African
Journals Online
Malawi Medical Journal
The Journal of the College of Medicine
and Medical Association of Malawi
Volume 14 No 2 2002
ABSTRACTS
Prevalence and
indicators of HIV and AIDS among adults admitted to medical and surgical wards
in Blantyre, Malawi
DK Lewis, M Callaghan, K Phiri, J Chipwete, JG Kublin, E Borgstein, EE
Zijlstra
Abstract
Despite high seroprevalence there are few recent studies
of the effect of HIV on hospitals in sub-Saharan Africa. We examined 1226
consecutive patients admitted during two 2-week periods in October 1999 and
January 2000. 70% medical patients were HIV positive, and 45% had AIDS. 36%
surgical patients were HIV positive and 8% had AIDS. Seroprevalence rose to a
peak among 30-40 year olds; 91% medical, 56% surgical and 80% all patients in
this age group were HIV positive. Seropositive women were younger than
seropositive men (median age 29 v 35, p<0.0001). Symptoms strongly
indicative of HIV were history of shingles, chronic diarrhoea or fever or
cough, history of tuberculosis, weight loss, and persistent itchy rash
(adjusted odds ratios all over 5). Clinical signs strongly indicative of HIV
were oral hairy leukoplakia, shingles scar, Kaposi’s sarcoma, oral thrush, and
hair loss (adjusted odds ratios all over 10). Of surgical patients with ‘deep
infections’ (breast abscess, pyomyositis, osteomyelitis, septic arthritis, and
multiple abscesses), 52% were HIV positive (OR compared with other surgical
patients 2.4). Severe bacterial infections, tuberculosis, and AIDS caused 68%
deaths. HIV dominates adult medicine, is a major part of adult surgery, is the
main cause of death in hospital, and affects the economically active age group
of the population.
Changes in Escherichia coli
resistance to co-trimoxazole in tuberculosis patients and in relation to
co-trimoxazole prophylaxis in Thyolo, Malawi
R Zachariah, AD Harries, MP Spielmann, V Arendt, D Nchingula, R Mwenda, O Courtielle, P Kirpach, B Mwale, FML Salaniponi
Abstract
In Thyolo district, Malawi, an operational research study is being
conducted on the efficacy and feasibility of co-trimoxazole prophylaxis in
preventing deaths in HIV-positive patients with tuberculosis (TB). A series of
cross-sectional studies were carried out to determine i) whether faecal Escherichia coli (E.coli) resistance to co-trimoxazole in TB patients changed with
time and ii) whether the resistance pattern was different in HIV positive TB
patients who were taking co-trimoxazole prophylaxis. Co-trimoxazole resistance
among E.coli isolates in TB patients
at the time of registration was 60% in 1999 and 77% in 2001 (p<0.01). Resistance was 89% among HIV-infected TB
patients (receiving co-trimoxazole), while in HIV negative patients
(receiving anti-TB therapy alone) it
was 62% (p<0.001). The study shows a significant increase of E.coli resistance to co-trimoxazole in TB
patients which is particularly prominent in HIV infected patients on
co-trimoxazole prophylaxis. Since a high degree of plasmid-mediated transfer of
resistance exists between E.coli and
the Salmonella species, these
findings could herald limitations on the short and long term benefits to be
anticipated from the use of co-trimoxazole prophylaxis in preventing
non-typhoidal salmonella bacteraemia and enteritis in HIV infected TB patients
in Malawi.
Mortality in
smear-negative tuberculosis patients in Phalombe
JCJ Calis, ML Bakker, RB Elens, M Borgdorff, AD Harries
Abstract
In two hospitals in Malawi, where HIV prevalence among tuberculosis
patients is 80-90%, the treatment outcome in patients registered with
smear-negative pulmonary tuberculosis was determined in relation to chest x-ray
(CXR) findings and certain laboratory parameters. Of 70 patients who were
registered and treated, 32 (46%) were known to have died. Mortality was
particularly high in those with a normal / minimally abnormal CXR (62%) and in
those with a white cell count of less than 3.5 x 109 /l (77%). The
reasons for this high mortality among patients with smear-negative PTB are not
known and requires more research.
Health seeking and
sexual behaviour among patients with sexually transmitted infections - the
importance of traditional healers
R Zachariah, W Nkhoma, AD Harries, V Arendt, A Chantulo, MP Spielmann, MP Mbereko, L
Buhendwa
Abstract
We aimed to describe health seeking and sexual behaviour including
condom use among patients presenting with sexually transmitted infections (STI)
and, to identify socio-demographic and behavioural risk factors associated with
“no condom use” during the symptomatic period. A cross-sectional study of
consecutive new STI cases presenting at the district STI clinic in Thyolo were
interviewed by STI counsellors after obtaining informed consent. All patients
were treated according to National guidelines. Of 498 new STI clients, 53% had
taken some form of medication before coming to the STI clinic, the most
frequent alternative source being the traditional healer (37%). 46% of all
clients reported sex during the symptomatic period (median=14 days), the majority (74%) not using condoms. 90% of
all those who had not used condoms resided in villages and had seen only the
traditional healer. Significant risk factors associated with “no condom use”
included:visiting a traditional
healer; being female; having less than 8 years of school education; and being
resident in villages. Genital ulcer disease (GUD) was the most common STI in
males (49%) while in females this comprised 27% of STIs. These findings,
especially the extremely high GUD prevalence is of particular concern,
considering the high national HIV prevalence in Malawi (9%) and the
implications for STI and HIV transmission.
There is an urgent need to integrate traditional healers in control
activities, encourage their role in promoting safer sexual behaviour, and to
reorient or even change existing strategies on condom promotion and STI
control.
The impact of HIV
infection on childhood pneumonia: comparison between developed and developing
regions
SM Graham
Abstract
Respiratory disease is the commonest cause of morbidity and mortality
in HIV-infected children. While the pattern of HIV-related pneumonia in African
adults is well documented and is recognised as quite different from that which
occurs among HIV-infected adults in high-income regions, less is known of the
situation in children. Most children are infected by mother-to-child
transmission and presentation of HIV-related pneumonia is often in infancy or
early childhood, an age group in which confirmation of the cause of pneumonia
is difficult. However, aetiological data are important. Poor response of the
infant with severe pneumonia to standard antibiotic (such as chloramphenicol)
or of the older child with chronic pneumonia to anti-tuberculosis treatment are
two very common clinical dilemmas that many Malawian health workers would
recognise. This review aims to present the available data relevant to Malawi,
contrast with experience from the developed world and to describe common
HIV-related pneumonias such as PCP and LIP. Unlike for adults, the pattern of
HIV-related pneumonia in Malawian children may not be so different in cause
from that described for children in developed countries prior to the use of PCP
prophylaxis and anti-retroviral therapies. The most important contrast is the
higher prevalence and poorer outcome.
Revisiting
human behaviour in relation to HIV/AIDS
CR
Bandawe
Abstract
It is widely
recognised that human behaviour change is a key element in the fight against
HIV/AIDS. The reality of the situation however is that the current approaches
to instigating sexual behaviour change appear to have borne little fruit. This
paper shall argue that in the fight against HIV/AIDS, a fundamental error is
made in the numerous outreach programmes that exist within Malawi and
elsewhere. This error is grounded in the assumptions that are made about how
persons respond to the messages garnered to the control of the disease. Until
this mistaken assumption is addressed, it is argued that no serious headway
shall be made in the control of this disease, which threatens the very fabric
of the Malawi nation.
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