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[PMID]: 29178197 [Au] Autor: MacKenzie RK; van Lettow M; Gondwe C; Nyirongo J; Singano V; Banda V; Thaulo E; Beyene T; Agarwal M; McKenney A; Hrapcak S; Garone D; Sodhi SK; Chan AK [Ad] Endereço: Dignitas International, Zomba, Malawi. [Ti] Título: Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi. [So] Source: J Int AIDS Soc;20(3), 2017 Nov. [Is] ISSN: 1758-2652 [Cp] País de publicação: Switzerland [La] Idioma: eng [Ab] Resumo: INTRODUCTION: There are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care. METHODS: We conducted a nested case-control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow-up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non-retained) cases and 405 (retained) controls were selected. RESULTS: In multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11). CONCLUSIONS: This study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low- and middle-income settings to prioritize interventions for ALHIV and determine their cost-effectiveness. [Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico Infecções por HIV/tratamento farmacológico Aceitação pelo Paciente de Cuidados de Saúde Padrão de Cuidado [Mh] Termos MeSH secundário: Adolescente Instituições de Assistência Ambulatorial Estudos de Casos e Controles Feminino Seres Humanos Malaui Masculino Estudos Prospectivos Estudos Retrospectivos Grupos de Autoajuda Centros de Atenção Terciária Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-HIV Agents) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180307 [Lr] Data última revisão: 180307 [Sb] Subgrupo de revista: IM; X [Da] Data de entrada para processamento: 171128 [St] Status: MEDLINE [do] DOI: 10.1002/jia2.25028

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[PMID]: 29351299 [Au] Autor: Lungu EA; Guda Obse A; Darker C; Biesma R [Ad] Endereço: HIV/AIDS Section, UNICEF Malawi, Lilongwe, Malawi. [Ti] Título: What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment. [So] Source: PLoS One;13(1):e0189940, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (ß = 0.842, p<0.001) and thorough examination of the child (ß = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8-$13) and MK2049.13 ($6) (95% CI: $3-$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums. [Mh] Termos MeSH primário: Cuidadores/psicologia Serviços de Saúde da Criança Comportamento de Escolha Pobreza População Urbana [Mh] Termos MeSH secundário: Adolescente Adulto Serviços de Saúde da Criança/economia Pré-Escolar Financiamento Pessoal Seres Humanos Lactente Estudos Longitudinais Malaui Inquéritos e Questionários Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180215 [Lr] Data última revisão: 180215 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180120 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0189940

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[PMID]: 29373574 [Au] Autor: Tweya H; Oboho IK; Gugsa ST; Phiri S; Rambiki E; Banda R; Mwafilaso J; Munthali C; Gupta S; Bateganya M; Maida A [Ad] Endereço: The International Union Against Tuberculosis and Lung Disease, Paris, France. [Ti] Título: Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi. [So] Source: PLoS One;13(1):e0188488, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients' demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi. METHODS: We conducted a retrospective cohort study of HIV-infected individuals aged 15 years or older at the time of registration for HIV care in 12 ART facilities, between April 2012 and March 2013. HIV-positive individuals who had not started ART (pre-ART patients) were clinically assessed to determine ART eligibility at registration and during clinic follow-up visits. ART-eligible patients were initiated on triple antiretroviral combination. Study data were abstracted from patients' cards, facility ART registers or electronic medical record system from the date of registration for HIV care to a maximum follow-up period of 24 months. Descriptive statistics were undertaken to summarize characteristics of the study patients. Separate univariable and multivariable poisson regression models were used to explore factors associated with LTFU in pre-ART and ART care. RESULTS: A total of 10,812 HIV-infected individuals registered for HIV care. Of these patients, 1,907 (18%) and 8,905 (82%) enrolled in pre-ART and ART care, respectively. Of the 1,907 pre-ART patients, 490 (26%) subsequently initiated ART and were included in both the pre-ART and ART analyses. The LTFU rates among patients in pre-ART and ART care were 48 and 26 per 100 person-years, respectively. Of the 9,105 ART patients with reasons for starting ART, 2,451 (27%) were initiated on ART because of pregnancy or breastfeeding (Option B+) status. Multivariable analysis showed that being ≥35 years and female were associated with decreased risk of LTFU in the pre-ART and ART phases of HIV care. However, being in WHO clinical stage 3 (adjusted risk ratio (aRR) 1.35, 95% confidence interval (CI): 1.20-1.51) and stage 4 (aRR 1.87, 95% CI: 1.62-2.18), body mass index ≤ 18.4 (aRR 1.24, 95% CI: 1.11-1.39) at ART initiation, poor adherence to clinic appointments (aRR 4.55, 95% CI: 4.16-4.97) and receiving HIV care in rural facilities (aRR 2.32, 95% CI: 1.94-2.87) were associated with increased risk of LTFU among ART patients. Being re-initiated on ART once (aRR 0.20, 95% CI: 0.17-0.22), more than once (aRR 0.06, 95% CI: 0.05-0.07), and being enrolled at a low-volume facility (aRR 0.25, 95% CI: 0.20-0.30) were associated with decreased risk of LTFU from ART care. CONCLUSION: A sizeable proportion of ART LTFU occurred among women enrolled during pregnancy or breast-feeding. Non- compliance to clinic and receiving ART in a rural facility or high-volume facility were associated with increased risk of LTFU from ART care. Developing effective interventions that target high-risk subgroups and contexts may help reduce LTFU from HIV care. [Mh] Termos MeSH primário: Infecções por HIV/tratamento farmacológico Perda de Seguimento [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Fármacos Anti-HIV/uso terapêutico Estudos de Coortes Feminino Seguimentos Infecções por HIV/complicações Seres Humanos Malaui Masculino Meia-Idade Cooperação do Paciente Gravidez Complicações Infecciosas na Gravidez/tratamento farmacológico Estudos Retrospectivos Fatores de Risco Serviços de Saúde Rural Serviços Urbanos de Saúde Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Anti-HIV Agents) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180213 [Lr] Data última revisão: 180213 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180127 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0188488

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[PMID]: 29216183 [Au] Autor: MacLennan CA; Msefula CL; Gondwe EN; Gilchrist JJ; Pensulo P; Mandala WL; Mwimaniwa G; Banda M; Kenny J; Wilson LK; Phiri A; MacLennan JM; Molyneux EM; Molyneux ME; Graham SM [Ad] Endereço: Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. [Ti] Título: Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. [So] Source: PLoS Negl Trop Dis;11(12):e0006027, 2017 12. [Is] ISSN: 1935-2735 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8-35.1), dyspnea (OR 4.2; 95%CI 1.5-12.0) and HIV infection (OR 3.3; 95%CI 1.1-10.2) were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children. [Mh] Termos MeSH primário: Bacteriemia/epidemiologia Infecções por HIV/complicações Meningites Bacterianas/epidemiologia Infecções por Salmonella/epidemiologia Salmonella/imunologia [Mh] Termos MeSH secundário: Adolescente Bacteriemia/etiologia Bacteriemia/microbiologia Bacteriemia/mortalidade Criança Pré-Escolar Farmacorresistência Bacteriana Múltipla Feminino Seres Humanos Lactente Modelos Logísticos Malaui/epidemiologia Masculino Meningites Bacterianas/etiologia Meningites Bacterianas/microbiologia Meningites Bacterianas/mortalidade Prevalência Estudos Prospectivos Fatores de Risco Salmonella/isolamento & purificação Infecções por Salmonella/etiologia Infecções por Salmonella/microbiologia Infecções por Salmonella/mortalidade Sorogrupo [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180212 [Lr] Data última revisão: 180212 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171208 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pntd.0006027

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[PMID]: 29300755 [Au] Autor: Vetrini D; Kiire CA; Burgess PI; Harding SP; Kayange PC; Kalua K; Msukwa G; Beare NAV; Madan J [Ad] Endereço: SDA Bocconi School of Management, Bocconi University, Milan, Italy. [Ti] Título: Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. [So] Source: PLoS One;13(1):e0190742, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa. MATERIALS AND METHODS: A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed. RESULTS: In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%. CONCLUSIONS: Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients. [Mh] Termos MeSH primário: Análise Custo-Benefício Retinopatia Diabética/economia Terapia a Laser/economia Edema Macular/economia Programas de Rastreamento/economia [Mh] Termos MeSH secundário: Adulto Fatores Etários Retinopatia Diabética/diagnóstico Retinopatia Diabética/terapia Seres Humanos Edema Macular/diagnóstico Edema Macular/terapia Malaui Cadeias de Markov Meia-Idade Estudos Prospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180210 [Lr] Data última revisão: 180210 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180105 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0190742

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[PMID]: 29287122 [Au] Autor: Bennett A; Nagelkerke N; Heinsbroek E; Premkumar PS; Wnek M; Kang G; French N; Cunliffe NA; Bar-Zeev N; Lopman B; Iturriza-Gomara M [Ad] Endereço: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi. [Ti] Título: Estimating the incidence of rotavirus infection in children from India and Malawi from serial anti-rotavirus IgA titres. [So] Source: PLoS One;12(12):e0190256, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Accurate estimates of rotavirus incidence in infants are crucial given disparities in rotavirus vaccine effectiveness from low-income settings. Sero-surveys are a pragmatic means of estimating incidence however serological data is prone to misclassification. This study used mixture models to estimate incidence of rotavirus infection from anti-rotavirus immunoglobulin A (IgA) titres in infants from Vellore, India, and Karonga, Malawi. IgA titres were measured using serum samples collected at 6 month intervals for 36 months from 373 infants from Vellore and 12 months from 66 infants from Karonga. Mixture models (two component Gaussian mixture distributions) were fit to the difference in titres between time points to estimate risk of sero-positivity and derive incidence estimates. A peak incidence of 1.05(95% confidence interval [CI]: 0.64, 1.64) infections per child-year was observed in the first 6 months of life in Vellore. This declined incrementally with each subsequent time interval. Contrastingly in Karonga incidence was greatest in the second 6 months of life (1.41 infections per child year [95% CI: 0.79, 2.29]). This study demonstrates that infants from Vellore experience peak rotavirus incidence earlier than those from Karonga. Identifying such differences in transmission patterns is important in informing vaccine strategy, particularly where vaccine effectiveness is modest. [Mh] Termos MeSH primário: Imunoglobulina A/sangue Infecções por Rotavirus/epidemiologia Rotavirus/imunologia [Mh] Termos MeSH secundário: Seres Humanos Incidência Índia/epidemiologia Lactente Recém-Nascido Malaui/epidemiologia Vacinas contra Rotavirus/imunologia [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Immunoglobulin A); 0 (Rotavirus Vaccines) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180207 [Lr] Data última revisão: 180207 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171230 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0190256

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[PMID]: 29281710 [Au] Autor: Pecenka C; Munthali S; Chunga P; Levin A; Morgan W; Lambach P; Bhat N; Neuzil KM; Ortiz JR; Hutubessy R [Ad] Endereço: Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America. [Ti] Título: Maternal influenza immunization in Malawi: Piloting a maternal influenza immunization program costing tool by examining a prospective program. [So] Source: PLoS One;12(12):e0190006, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: This costing study in Malawi is a first evaluation of a Maternal Influenza Immunization Program Costing Tool (Costing Tool) for maternal immunization. The tool was designed to help low- and middle-income countries plan for maternal influenza immunization programs that differ from infant vaccination programs because of differences in the target population and potential differences in delivery strategy or venue. METHODS: This analysis examines the incremental costs of a prospective seasonal maternal influenza immunization program that is added to a successful routine childhood immunization and antenatal care program. The Costing Tool estimates financial and economic costs for different vaccine delivery scenarios for each of the major components of the expanded immunization program. RESULTS: In our base scenario, which specifies a donated single dose pre-filled vaccine formulation, the total financial cost of a program that would reach 2.3 million women is approximately $1.2 million over five years. The economic cost of the program, including the donated vaccine, is $10.4 million over the same period. The financial and economic costs per immunized pregnancy are $0.52 and $4.58, respectively. Other scenarios examine lower vaccine uptake, reaching 1.2 million women, and a vaccine purchased at $2.80 per dose with an alternative presentation. CONCLUSION: This study estimates the financial and economic costs associated with a prospective maternal influenza immunization program in a low-income country. In some scenarios, the incremental delivery cost of a maternal influenza immunization program may be as low as some estimates of childhood vaccination programs, assuming the routine childhood immunization and antenatal care systems are capable of serving as the platform for an additional vaccination program. However, purchasing influenza vaccines at the prices assumed in this analysis, instead of having them donated, is likely to be challenging for lower-income countries. This result should be considered as a starting point to understanding the costs of maternal immunization programs in low- and middle-income countries. [Mh] Termos MeSH primário: Programas de Imunização/economia Vacinas contra Influenza/administração & dosagem [Mh] Termos MeSH secundário: Feminino Seres Humanos Malaui Projetos Piloto Gravidez Estudos Prospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Influenza Vaccines) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180206 [Lr] Data última revisão: 180206 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171228 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0190006

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[PMID]: 28464837 [Au] Autor: Makuuchi R; Jere S; Hasejima N; Chigeda T; Gausi J [Ad] Endereço: Nippon International Cooperation for Community Development, 101 Nishi-rokkaku-cho, Nakagyo-ku, Kyoto, 604-8217, Japan. makuuchiryoko@gmail.com. [Ti] Título: The correlation between malaria RDT (Paracheck pf.®) faint test bands and microscopy in the diagnosis of malaria in Malawi. [So] Source: BMC Infect Dis;17(1):317, 2017 05 02. [Is] ISSN: 1471-2334 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Faint test bands of Paracheck Pf.® are interpreted as malaria positive according to world health organization (WHO) guideline. However if there are conspicuous number of faint test bands, a performance of Paracheck Pf.® could be influenced depending on whether interpreting faint test bands as malaria positive or negative. Finding out the frequency and accurate interpretation of faint test bands are important to prevent the overdiagnosis and drug resistance. METHODS: A cross-sectional, descriptive study was conducted to find out the frequency of faint test bands and evaluate the performance of Paracheck Pf.® by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of diagnosis of Paracheck Pf.® using microscopy as the gold standard. 388 suspected patients with malaria in Malawi were recruited in this study. Malaria rapid diagnostic tests (RDTs) and microscopy were used and patients' information which includes age, sex, body temperature and signs or symptoms of malaria were recorded. RESULTS: Among all patients involved in the study, 29.1% (113/388) were found malaria positive by RDT. Overall 5.4% (21/388) of all Paracheck Pf.® tests resulted in a "faint test band" and 85.7% (18/21) corresponded with malaria negative by microscopy. Faint test bands which corresponded with malaria positive by microscopy were lower parasite density and there are no patients who showed definitive symptom of malaria, such as fever. When Paracheck Pf.® "faint test bands" were classified as positive, accuracy of diagnosis was 76.5% (95% CI 72%-80.7%) as compared to 80.4% (95% CI 76.1%-84.2%) when Paracheck Pf.® "faint test bands" were classified as negative. CONCLUSIONS: This study shows that frequency of faint test bands is 5.4% in all malaria RDTs. The accuracy of diagnosis was improved when faint test bands were interpreted as malaria negative. However information and data obtained in this study may not be enough and more intensive research including a frequency and property of faint test bands is needed for significant interpretation of faint test bands. [Mh] Termos MeSH primário: Malária/diagnóstico Kit de Reagentes para Diagnóstico [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Criança Pré-Escolar Estudos Transversais Testes Diagnósticos de Rotina/métodos Feminino Febre/diagnóstico por imagem Febre/etiologia Seres Humanos Malária/etiologia Malária Falciparum/diagnóstico Malaui Masculino Microscopia/métodos Meia-Idade Exame Físico Sensibilidade e Especificidade Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Reagent Kits, Diagnostic) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 180120 [Lr] Data última revisão: 180120 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170504 [St] Status: MEDLINE [do] DOI: 10.1186/s12879-017-2413-x

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[PMID]: 29267304 [Au] Autor: Hunt L; Mulwafu W; Knott V; Ndamala CB; Naunje AW; Dewhurst S; Hall A; Mortimer K [Ad] Endereço: Liverpool School of Tropical Medicine, Liverpool, United Kingdom. [Ti] Título: Prevalence of paediatric chronic suppurative otitis media and hearing impairment in rural Malawi: A cross-sectional survey. [So] Source: PLoS One;12(12):e0188950, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population. METHODS: We performed a community-based cross-sectional study of children aged 4-6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz. RESULTS: We recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2-8.6), 24.5% (95%CI 16.3-30.0), and 12.5% (95%CI 6.2-16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children. INTERPRETATION: We found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population. [Mh] Termos MeSH primário: Perda Auditiva/epidemiologia Otite Média Supurativa/epidemiologia População Rural [Mh] Termos MeSH secundário: Criança Pré-Escolar Doença Crônica Análise por Conglomerados Estudos Transversais Feminino Perda Auditiva/etiologia Seres Humanos Malaui/epidemiologia Masculino Otite Média Supurativa/complicações Otoscopia [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180116 [Lr] Data última revisão: 180116 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171222 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0188950

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[PMID]: 27771822 [Au] Autor: Kohler RE; Tomlinson J; Chilunjika TE; Young S; Hosseinipour M; Lee CN [Ad] Endereço: Harvard TH Chan School of Public Health; Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02115, USA. Racquel_kohler@dfci.harvard.edu. [Ti] Título: "Life is at a standstill" Quality of life after lower extremity trauma in Malawi. [So] Source: Qual Life Res;26(4):1027-1035, 2017 04. [Is] ISSN: 1573-2649 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: PURPOSE: Low- and middle-income countries face a disproportionate burden of death and disability from injuries, many of which are due to road traffic accidents or falls. Lower extremity injuries in particular have implications not only for physical disabilities affecting work and school performance, but also for quality of life (QOL) of the individual. This qualitative study explores the psychosocial impact and QOL changes due to lower extremity injuries among trauma patients in central Malawi. METHODS: We transcribed and translated interviews with 20 patients who received care for a trauma to the lower extremity at a tertiary hospital in Lilongwe. We used NVivo to organize and thematically analyze the data. RESULTS: Participants reported limitations in physical functioning, activities of daily living, social roles, and vocational and social activities. Limited mobility led to unplanned long-term disruptions in work, personal financial loss, and household economic hardship. As a result, psychological distress, fears and worries about recovery, and poor perceptions of health and QOL were common. Several contextual factors influenced patient outcomes including socioeconomic status, religious beliefs, social networks, local landscape, housing structures, and transportation accessibility. CONCLUSION: Lower extremity trauma led to physical suffering and ongoing social and economic costs among Malawians. Injuries affecting mobility have broad QOL and economic consequences for patients and affected family members. Interventions are needed to improve post-injury recovery and QOL. Better access to trauma surgery and social and welfare support services for people living with disabling conditions are needed to alleviate the consequences of injuries. [Mh] Termos MeSH primário: Atividades Cotidianas Transtornos de Ansiedade/psicologia Traumatismos da Perna/psicologia Qualidade de Vida [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Feminino Seres Humanos Escala de Gravidade do Ferimento Entrevistas como Assunto Malaui Masculino Meia-Idade Apoio Social Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 180110 [Lr] Data última revisão: 180110 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161025 [St] Status: MEDLINE [do] DOI: 10.1007/s11136-016-1431-2

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