Abstracts of the 20th College of Medicine Research Dissemination Conference : Theme: College of Medicine Research Excellence Yesterday, Today, and Tomorrow
Sande LA., Chiwaula LS., Kambewa P., Mathanga DP., McCann RS., Mburu MM., Schluter D., Chipeta MG., Diggle PJ., Terlouw DJ., van den Berg H., Phiri K., van Vugt M., Takken W., Mzilahowa T., Luka-Banda M., Uzalili V., Mathanga DP., Campbell CH., Mukaka M., Gimnig JE., Kabaghe AN., Chipeta MG., McCann RS., Phiri KS., van Vugt M., Takken W., Diggle P., Terlouw DJ., Mathanga DP., Tembo AK., Mzilahowa T., Bauleni A., Mtimaukenena K., Taylor TE., Valim C., Walker E., Wilson ML., Nyirenda TS., Nyirenda JT., Tembo D., Storm J., Dube Q., Msefula C., MacLennan CA., Heyderman RS., Gordon MA., Mandala WL., Chirombo J., Ceccato P., Lowe R., Terlouw DJ., Thomson MC., Kathyola D., Diggle PJ., Read JM., Mzilahowa T., Chiumia M., Mbewe RB., Uzalili V., Luka M., Kutengule A., Mathanga DP., Ali D., Chiphwanya J., Zoya J., Mulenga S., Dodoli W., Bergeson-Lockwood J., Troell P., Oyugi J., Lindblade K., Gimnig JE., Mkandawire FA., Mungwira RG., Divala TH., Nyirenda OM., Kanjala M., Tsirizani LE., Muwalo F., Ndembi N., Taylor TE., Mallewa J., van Oosterhout JJ., Laurens MB., Laufer MK., Mzilahowa T., Gowelo S., Chiphwanya J., Banda JH., Bauleni A., Mukaka MM., Sisya TJ., Banda RL., Nkhoma SC., Mallewa J., Mugyenyi P., Berkley J., Szubert AJ., Chidviza E., Thomason MJ., Chepkorir P., Abongomera G., Baleeta K., Etyang A., Warambwa C., Melly B., Mudzingwa S., Kelly C., Agutu C., Wilkes H., Musiime V., Lugewma A., Pett SL., Bwakura-Dangarembizi M., Prendergast AJ., Walker AS., Gibb DM., Kumwenda M., Munthali A., Choko A., Chikovore J., Nliwasa M., Sambakunsi R., Chipungu G., Mwapasa M., Kaswaswa K., Gutteberg T., Corbett EL., Desmond N., van Lettow M., Landes M., van Oosterhout JJ., Schouten E., Phiri H., Nkhoma E., Kalua T., Gupta S., Tippett-Barr B., Kityo C., Siika A., Szubert AJ., Mallewa J., Bwakura-Dangarembizi M., Kabahenda S., Mwaringa S., Pett SL., Griffiths A., Lugemwa A., Wachira S., Musoro G., Rajapakse C., Etyang T., Abach J., Wavamunno P., Nyondo-Mipando L., Reid A., Nathoo K., Hakim J., Gibb DM., Walker AS., Haas AD., Msukwa MT., Egger M., Tenthani L., Tweya H., Jahn A., Gadabu OJ., Tal K., Salazar-Vizcaya L., Estill J., Spoerri A., Phiri N., Chimbwandira F., van Oosterhout JJ., Keiser O., Chinula L., Wiener J., Tang J., Nelson JAE., Hurst S., Tegha G., Msika A., Ellington S., Hosseinipour M., Mataya R., Haddad LB., Kourtis AP., Tippett Barr BA., Schouten E., van Oosterhout JJ., Gupta S., Phiri H., Thindwa D., Blair C., Jahn A., van Lettow M., Musiime V., Szubert AJ., Siika A., Mallewa J., Agutu C., Pett SL., Bwakura-Dangarembizi M., Lugemwa A., Kaunda S., Karoney M., Maitland K., Griffiths A., Kityo C., Mugyenyi P., Prendergast AJ., Walker AS., Gibb DM., Jumbe E., Zhang A., Chemey E., Evans C., Kamba C., Norris A., Pan X., Mwapasa V., Wang S., Torrelles JB., Kwiek J., Nyirenda JLZ., Phiri K., Sambo M., Lora W., Kumwenda M., Desmond N., Mkalira KE., Kumitawa A., Kumwenda B., Pfaff C., Singano V., Akello H., Amberbir A., Garone D., Berman J., Kwekwesa A., Matengeni A., Speight C., Allain T., van Oosterhout J., Nyirenda D., Gooding K., Squire B., Bandawe C., Sariola S., Desmond N., Gondwe A., Berman J., Mitambo C., Khan S., Matanje-Mwagomba BL., Kachimanga C., Wroe E., Amberbir A., Nyirenda M., Phiri S., Heller T., Gugsa S., Gumulira J., Phaff C., Sagno JB., Garone D., van Oosterhout JJ., Kathyola D., Kabaghe AN., Phiri MD., Phiri KS., Terlouw DJ., van Vugt M., Theu M., Chiotha S., Kayira C., Mwagomba B., Amoah AS., Stanley C., Westmoreland K., Itimu S., Salima A., Van Der Gronde T., Ward P., El-Mallawany N., Wasswa P., Mtete I., Butia M., Gopal S., Mwakikunga A., Schepartz L., Hosie M., Chipeta MG., Terlouw DJ., Phiri KS., Diggle PJ., Nahache E., Muula A., Swarthout TD., Kamng'ona A., Mwalukomo TS., Everett D., Bar-Zeev N., Chipasula T., Malisita K., Mwansambo C., Banda M., Hinds J., Gould KA., French N., Rao N., Turner A., Harrington B., Nampandeni P., Banda V., Norris A., Jayachandran V., Chapotera G., Stones W., Esber A., Norris A., Jumbe E., Kandodo J., Nampandeni P., Turner AN., Bartels RH., Bourdon C., Potani I., Mhango B., van den Brink DA., Mponda JS., Bandsma RH., Boele van Hensbroek M., Voskuijl WP., Nyirenda JLZ., Phiri K., Katundu KGH., Lampiao F., Blindauer CA., Stewart AJ., Chirambo A., Nyirenda T., Kaluwa N., Msefula C., Molina S., Gordon M., Chikowe I., Lieberman M., Kapito-Tembo A., Chirwa G., Valle M., Chirwa C., Makwinja T., Zulu M., Khumalo W., Macheso A., Mathanga D., Aung K., Phiri A., Muula AS., Mzunzu G., Kunkeyani C., Mvula H., Heinsbroek E., Chihana M., Crampin AC., Kabuluzi S., Chirwa G., Mwansambo C., Costello A., Cunliffe NA., Heyderman RS., French N., Bar-Zeev N., Bandason E., Xu P., Dong K., Nyangulu W., Mwinjiwa E., Divala T., Mungwira R., Nyirenda O., Kanjala M., Mbambo G., Taylor TE., Laurens MB., Laufer MK., van Oosterhout JJ., Mwale D., Manda-Taylor L., Tchongwe-Divala L., Kabaghe A., McCann RS., van Vugt M., Phiri K., Terlouw DJ., Nkhoma S., Lemani C., Chirombo J., Kamtuwanje N., Chikosi L., Phoya A., Bonyonga T., Mwale M., Chiudzu G., Tang JH., Gondwe MJ., Gombachika B., Majamanda M., Lipenga T., McCann RS., Mzilahowa T., Nkhoma S., Donnelly M., Divala TH., Mungwira RG., Nyirenda O., Khonde L., van Oosterhout JJ., Laufer MK., Laurens MB., Kapito-Tembo A., Valim C., Bauleni A., Nyirenda O., Pensulo P., Mathanga D., Taylor TE., Laufer MK., Sesay SSS., Mategula D., Giorgi E., Lalloo DG., Diggle PJ., Terlouw DJ., Mbirimtengerenji N., Daniels FM., Martin P., Malewezi B., Cunningham L., Nyika T., Sayeed S., Stuart-Shor E., Kerry V., Mussa LC., Phiri K., Nyangulu W., Mwinjiwa E., Berman J., Divala T., Mungwira R., Nyirenda O., Laufer M., Laurens M., van Oosterhout JJ., Kapito-Tembo A., Chirwa G., Valle M., Chirwa C., Makwinja T., Zulu M., Khumalo W., Macheso A., Mathanga D., Aung K., Mitambo C., Terlouw DJ., Berman J., Squire B., Kathyola D., Mbeye N., Phiri K., Mwagomba B., Ade S., Ali E., Ben-Smith A., Khomani P., Bondwe P., Nkhoma D., Douglas GP., Tayler-Smith K., Chikosi L., Harries AD., Gadabu OJ., Thindwa D., Landes M., van Lettow M., Kanyemba A., Nkhoma E., Phiri H., van Oosterhout JJ., Kalua T., Tippett-Barr B., Slaymaker E., Marston M., Calvert C., Dube A., McLean E., Kanjala C., Martin E., Michaels D., Takaruza A., Nakiyingi-Miiro J., Nabukalu D., Lutalo T., McGrath N., Kwaro D., Geubbels E., Zaba B., Msukwa MT., Haas AD., Tenthani L., Hofer CB., Spoerri A., Chimbwandira F., van Oosterhout JJ., Keiser O., Tamba Tolno V., Guidotti G., Jere H., Giuliano M., Sagno JB., Germano P., Liotta G., Thole D., Sangarè H., Andreotti M., Floridia M., Palombi L., Marazzi MC., Banda C., Prust M., Chimbwandira F., Eliya M., Callahan K., Prescott M., McCarthy E., Tagar E., Gunda A., Garone D., Mateyu G., Chigayo M., Ndindi H., Gaven S., Harawa K., Singano V., van Schoor V., van Oosterhout JJ., Kwekwesa A., Singano V., Amberbir A., Garone D., Mateyu G., Msonko J., Chu S., van Lettow M., Kalima K., Berman J., Mataka Y., Kwekwesa A., Matengeni A., Phiri K., van Oosterhout JJ., Thindwa D., Landes M., van Lettow M., Kanyemba A., Nkhoma E., Phiri H., van Oosterhout JJ., Kalua T., Tippett-Barr B., Sagno JB., van Oosterhout J., Liotta G., Luhanga R., Chilima B., Jere H., Palombi L., Kayira L., Sambo M., Sibande W., Corbett EL., Desmond N., Kumwenda M., Lora W., Landes M., van Lettow M., Maida A., Schouten E., van Oosterhout JJ., Tippett Barr B., Ngwira L-G., Dowdy DD., Khundi M., Nkhoma A., Choko AT., Makombe S., Murowa M., Barnes GL., Chaisson RE., Corbett EL., Fielding K., Phiri N., Haas AD., Msukwa MT., van Oosterhout JJ., Tal K., Tenthani L., Tweya H., Keiser O.
Introduction Malaria is responsible for 50 percent of all preventable absenteeism and leads to a loss of 4 to 10 million school days per year among African school-going children. In Malawi, malaria is a frequent cause of absenteeism in school, resulting in poor scholastic performance among students. Since 2013, Save the Children International (SCI) has been implementing a malaria intervention in primary schools in Traditional Authority (TA) Chikowi, Zomba district. The intervention protocol includes malaria diagnosis using malaria rapid diagnostic tests (mRDTs) and treatment of uncomplicated cases using artemisinin combination therapy (ACT), with all of this carried out by teachers. We conducted a cost-effectiveness analysis of the school-based malaria intervention programme in TA Chikowi in order to determine if the strategy is economically viable. Methods The study modelled treatment-seeking behaviour using decision tree modelling, with costs analysed from a societal perspective using the ingredients method. Effectiveness was measured as expected school attendance days and cost-effectiveness was assessed using an incremental cost-effectiveness ratio, with outpatient malaria care as the comparator. Results The TA Chikowi intervention strategy is highly cost-effective, with the opportunity cost of teachers' time, antimalarial drugs, and staff costs being the cost drivers. The annual cost of the intervention is US$12.57 (MWK5,781.58) per child, which (for each additional schooling day gained) is US$0.28 (MWK128.81) more than it costs for a health facility to deliver outpatient malaria services in the same time period. Conclusions The intervention should be implemented and scaled-up to other areas in the district and is expected to be highly cost-effective in areas with high malaria prevalence. Background Option B+ was conceptualized and implemented in Malawi in 2011, and a two year cohort study called the National Evaluation of Malawi's PMTCT Program (NEMAPP) was implemented in November 2014. A primary objective of NEMAPP is to measure national mother-to-child-transmission (MTCT) in the era of Option B+, and determine Malawi's progress towards the virtual elimination of MTCT. Methods NEMAPP was implemented at 54 health facilities in 10 districts. A stratified cluster sampling design was used to identify a nationally representative sample of 4–12 week old infants. Mothers were consecutively consented and screened for HIV while attending an under-5 clinic, and all identified HIV-exposed infants underwent HIV-1 DNA testing. This paper presents results of early infant transmission at the time of enrolment into NEMAPP. Complex weighted survey design analysis was conducted using SPSS. Results Amongst 2,125 HIV-positive mothers of 4–12 week old infants, 2,082 (96.1%) reported knowing their HIV status in pregnancy, and 1,865 (88.5%) were on ART in pregnancy. Overall MTCT was 4.2% (95% CI 2.9–6.1); for women on ART in pregnancy, MTCT was 2.5% (95% CI 1.6–3.9). Of the women not on ART in pregnancy, MTCT was 17.9% (95% CI 13.0 24.2). MTCT varied by timing of ART initiation: from 1.4% (95% CI 0.5–3.9) in those on ART before pregnancy, to 20.2% (95% CI 5.8–50.7) in those starting ART post-partum. Conclusions Five years after trailblazing the way globally with Option B+, Malawi's MTCT rates under Option B+ are comparable to that of developed nations. The largest proportional contribution to new pediatric infections is from the small percentage of HIV-positive women not on ART in pregnancy. With the current sustained emphasis on routine testing in ANC to close the remaining treatment gap, Malawi will be ready to submit a validation request for virtual elimination of MTCT to WHO before 2020. Introduction Synod of Livingstonia Development Department (SOLDEV) started implementing community water and sanitation project in Mzimba district in 2002. Ecological sanitation promotes personal hygiene and use of human manure for fruits and crops production. The research was conducted to assess awareness, coverage and adoption levels of the ecological sanitation latrines in Traditional Authority Mzukuzuku in Mzimba District. Methods The assessment engaged cross-sectional and observatory approaches in the quantitative paradigm. The structured questionnaire was used to conduct interviews with the adults in the sampled villages; targeting heads of households. Results Many people; 92.3%, heard about ecological sanitation while 45.6% had satisfactorily defined ecological sanitation in simple terms. The coverage of basic sanitation latrines is 58.9% and that of ecological sanitation is 25%. Furthermore, the results showed that 33% of the households have ever used compost manure from the human faeces and 76.8% of the household accepts use of human manure for fruit and crop production. Conclusions The results suggest that awareness is not adequate and adoption levels are low. In brief, awareness has to be improved so that many people have adequate knowledge about ecological sanitation. It is also suggested that the promoters be added and accessibility to construction materials should be improved for promotion of coverage and adoption of ecological sanitation latrines in the district. Despite low adoption levels, the project contributed to introduction of Ecological sanitation latrines and improvement of sanitation standards and coverage of latrines in the impact communities. Introduction In resource-limited settings, it is not unusual to experience delayed project start-up. Initiating projects later than originally planned may lead to implementing activities hastily in order to get back on schedule thereby compromising deliverables. However, recent experience from the initiation of an HIV clinical trial through Dignitas International (DI), a medical and research organization operating in Malawi showed that delayed project initiation is not always detrimental to its deliverables; rather, it can bring unexpected benefits. Methods In 2015, in partnership with the University of Maryland and the Blantyre Malaria Project (Malawi), DI initiated a National Institutes of Health (USA) funded HIV clinical trial. Project initiation was however postponed due to a global shortage of a study drug. The drug supplier estimated a 2–3 months delay for the study drug delivery. Given this information, DI management evaluated the administrative implications. Rather than temporarily lay off the newly hired study staff, DI opted to utilize the delay to carryout enhanced training. Study protocol, SOPs and data collection tools were repeatedly reviewed and trained in. Twenty complete “dry-runs” were carried out while only five were planned. Additional training visits were made to a nearby longer existing trial site to enhance training, confidence and familiarity with study procedures. During the initial study monitoring visit a considerably lower number of citations was reported than found on average in other sites. This performance was well above adequate and unexpected for a newly initiated site. Results Time gained due to delayed project initiation can be put into good use and yield positive results. In this case the “unplanned” training helped the study team to be well conversant with the study procedures. Conclusions When project initiation is delayed, research managers should balance short and medium-term considerations and consider the possible benefits of the delay. Introduction EID in HIV exposed infants and ART in infants is critical. In 2014 only 36–53% of infants less than 2 months who had a positive HIV results or diagnosed with severe HIV disease in Malawi were initiated on ART (1). In Malawi HIV testing for infants is centralized Methods Both quantitative and qualitative data collection methods were used. EID log books were reviewed and also structured questionnaires were administered to HIV positive mothers. Focus Group Discussions (FGDs) were conducted with Health workers and the HIV positive mothers with infants in Mangochi and Salima districts Results Turnaround time for the results was 63days (IQR 42 to 92) from Central Laboratories to Health Centres and 9 days (IQR 2 to 48) from the Health Centres to mothers and or guardians. From FGDs there identified were inefficient sample transportation, poor DBS tracking, stigma and discrimination and lack of community knowledge on EID and infants ART. Possible solutions to the stated problem were decentralization of HIV DNA PCR testing, conducting EID community awareness, introduction of Mother Infant Pairs (MIP) clinics and drones (Unmanned vehicles). Conclusions HIV DNA PCR test to HEI has to be at 6 to 8 weeks of age as recommended by WHO. This is not so in Malawi, many HEI attained this test late in 2014. Therefore there is need to increase the EID uptake, coverage and linkage to HIV care and treatment amongst the HIV exposed infants in Malawi.