores (rho: -0.157, p: 0.021). The depression scores (p < 0.001), anxiety scores (p < 0.001) and PCL-5 (p = 0.001) scores were statistically significantly higher in patients with respiratory symptoms at the time of enrollment (after a mean duration of 87.9 days following discharge). Married individuals had statistically significantly lower anxiety, depression, and PCL-5 scores. Beck anxiety scores were statistically significantly higher in patients receiving systemic steroid.
Conclusion
A substantial portion of patients with COVID-19 suffer from mood disorders after hospital discharge. Those patients with residual symptoms who live alone and receive corticosteroid represent a vulnerable population.

Surgery camp for Colostomy reversals at a referral hospital in Lilongwe, Malawi

Vanessa Msosa — 2024-12-19

Aim
An end colostomy is a potentially life-saving surgical intervention, but postoperative ostomy management is challenging in resource-limited settings. Socioeconomic, health system, and surgical capacity barriers may delay colostomy reversal. A surgery camp model for addressing the burden of unreversed colostomies has not previously been undertaken in Malawi. The study aims to present our institution’s experience with the surgery camp model, assess patient outcomes, and identify improvement strategies for future efforts.
Methods
The surgery department at Kamuzu Central Hospital (KCH) carried out a two-day surgical camp in partnership with Access Health Africa (AHA) to reduce the local burden of reversible colostomies and train KCH surgery registrars in stapled end-to-end anastomosis (EEA). New, standardized preoperative and postoperative order sets for colostomy reversal were developed and implemented. Patient records were retrospectively reviewed, and descriptive analysis was performed. 13 patients underwent colostomy reversal via exploratory laparotomy. Twelve patients were male, median age was 41 (IQR 27 – 51), and average delay to reversal was 4.3 ± 6.6 months after clinical readiness.
Results
Sigmoid volvulus was the most common indication for Hartmann’s procedure (62%) among patients undergoing reversal. One major complication was reported, a return to theatre for suspected anastomotic leak with no adverse findings. Patients were discharged 5.3± 2.8 days after surgery. Operating theatre staff successfully prepared for increased surgical volume, and standard pre- and postoperative order sets remain in use. Distribution of administrative responsibility and communication between visiting and host teams were noted as targets for improvement.
Conclusion
Given the clinical, educational, and organizational success of the two-day surgery camp, a second, expanded effort is anticipated. Goals include inclusion of ileostomy patients, advanced notification in district facilities and clinics, and additional administrative support with case allocation, supply acquisition, and personnel coordination.

Assessing informed consent in surgical patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: a cross-sectional study

Lucy Kaomba — 2024-12-19

Introduction
Informed consent is critical to medical practice, and a clearly outlined process that results in signing the consent form may improve the validity of the given consent. There is a paucity of studies in Malawi that have assessed the informed consent process in surgical patients.
Aim: To assess the informed consent process for patients undergoing surgery at QECH in Malawi.
Methods
A cross-sectional quantitative descriptive study was conducted among postoperative patients in the adult surgical wards at QECH through face-to-face interviews. The calculated sample size was 235. A consecutive sampling technique was used. Those below 18 years and those who didn’t or couldn’t consent were excluded. Data was entered and analyzed in Microsoft Excel 2016 and IBM SPSS 25.0. The level of significance was considered as P<0.05.
Results
A total of 222 patients were interviewed. The age range was 21 to 75 years, with a median of 38.5. Two hundred and twelve (95%) patients signed a consent form before surgery, and 21 (9%) knew the content of the form. Most patients, 100 (47%) had a primary school education, and 156 (70%) could read and write. Those with secondary or tertiary education were more likely to want to ask a question given the opportunity (OR 2.82, p= 0.0012), but there was no significant difference in the likelihood of being given time to ask questions between the two groups who had primary and no formal education vs those who had secondary and tertiary education (OR 1.4, p=0.3367)
Conclusion
This study highlights the necessity of employing effective communication strategies during the consent process for surgical procedures and the need to tailor the consent form to the patient’s education level.

Evaluation of systemic immune-inflammation index and systemic inflammation response index in the differentiation of acute Ischemic stroke and transient Ischemic attack

Mustafa YILMAZ — 2024-12-19

Objective
The aim of this study was to examine the levels of hematologic parameters in acute ischemic stroke (AIS) and transient ischemic attack (TIA) and to evaluate the use of Neutrophil/Lymphocyte ratio (NLR), Systemic Immune-Inflammation Index (SII), and systemic inflammation response index (SIRI) in the differentiation of AIS and TIA.
Materials and Methods
Data and hematological results of patients admitted to the emergency department and diagnosed with AIS and TIA were compared retrospectively.
Results
The study included 36 TIA patients (M/F = 15/21) with a mean age of 64.52 ± 15.597 years and 74 AIS patients (M/F = 35/39) with a mean age of 71.91 ± 13.86 years. Laboratory data showed that lymphocyte count (p = 0.022) and hemoglobin level (p = 0.017) were significantly higher in AIS patients. In addition, monocyte count (p = 0.001), neutrophil/lymphocyte ratio (NLR) (p < 0.001), CRP level (p = 0.007), and SII (p = 0.001) and SIRI values ( < 0.001) were significantly increased in AIS patients compared to TIA patients.
Conclusion
The results obtained in the present study show that hematologic inflammatory parameters are increased in AIS. NLR, SII and SIRI may provide insight in the differential diagnosis of AIS and TIA.

Hydrocephalus, healing, and disrupted daily living: exploring maternal experiences at Queen Elizabeth Central Hospital in Blantyre, Malawi

Camilla G. Aukrust — 2024-12-19

Background
Each year, nearly 400,000 new cases of paediatric hydrocephalus are estimated to occur worldwide, and almost half of these cases are expected to affect children in Africa. At Queen Elizabeth Central Hospital (QECH), an urban tertiary hospital in Blantyre, Malawi, located in south-east Africa, around 200 children received neurosurgical treatment for hydrocephalus in 2023. These children require lifelong follow-up and care, which places significant demands on their caregivers.
Objectives
The following research objectives guided the study: 1) To explore how mothers of children with hydrocephalus perceive the condition. 2) To examine the care pathways that mothers and their children with hydrocephalus engage in. 3) To identify the implications of having a child with hydrocephalus.
Methods
We applied a qualitative method with an explorative design. We conducted 15 in-depth interviews and two focus group discussions among 16 mothers (aged 20-35 years) of inpatient or outpatient children with hydrocephalus at QECH. Convenience sampling was used to recruit the 16 participants. We conducted a thematic analysis.
Results
1) Mothers referred to various disease explanations, often switching between attributing the condition to God, supernatural causes such as bewitchment, and biomedical factors. 2) The care pathways for mothers and their children with hydrocephalus at QECH are fraught with challenges, creating strenuous trajectories that hinder access to care and present significant challenges. 3) Having a child with hydrocephalus has extensive social implications, including stigma and disruption of daily living.
Conclusions
Our findings highlight the need for intersectoral action to optimise treatment and reduce stigma. This involves educational programs and awareness-raising campaigns to improve maternal health literacy. Additionally, targeted initiatives are urgently needed to improve healthcare infrastructure, transportation, and pathways to care. Since hydrocephalus management is a lifelong process, the possibility of conducting follow-up through outreach clinics or telemedicine and community-based rehabilitation should be further explored. Finally, to improve management for children with hydrocephalus in Blantyre and across Malawi includes efforts to bolster the educational, economic, social, and legal position of women.

Quality of hypertension management and health insurance impact: an assessment of insured and uninsured patients with systemic hypertension in a teaching Hospital in Ilorin, Nigeria

Olalekan Agede — 2024-12-19

Background
Patient satisfaction is an important indicator used to measure quality of care and the performance of healthcare services. This study assessed patient satisfaction with the quality of hypertension care received by both insured and uninsured patients with systemic hypertension.
Methods
This comparative cross-sectional study was conducted among insured and uninsured patients with systemic hypertension attending the Medical Outpatient Department clinics of the University of Ilorin Teaching Hospital, Kwara State, Nigeria, from May to July, 2023. Data were collected from 95 patients from each group, selected by systematic random sampling; using an interviewer-administered, anonymous, structured close ended questionnaire. Different aspects of the healthcare services were assessed; these include patient registration process, waiting time, staff attitudes, laboratory services, availability and cost of prescribed drugs etc. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27.0 software.
Results
The insured patients with systemic hypertension had a higher overall mean satisfaction (74.1±20.8) compared to the uninsured group (69.3±23.2), though this was not statistically significant (p value = 0.417). However, the insured patients with systemic hypertension had significant satisfaction scores compared to uninsured hypertensive group in the domains of waiting time (63.6± 24.9 vs 48.0 ± 25.8, p=0.000), drug cost and availability (73.9 ± 24.1 vs 56.2 ± 25.0, p=0.000), and cost of service and care (74.1±24.0 vs 59.8±26.0, p=0.000).
Conclusions
This study concluded that both insured and uninsured patients with systemic hypertension had comparable treatment, though the insured group had some better satisfaction scores in some of the assessed healthcare domains. The healthcare policy makers should endeavour to improve health insurance coverage, and utilize identified factors in policy formulation and implementation to encourage utilization of health insurance among patients.

Assessment of Left Ventricular function and Aortic blood flow in children with Tetralogy of Fallot (TOF) attending two health institutions in Enugu Metropolis

Josephat M Chinawa — 2024-12-19

Background
Children with Tetralogy of Fallot (TOF) usually present with right heart abnormalities, however much is not known if these children presents with left ventricular dysfunction.
Objectives
This article is aimed to ascertain the left ventricular function of children with TOF compared with those without any congenital heart disease. It also elicits the correlation if any, between left ventricular mass and descending aorta blood flow.
Methods
This is a comparative study involving 91 children with TOF with age and gender matched control . Echocardiographic evaluation of left ventricular function and their parameters in children with TOF were compared with controls. The data was analyzed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago).
Results
The mean LVIDd of subjects without TOF, 25.7±10.1 was higher than that of those with TOF, 21.2±7.1 and the difference in mean was found to be statistically significant, (Student t=3.455, p=0.001). The mean EF of respondents with TOF, 61.9±19.3 was lower than that of subjects without TOF, 67.2±9.3 and the difference in mean was found to be statistically significant, (Student t=2.333, p=0.021). The mean FS of respondents with TOF, 43.1±16.6 was significantly lower than that of respondents without FS 46.7±8.2 (Student t=3.519, p=0.001). The mean velocity of respondents without TOF, 1.3±0.3 was significantly higher than that of respondents with TOF, 1.2±0.2. (Student t=4.199, p<0.001).
For respondents who had TOF, there was a weak negative correlation between LV mass and velocity, increases with LV mass correlates with decreases in velocity but this was not found to be statistically significant, (n=63, r=-0.214, p=0.093).
Conclusion
Though it is generally known that children with TOF present with right ventricular dysfunction, however this study has shown that they also present with various degrees of left ventricular systolic abnormalities. Though left ventricular systolic function in children with TOF is lower than that in normal children, all values still fall within normal refrence ranges.

Antipsychotic medication non-adherence and its determinants among out-patients with schizophrenia

Paul Erohubie — 2024-12-19

Introduction
While antipsychotics are key requirement in acute and long-term management of schizophrenia, medication adherence remains a major unmet need in its care. This paper assessed the prevalence of oral antipsychotic non-adherence among outpatients with schizophrenia and its associated clinico-demographic factors.
Method
Three hundred and ten adult outpatients (18-64 years of age) were cross-sectionally interviewed after being diagnosed of schizophrenia using ICD-10 criteria, and the diagnosis confirmed with the Mini International Neuropsychiatric Interview (MINI). The socio-demographic questionnaire, Morisky Medication Adherence scale (MMAS-8), Brief Psychiatric Rating Scale (BPRS), Liverpool University Neuroleptic Side Effects Scale (LUNSERS), Drug Attitude Inventory (DAI-10), Scale to Assess Unawareness of Mental Disorders (SUMD) were used to obtain participants’ demographic profile, level of medication adherence, illness severity, attitude towards antipsychotics, and level of insight respectively.
Results
At least one in every two outpatients with schizophrenia (n=158; 51.0%) did not adhere to their antipsychotics as prescribed. The independent risk factors for poor oral antipsychotic adherence were illness severity (p= 0.001; AOR 1.13), psychoactive substance use (p= 0.009; AOR 1.87), young age (p= 0.014; AOR 2.09), perceived poor social support (p= 0.025; AOR 3.58), use of first generation antipsychotics alone (p= 0.006; AOR 17.99), use of second generation antipsychotics alone (p= 0.02; AOR 29.36), and awareness of symptoms (p= 0.025; AOR 1.18).
Conclusion
The high rate of poor medication adherence should necessitate much emphasis on the highlighted modifiable risk factors and the need for continuous adherence assessments and education in clinical practice.