Malawi Medical Journal

Impact of in-service training on the knowledge, attitude, and practice of pharmacovigilance in Malawi: a cross-sectional mixed methods study

Francis Chiumia — 2024-06-30

Background
Spontaneous reporting of adverse drug reaction (ADRs) is low in Malawi. We assessed the impact of training intervention on
knowledge, attitudes, and practices of health care professionals (HCPs) in pharmacovigilance (PV).
Methods
We employed a mixed-methods study design. A questionnaire was administered among HCPs who were trained in PV, followed by
face-face interviews. We further extracted individual case safety reports which were submitted to the local databasewithin a period
of six months prior and after the PV training. Quantitative data was analyzed using STATA 14.1. Paired t-test was used to assess the
differences in PV knowledge among HCPs before and after the training. For qualitative data, we manually derived key themes from
the participant’s responses.
Results
Overall, the mean knowledge score was significantly improved across all the participants from a mean of 56% (95% CI 53% to
58%) to 66% (95% CI 64% to 69%) after the training, p< 0.001. There was a 2.8-fold increase in the number of participants who
were able to detect an ADR after the training and a 1.8-fold increase in the percentage of reporting the detected ADRs after the
training. Participants expressed preference of a paper-based reporting system to other reporting tools. However, they outlined several challenges to the system which discourages HCPs from reporting ADRs, such as lack of feedback, unavailability of reporting forms and delay to transmit data to the national centre.
Conclusion
The survey found that in-service training for HCPs improves KAP of PV and reporting rates of ADRs. We recommend widening of the training and introducing PV courses in undergraduate programs for health care workers in Malawi.

Identification of prognostic indicator based on hypoxia-related lncRNAs analysis in lung adenocarcinoma

Jiaojiao Zhang — 2024-10-14

Introduction
There were no systematic studies about hypoxia-related long noncoding RNAs (lncRNAs) signatures to predict the survival of patients with lung adenocarcinoma (LUAD). Setting up matching hypoxia-related lncRNA signatures was necessary.
Objective
This study aimed to establish hypoxia-related lncRNAs signatures and to seek new biomarkers to predict the prognosis of the patients with lung adenocarcinoma.
Methodology
The Cancer Genome Atlas (TCGA) database provided the expression profiles of lncRNAs that includes 535 lung adenocarcinoma samples. The coexpression network of lncRNAs and hypoxia-related different expression genes (DEGs) was utilized to select hypoxia-related lncRNAs. The lncRNAs were further screened using univariate Cox regression. In addition, Lasso regression and multivariate Cox regression were used to develop a hypoxia-related lncRNAs signature. A risk score based on the signature was established, and Cox regression was used to test if it was an independent prognostic factor.
Results
Nine prognostic hypoxia-related lncRNAs (LINC01150, AC010980.2, AL606489.1, AL034397.3, LINC00460, LINC02081, FAM83A-AS1, AL365181.2, and AC026355.1) were identified to be significantly different, which made up a hypoxia-related lncRNAs signature. The high-risk group had shorter OS compared with the low-risk group (P = 3.329e − 09, log-rank test). A risk score based on the signature was a significantly independent factor for the patients with LUAD (HR = 1.449, 95% CI = 1.312 − 1.602, P < 0.001).
Conclusion
The nine hypoxia-related lncRNAs and their signature might be molecular biomarkers and therapeutic targets for the patients with LUAD.

Co-infection of SARS-CoV-2 and Influenza A: a report from in Southwestern Iran

Saber Soltani — 2024-09-30

Background
Since December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in China, and quickly spread worldwide. To date, SARS-CoV-2 infection has become a global concern and health problem.
Method
In this study, we evaluated the co-infection of SARS-CoV-2 and Influenza viruses in confirmed COVID-19 patients in Abadan, Iran. They referred to the centers for COVID-19 detection at Abadan University of Medical Sciences in Southwest Iran. Nasopharyngeal and oropharyngeal throat swabs were collected from each person and tested for Influenza A using a multiplex Real Time-Polymerase Chain Reaction.
Results
In this study, among 40 SARS-CoV-2-positive cases, 2 patients (5%) were co-infected with influenza A virus.
Conclusion
The low frequency of influenza in our study could be due to the small sample size, which is one of the main limitations of our study. Also, other respiratory tract infections were not investigated in this study.

Technical Priorities for Orthopaedic Trauma Care Development in Malawi

Kiran J. Agarwal- Harding — 2024-10-14

Introduction
Malawi has a high and rising incidence of musculoskeletal injuries and inadequate orthopaedic trauma care capacity, which must be urgently addressed.
Methods
We performed a scoping literature review to define essential goals and challenges to musculoskeletal trauma care delivery in Malawi pertaining to the following domains: injury prevention, prehospital care, rural health centres, district hospitals, and central hospitals. For each domain, essential goals were ratified and challenges were prioritized by a panel of experts on Malawian orthopaedic trauma care.
Results
The five highest priorities pertained to injury prevention (2), central hospital-level definitive treatment (2), and district hospital-level initial fracture management (1). We believe the next steps are to use the prioritized list of challenges to form working groups with the goal of examining and developing strategies to address each challenge. For the top priority challenges in each domain, we recommend the following: 1) Prevent road injuries by law enforcement, children’s education, civic engagement, and road infrastructure development; 2) Improve pre-hospital transportation by scaling up emergency dispatch systems, fixing broken ambulances, and training public transportation workers in basic first aid; 3) Provide health workers in Rural Health Centres with basic training in musculoskeletal injury management and triage; 4) Improve diagnostic x-ray capacity at District Hospitals by fixing/replacing broken machinery and ensuring stable power supply; 5) Improve operative capacity at Central Hospitals by increasing operating theatre availability, efficiency, and utilization, and supporting specialist surgical training programmes.
Discussion
We hope that this manuscript will serve as a practical, actionable guide for policymakers, donors, health system leaders, educators and orthopaedic trauma care providers. Through this process, we also hope to create a replicable methodology and framework that can be applied to other clinical departments in Malawi, and for similar work in other low- and middle-income countries.

Do serum Delta-Neutrophil Index and Neutrophil-to-Lymphocyte ratio predict fetal growth restriction?

Seval Yılmaz Ergani — 2024-10-14

Aım
To investigate the prognostic significance of delta-neutrophil index (DNI) and neutrophil/lymphocyte ratio (NLR) in women with intrauterine growth retardation (IUGR) and normal pregnant women.
Methods
Normal pregnant women who delivered at Health Sciences University Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between January 2015 and July 2020 and pregnant women with IUGR were included in the study. 486 pregnant women and 400 normally pregnant women diagnosed with IUGR according to Delphi criteria were included in the analysis. Data available at presentation for delivery or within four weeks before delivery were used for analysis of DNI and other laboratory values in both the patient and control groups.
Results
The mean age of study group was 28.3±4.6 and control group was 27.2±5.6 years. There were significant differences between the study and control groups regarding maternal age, prepregnancy BMI, BMI at delivery and gestational age at admission and delivery, hemoglobin(Hb) levels, hematocrit (Hct) values,WBC values, lymphocyte,monocyte,neutrophile,thrombocyte counts, NLRs, DNI values, between the two groups. The median NLRs were 4.6 (range, 1.54±44.29), the mean DNI value of IUGR was --0.26±3.4 and the mean DNI value of control group was -3.7±5.8 (p<0.001, p<0.001, respectively). The NLR and DNI levels are significantly higher in the IUGR group. The optimal cut-off value for NLR was 3.84, with a sensitivity of 70.6% a specificity of 70.5%, and an area under the receiver operating characteristic curve of 0.780. The optimal cutoff value for DNI was -1.18, with a sensitivity of 53.9%, a specificity of 52%, and an area under the ROC curve of 0.692. The Odds Ratio of the DNI was 1.2, and NLR was 5.7.
Conclusıon
Considering its sensitivity and specificity, the NLR value shows that inflammatory events are much more effective in pregnant women with IUGR than we thought.

The correlation between children’s health literacy level and healthy eating self-efficacy

Necla KASIMOĞLU — 2024-10-14

Background
The school environment provides an important opportunity for children and educators to develop health education and health literacy the ability to make rational health decisions and identify and determine factors that affect health. The aim of this study is to determine the correlation between health literacy and eating self-efficacy levels of primary school students and the affecting factors.
Methods
The study was conducted with 486 fourth graders studying in a primary school located in eastern Turkey between September 2021 and June 2022. The data were collected through face-to-face interviews using the Personal Information Form, the Health Literacy for School-Age Children Scale (HLSAC), and the Healthy Eating Self-Efficacy Scale for Children (HESES-C). Data were analyzed by number, percentage, mean, independent samples t-test, non-parametric Mann–Whitney U and Kruskal–Wallis tests, and Pearson’s correlation tests.
Results
The gender of the students and the education level of their mothers had a statistically significant correlation with their mean HESES-C and HLSAC scores scores (p<0.05). There was a significant negative correlation between the students’ HLSAC and their HESES-C mean scores.
Conclusions
According to the findings of the study, the students had a moderate level of health literacy and a low level of healthy eating self-efficacy. There was a negative relationship between health literacy levels and healthy eating self-efficacy.

The utilization of c-type natriuretic peptide levels on experimental muscle and kidney ischemia/reperfusion model

Özlem Çakırköse — 2024-10-14

Introduction
C-type Natriuretic Peptide (CNP) is the third natriuretic peptide (NP) identified from the nervous system and endothelial cells. CNP is believed to be produced locally in tubular cells and glomeruli of kidneys. We aim to determine the clinical value of CNP levels at lower extremity muscle ischemia/reperfusion (I/R), kidney I/R, and both I/R models and evaluate them in laboratory practices.
Method
This study is an original experimental study and was carried out on a total of 40 rats. (8-12 weeks and 321±69 gr). The rats were assigned into 5 groups, each containing 8 rats. CNP levels in the plasma were evaluated in the control group. CNP and muscle biopsies were held after ischemia/reperfusion from the left lower extremity in Group E and bilateral muscle ischemia/reperfusion in Group BE. CNP and renal biopsies were held after right nephrectomy+left renal I/R at Group R. CNP, muscle, and renal biopsies were held after right nefrectomy+left renal ischemia+bilateral renal ischemia in Group BER.
Results
The plasma level of CNP in the control group was determined as 144.99±33.04 pg/ml. There was no significant difference between groups at plasma CNP levels in predicting ischemia. Although in terms of reperfusion between Control-Group E, Control-Group BER, Group E-Group BE, Group E-Group R, Group BE-Group BER, Group R-Group BER; statistical significance was determined (p<0.05).
Conclusion
This study suggests that as a laboratory test, the endothelial-derived vasodilator CNP level cannot predict the location and degree of muscle and renal ischemia at the specified time. Similarly, the CNP level is valuable in evaluating adjunct muscle reperfusion to renal reperfusion. As a result, CNP levels may not be useful in predicting ischemia at a particular period, but they can be used to predict reperfusion.

Determining the relationship between Orthorexia Nervosa risk and body image in pregnancy

Pınar ÇİÇEKOĞLU ÖZTÜRK — 2024-10-14

Background
Pregnancy is a process that involves social, psychological, and physical changes which may be a turning point for improvement or onset/relapse of eating disorders. Studies conducted have emphasized that, in addition to classical eating disorders (anorexia nervosa and bulimia nervosa), new types (e.g., orthorexia nervosa) and subclinical disorders are also seen in pregnant women. Based on this information, this is a descriptive study that was carried out to determine the relationship between the risk of orthorexia in pregnant women and body image.
Material-Method
The study included pregnant women receiving prenatal care at the obstetrics polyclinics of a state hospital in a province (n=175). After applying the first test on the pregnant women (in their first trimester), the posttests were carried out after the 30th week covering the third trimester of pregnancy. ORTO-11 scale, the Eating Attitude Test (EAT-40), and the Pregnancy Self-Perception Scale were used in data collection.
Results
The mean age of the pregnant women who participated in the study was 27.02±5.02. The mean first-test ORTO-11 score of the participants was 29.29±3.77, and their mean post-test ORTO-11 score was 26.58±4.08, while the difference was statistically significant, and the concerns of the pregnant women in their final trimester regarding eating healthy were higher than those when they first learned about their pregnancy. Among the pregnant women in their final trimester, the mean EAT-40 score was 19.64±8.66, the mean pregnancy motherhood perception dimension score was 25.30±2.97, and the mean pregnancy body perception dimension score was 15.39±4.00.
Conclusion
Based on the data of the study, it may be stated that the pregnant women in their final trimester had obsessions about healthy eating, and they had a negative perception of the changes in their bodies. Disorders in eating attitudes in pregnancy may significantly affect the outcomes of pregnancy and newborn health.

Suicide in Malawi- another example of dispensability of men?

Adamson S. Muula — 2024-10-14

A 2021 article by Banda et al, presented the growing epidemic of suicide in Malawi. She and her co-authors proposed interventions to curb the suicide outbreak in Malawi. In fact, if we follow the traditional definition of an “outbreak”, suicide in Malawi has passed the outbreak stage. It has now become endemic, and much more so among males.

Provision of sexual and reproductive health services to internally displaced women and refugees in Africa: a systematic review

Atenchong Ngwibete — 2024-09-30

Aim
The objective of this review is to identify the types of sexual and reproductive health (SRH) services that had been provided to internally displaced persons(IDP) and refugees in Africa, the key stakeholders and partners who provide these services, and the modes of service delivery.
Method
A systematic review was done using published quantitative and qualitative study designs, and grey literature, the provision and delivery of SRH services for displaced persons was reviewed. Studies included met at least two criteria. Only studies carried out from 2010 till date were included. Data of interest were extracted and the mixed-methods appraisal tool (MMAT) was used to evaluate the quality of each study. Primary outcomes included SRH services delivery, including family planning services; sexually transmitted infections (STI); reproductive cancer prevention, diagnosis, care and treatment; and response to sexual gender-based violence (SGBV).
Results
Twenty-one publications met the criteria for the review. While some SRH services are available for women in IDP and refugee camps, adolescent SRH services, preventive care for gynaecological cancers and voluntary abortion care were generally not available. Service delivery was faced with some limitations, including lack of funds, authorization and policy issues, training gaps and lack of supplies. Nurses, midwives, community health workers (CHWs) and lay refugees were the key personnel providing services. They were overworked in most places. Services were primarily funded by the United Nations (UN) and non-governmental organizations (NGOs), but governments, private enterprises and community-based organizations (CBO) worked together to provide care.
Conclusion
There is a need to expand service delivery for women IDPs and refugees in Africa to include comprehensive SRH care. Deploying more qualified/trained personnel can improve the effectiveness and reliability of the care provided. Better funding for SRH care can help to improve service delivery and the incorporation of other aspects of SRH into care provision.

Establishment of routine image interpretation presentation for radiographers in the Radiology department, Mzuzu Central Hospital

Jin Shang — 2024-10-14

Objective
By establishing routine image interpretation presentation in the Radiology Department of Mzuzu Central Hospital (MCH), radiographers can conduct technical analysis and quality control of DR, CT among other medical imaging techniques used in clinical practice, which can effectively improve the overall level of radiographers.
Methods
Formulate the general principles of radiographer image interpretation for the Radiology Department: (1) Select typical cases and special cases to analyze the examination methods and image standard interpretation; (2) Select cases that individuals have done relatively satisfactory or unsatisfactory, or even failed to analyze the lessons learned; (3) Select normal cases to identify important imaging anatomy and describe imaging manifestations, so as to improve the basic knowledge level of imaging diagnosis and the ability to interpret images. Secondly, establish an imaging technology reading system under the perspective of new media, and extend it to real-time discussion of technical issues in an online chat group.
Results
(1) Through image interpretation, the overall quality of radiographers have been significantly improved; (2) Through continuous learning of the imaging manifestations of typical cases, the level of imaging diagnosis can be effectively improved; (3) Find out the causes of some failed examinations, put forward rectification suggestions, and avoid mistakes again; (4) Special patients and special patients formulate personalized plans based on common practical experience to quickly complete the examination.
Conclusion
By establishing routine image interpretation presentations for radiographers and incorporating new media perspectives into image interpretation, we have observed higher levels of radiographer participation in learning discussions within technical groups. This approach has significantly improved the comprehensive business capabilities of radiographers and fostered greater unity within the technical team.