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McCollum E.D.,University of Malawi | Bjornstad E.,University of Malawi | Preidis G.A.,Baylor College of Medicine | Hosseinipour M.C.,University of North Carolina at Chapel Hill | Lufesi N.,Community Health science Unit
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Background: Although hypoxemic children have high mortality, little is known about hypoxemia prevalence and oxygen administration in African hospitals. We aimed to determine the hypoxemia prevalence and quality of oxygen treatment by local clinicians for hospitalized Malawian children. Methods: The study was conducted in five Malawian hospitals during January-April 2011. We prospectively measured the peripheral oxygen saturation (SpO2) using pulse oximetry for all children, 15 years old and also determined clinical eligibility for oxygen treatment using WHO criteria for children, 5 years old. We determined oxygen treatment quality by Malawian clinicians by comparing their use of WHO criteria for patients, 5 years old using two standards: hypoxemia (SpO2, 90%) and the use of WHO criteria by study staff. Results: Forty of 761 (5.3%) hospitalized children, 15 years old had SpO2, 90%. No hospital used pulse oximetry routinely, and only 9 of 40 (22.5%) patients, 15 years old with SpO2, 90% were treated with oxygen by hospital staff. Study personnel using WHO criteria for children, 5 years old achieved a higher sensitivity (40.0%) and lower specificity (82.7%) than Malawian clinicians (sensitivity 25.7%, specificity 94.1%). Conclusion: Although hypoxemia is common, the absence of routine pulse oximetry results in most hospitalized, hypoxemic Malawian children not receiving available oxygen treatment. © Royal Society of Tropical Medicine and Hygiene 2013. All rights reserved. Source

Nsona H.,Community Health science Unit | Mleme T.,National Statistical Office | Jamali A.,National Statistical Office
American Journal of Tropical Medicine and Hygiene | Year: 2015

Program managers, investors, and evaluators need real-time information on how program strategies are being scaled up and implemented. Integrated Community Case Management (iCCM) of childhood illnesses is a strategy for increasing access to diagnosis and treatment of malaria, pneumonia, and diarrhea through community-based health workers. We collected real-time data on iCCM implementation strength through cell phone interviews with communitybased health workers in Malawi and calculated indicators of implementation strength and utilization at district level using consensus definitions from the Ministry of Health (MOH) and iCCM partners. All of the iCCM implementation strength indicators varied widely within and across districts. Results show that Malawi has made substantial progress in the scale-up of iCCM since the 2008 program launch. However, there are wide differences in iCCM implementation strength by district. Districts that performed well according to the survey measures demonstrate that MOH implementation strength targets are achievable with the right combination of supportive structures. Using the survey results, specific districts can now be targeted with additional support. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene. Source

Chinkhumba J.,Malaria Alert Center | Skarbinski J.,Centers for Disease Control and Prevention | Chilima B.,Community Health science Unit | Campbell C.,Centers for Disease Control and Prevention | And 6 more authors.
Malaria Journal | Year: 2010

Background. Malaria rapid diagnostics tests (RDTs) can increase availability of laboratory-based diagnosis and improve the overall management of febrile patients in malaria endemic areas. In preparation to scale-up RDTs in health facilities in Malawi, an evaluation of four RDTs to help guide national-level decision-making was conducted. Methods. A cross sectional study of four histidine rich-protein-type-2- (HRP2) based RDTs at four health centres in Blantyre, Malawi, was undertaken to evaluate the sensitivity and specificity of RDTs, assess prescriber adherence to RDT test results and explore operational issues regarding RDT implementation. Three RDTs were evaluated in only one health centre each and one RDT was evaluated in two health centres. Light microscopy in a reference laboratory was used as the gold standard. Results. A total of 2,576 patients were included in the analysis. All of the RDTs tested had relatively high sensitivity for detecting any parasitaemia [Bioline SD (97%), First response malaria (92%), Paracheck (91%), ICT diagnostics (90%)], but low specificity [Bioline SD (39%), First response malaria (42%), Paracheck (68%), ICT diagnostics (54%)]. Specificity was significantly lower in patients who self-treated with an anti-malarial in the previous two weeks (odds ratio (OR) 0.5; p-value < 0.001), patients 5-15 years old versus patients > 15 years old (OR 0.4, p-value < 0.001) and when the RDT was performed by a community health worker versus a laboratory technician (OR 0.4; p-value < 0.001). Health workers correctly prescribed anti-malarials for patients with positive RDT results, but ignored negative RDT results with 58% of patients with a negative RDT result treated with an anti-malarial. Conclusions. The results of this evaluation, combined with other published data and global recommendations, have been used to select RDTs for national scale-up. In addition, the study identified some key issues that need to be further delineated: the low field specificity of RDTs, variable RDT performance by different cadres of health workers and the need for a robust quality assurance system. Close monitoring of RDT scale-up will be needed to ensure that RDTs truly improve malaria case management. © 2010 Chinkhumba et al; licensee BioMed Central Ltd. Source

La Vincente S.F.,University of Melbourne | Peel D.,Ashdown Consultants | Carai S.,World Health Organization | Weber M.W.,World Health Organization | And 5 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2011

SETTING: The paediatric wards of hospitals in Malawi and Mongolia. OBJECTIVE: To describe oxygen concentrator functioning in two countries with widespread, long-term use of concentrators as a primary source of oxygen for treating children. DESIGN: A systematic assessment of concentrators in the paediatric wards of 15 hospitals in Malawi and nine hospitals in Mongolia. RESULTS: Oxygen concentrators had been installed for a median of 48 months (interquartile range [IQR] 6-60) and 36 months (IQR 12-96), respectively, prior to the evaluation in Malawi and Mongolia. Concentrators were the primary source of oxygen. Three quarters of the concentrators assessed in Malawi (28/36) and half those assessed in Mongolia (13/25) were functional. Concentrators were found to remain functional with up to 30 000 h of use. However, several concentrators were functioning very poorly despite limited use. Concentrators from a number of different manufacturers were evaluated, and there was marked variation in performance between brands. Inadequate resources for maintenance were reported in both countries. CONCLUSION: Years after installation of oxygen concentrators, many machines were still functioning, indicating that widespread use can be sustained in resourcelimited settings. However, concentrator performance varied substantially. Procurement of high-quality and appropriate equipment is critical, and resources should be made available for ongoing maintenance. © 2011 The Union. Source

Kohler I.V.,University of Pennsylvania | Soldo B.J.,University of Pennsylvania | Anglewicz P.,Tulane University | Chilima B.,Community Health science Unit | Kohler H.-P.,University of Pennsylvania
Population Health Metrics | Year: 2013

Background: The objective of these analyses is to document the relationship between biomarker-based indicators of health and socioeconomic status (SES) in a low-income African population where the cumulative effects of exposure to multiple stressors on physiological functions and health in general are expected to be highly detrimental for the well-being of individuals.Methods: Biomarkers were collected subsequent to the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), a population-based study in rural Malawi, including blood lipids (total cholesterol, LDL, HDL, ratio of total cholesterol to HDL), biomarkers of renal and liver organ function (albumin and creatinine) and wide-range C-reactive protein (CRP) as a non-specific biomarker for inflammation. These biomarkers represent widely used indicators of health that are individually or cumulatively recognized as risk factors for age-related diseases among prime-aged and elderly individuals. Quantile regressions are used to estimate the age-gradient and the within-day variation of each biomarker distribution. Differences in biomarker levels by socioeconomic status are investigated using descriptive and multivariate statistics.Results: Overall, the number of significant associations between the biomarkers and socioeconomic measures is very modest. None of the biomarkers significantly varies with schooling. Except for CRP where being married is weakly associated with lower risk of having an elevated CRP level, marriage is not associated with the biomarkers measured in the MLSFH. Similarly, being Muslim is associated with a lower risk of having elevated CRP but otherwise religion does not predict being in the high-risk quartiles of any of the MLSFH biomarkers. Wealth does not predict being in the high-risk quartile of any of the MLSFH biomarkers, with the exception of a weak effect on creatinine. Being overweight or obese is associated with increased likelihood of being in the high-risk quartile for cholesterol, Chol/HDL ratio, and LDL.Conclusions: The results provide only weak evidence for variation of the biomarkers by socioeconomic indicators in a poor Malawian context. Our findings underscore the need for further research to understand the determinants of health outcomes in a poor low-income context such as rural Malawi. © 2013 Kohler et al.; licensee BioMed Central Ltd. Source

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