Publications by authors named "Amelia C Crampin"

Supplementary methods of mortality surveillance are needed in settings with incomplete death registration. Local perceptions of mortality levels might be useful indicators of excess deaths. Early in the COVID-19 pandemic, we developed a survey question asking respondents to evaluate the recent frequency of funerals in their community relative to a pre-pandemic baseline.

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We investigated behavioral responses to COVID-19 in Malawi, where a first wave of the pandemic occurred between June and August 2020. Contrary to many countries on the African continent, the Government of Malawi did not impose a lockdown or a stay-at-home order in response to the initial spread of SARS-CoV-2. We hypothesized that, in the absence of such requirements to restrict social interactions, individuals would primarily seek to reduce the risk of SARS-CoV-2 transmission during contacts, rather than reduce the extent of their social contacts.

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  • * This study employed eight focus groups in Malawi to explore the perspectives of breastfeeding women, couples, and healthcare providers on the collection of these "non-invasive" biosamples, revealing varying perceptions of invasiveness.
  • * Findings indicate a disconnect between biomedical views of "non-invasive" sampling and community concerns, underscoring the need for researchers to address therapeutic misconceptions and engage openly with the communities involved in biosampling.
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Building longitudinal population cohorts in Africa for coordinated research and surveillance can influence the setting of national health priorities, lead to the introduction of appropriate interventions, and provide evidence for targeted treatment, leading to better health across the continent. However, compared to cohorts from the global north, longitudinal continental African population cohorts remain scarce, are relatively small in size, and lack data complexity. As infections and noncommunicable diseases disproportionately affect Africa's approximately 1.

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  • Multimorbidity means having two or more long-lasting health problems at the same time, and it's becoming a big issue for health care around the world.
  • A group of 60 researchers from 10 African countries worked together to figure out if the idea of multimorbidity is useful in Africa and how it can be adapted to fit local needs.
  • During their workshop, they talked about different perspectives on multimorbidity and came up with new ideas that focus on what people really need and the impact it has on their lives and health systems.
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The growing burden of asthma in low- and middle-income countries has been linked to urbanisation and lifestyle changes. However, this burden has not been well characterised in adults. Therefore, we investigated the prevalence of self-reported diagnosed asthma and associated factors in urban and rural adults in Malawi, Southern Africa.

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Proximity to family, household composition, and structure are often studied as outcomes and as explanatory factors in a wide range of scientific disciplines. Here, we describe a large longitudinal dataset (currently including data from over 70,000 individuals from 2004 to 2017), including data on household structure, proximity to kin, population density, and other socio-demographic factors derived from data from the Karonga Health and Demographic Surveillance Site (HDSS) in Northern Malawi. We present how the dataset is generated, list some examples of how it can be used, and provide information on the limitations that affect the types of analyses that can be carried out.

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  • Migration among young people in sub-Saharan Africa is driven by cultural norms, family considerations, and is influenced by changes such as urbanization and increased media access.
  • The study utilized longitudinal data from a Health and Demographic Surveillance Site in Malawi to analyze migration patterns between 2004-2017, focusing on gender roles and the impact of family ties.
  • Key findings indicate that young women tend to migrate longer distances for marriage and often return home after marital dissolution, while the proximity to relatives can reduce the likelihood of migration, with distinct differences in treatment and migration patterns observed between genders from early childhood.
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In low-income Africa, the epidemiology of physical multimorbidity and associated mental health conditions is not well described. We investigated the multimorbidity burden, disease combinations, and relationship between physical multimorbidity and common mental health disorders in rural and urban Malawi using early data from 9,849 adults recruited to an on-going large cross-sectional study on long-term conditions, initiated in 2021. Multimorbidity was defined as having two or more measured (diabetes, hypertension) or self-reported (diabetes, hypertension, disability, chronic pain, HIV, asthma, stroke, heart disease, and epilepsy) conditions.

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Background: Cardiovascular diseases (CVD) were responsible for 20.5 million annual deaths globally in 2021, with a disproportionally high burden in sub-Saharan Africa (SSA). There is growing evidence of the use of citizen science and co-design approaches in developing interventions in different fields, but less so in the context of CVD prevention interventions in SSA.

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We investigated prevalence and demographic characteristics of adults living with multimorbidity (≥2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling.

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Sub-Saharan Africa is projected to have the highest increase in the number of people with diabetes worldwide. However, the drivers of diabetes in this region have not been clearly elucidated. The aim of this study was to evaluate the incidence of diabetes and the predictors of progression in a population-based cohort with impaired fasting glucose (IFG) in Malawi.

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Excess salt intake is a major modifiable risk factor for cardiovascular disease. Promoting salt reduction as part of routine school-health programming may be a pragmatic way to address this risk factor early in the life course but has not been tested in sub-Saharan Africa (SSA). Here we describe the formative work with stakeholders and process evaluation of pilot work to develop a school-based salt reduction programme for children aged 11-14 years, in preparation for a cluster-randomised trial in rural/urban Malawi.

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The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES).

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The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan African countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours.

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Article Synopsis
  • * Through in-depth interviews with 32 participants, the researchers used Normalization Process Theory and Burden of Treatment Theory to analyze key challenges, including managing life disruptions and navigating healthcare systems amidst poverty.
  • * Findings reveal that poor healthcare resources and limited access to treatment exacerbate the burden, while supportive social networks and access to health education can help alleviate these challenges.
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Background: The importance of remote infection with M.tuberculosis as a cause of tuberculosis disease (TB) is unclear, with limited evidence of impact on TB rates beyond 10 years. Our objective was to assess rates of tuberculosis over 30 years by M.

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Objectives: Given the decline in physical activity levels in Malawi, like other sub-Saharan African countries, and its implication for non-communicable disease (NCD) prevention, this study aimed to compare and contrast accounts of practices and attitudes towards physical activity among Malawian men and women (previously identified as having pre-diabetes) in urban and rural settings.

Setting: Two communities: one urban (Lilongwe) and one rural (Karonga).

Participants: 14 men (urban N=6, rural N=8) and 18 women (urban N=9, rural N=9) classified as prediabetic during their participation in an NCD survey 3-5 years previously.

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The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach.

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Leprosy is a chronic infection of the skin and peripheral nerves caused by Mycobacterium leprae. Despite recent improvements in disease control, leprosy remains an important cause of infectious disability globally. Large-scale genetic association studies in Chinese, Vietnamese and Indian populations have identified over 30 susceptibility loci for leprosy.

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Objective: Handgrip strength, a simple measure of muscle strength, has been reported as a predictor of both prediabetes and type 2 diabetes mellitus (T2DM) and has been suggested for screening prediabetes and T2DM risk. This study examined the relationship of handgrip strength with prediabetes and T2DM among rural- and urban-dwelling adults in Malawi.

Methods: This was a cross-sectional study nested in a follow-up study of prediabetic and prehypertensive individuals identified during an extensive noncommunicable disease survey in Malawi.

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Background: A large, double-blind, randomised, placebo-controlled trial of repeat BCG found 49% efficacy against leprosy but no protection against tuberculosis after 6-9 years' follow-up in 1995. We report here additional follow-up, which resulted in greatly increased tuberculosis case numbers, and allowed subgroup analysis.

Methods: Nearly 47 000 individuals of all ages living in northern Malawi with a BCG vaccine scar were randomly assigned (1:1) between 1986 and 1989 to receive a second BCG or placebo.

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Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi.

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