Publications by authors named "Menard Chihana"

Article Synopsis
  • The study examined changes in the prevalence of advanced HIV disease in sub-Saharan Africa before and after the implementation of WHO guidelines aimed at treating all people living with HIV, regardless of CD4 count.
  • Through cross-sectional surveys in Ndhiwa, Kenya, and Eshowe, South Africa, the research found a significant decrease in advanced HIV cases from 2012/2013 to 2018, particularly in Ndhiwa, where the proportion dropped from 11.8% to 5.0%.
  • The results suggest improved access to care and treatment, especially for men in Ndhiwa; however, no significant changes were observed in Eshowe, indicating varied impacts of HIV management strategies across different
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Background: Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people's movement, HIV service delivery was affected.

Objectives: To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19.

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Article Synopsis
  • Female sex workers (FSWs) in Nsanje district, Malawi, are predominantly from economically disadvantaged backgrounds and often start selling sex at a young age; a study revealed that around 25.9% of participants were adolescents aged 13-19 years.
  • The study found alarming rates of HIV prevalence at 52.6%, increasing with age, along with significant levels of other STIs, unwanted pregnancies, and sexual violence, particularly against young women.
  • Despite these challenges, the majority of FSWs showed high awareness of their HIV status and access to antiretroviral therapy (ART), demonstrating the effectiveness of peer-led strategies in improving health outcomes in this vulnerable population.*
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Background: Rapid diagnostic tests (RDT) for malaria are the primary tool for malaria diagnosis in sub-Saharan Africa but the utility of the most commonly used histidine-rich protein 2 (HRP2) antigen-based tests is limited in high transmission settings due to the long duration of positivity after successful malaria treatment. HRP2 tests are also threatened by the emergence of Plasmodium that do not carry pfhrp2 or pfhrp 3 genes. Plasmodium lactate dehydrogenase (pLDH)-based tests are promising alternatives, but less available.

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Introduction: High coverage of antiretroviral therapy (ART) in people living with HIV (PLHIV) increases viral suppression at population level and may reduce incidence. Médecins sans Frontières, in collaboration with the South African Department of Health, has been working in Eshowe/Mbongolwane (KwaZulu Natal) since 2011 to increase access to quality HIV services. Five years after an initial survey, we conducted a second survey to measure progress in HIV diagnosis and viral suppression and to identify remaining gaps.

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Background: HIV-positive individuals who maintain an undetectable viral load cannot transmit the virus to others. In 2012, an HIV population-based survey was conducted in Ndhiwa sub-county (Kenya) to provide information on the HIV local epidemic. We carried out a second survey 6 years after the first one, to assess progress in HIV diagnosis and care and differences in the HIV prevalence and incidence between the two surveys.

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Article Synopsis
  • The Malawi Ministry of Health and Médecins sans Frontières have been working together since 2011 to improve access to HIV care by decentralizing antiretroviral therapy from hospitals to local clinics in Nsanje District.
  • A household survey was conducted from September 2016 to January 2017, where participants aged 15 and older were tested for HIV, and those who tested positive had their viral load measured.
  • The results showed a 12.1% HIV prevalence in the surveyed population, with higher rates in women, and indicated strong awareness of HIV status (80%) and linkage to care (78%), with 95.3% of those aware receiving ART.
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Article Synopsis
  • In Gutu, Zimbabwe, a comprehensive HIV care program established by Médecins Sans Frontières since 2011 has shown significant outcomes in HIV prevalence and care linkage five years later.
  • A cross-sectional study conducted in 2016 revealed a 13.6% HIV prevalence among tested adults, with high rates of awareness (87.4%), linkage to care (85.5%), and ART coverage (83.0%).
  • The findings indicate that women did better than men in care outcomes, and the HIV incidence was low at 0.35%, suggesting the program's effectiveness in improving HIV management in the community.
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: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality.: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa.: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September-November 2012), (Chiradzulu (Malawi): February-May 2013) and (Eshowe (South Africa): July-October 2013).

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Background: Latest WHO guidelines recommend starting HIV-positive individuals on antiretroviral therapy treatment (ART) regardless of CD4 count. We assessed additional impact of adopting new WHO guidelines.

Methods: We used data of individuals aged 15-59 years from three HIV population surveys conducted in 2012 (Kenya) and 2013 (Malawi and South Africa).

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Background: School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events.

Methods: Data from 2007-2016 from a demographic surveillance site in northern Malawi with annual updating of schooling status and grades, and linked sexual behaviour surveys, were analysed to assess the associations of age-specific school performance (measured as age-for-grade) and status (in or out of school) on subsequent age at sexual debut, pregnancy and marriage.

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Timely progression through school is an important measure for school performance, completion and the onset of other life transitions for adolescents. This study examines the risk factors for grade repetition and establishes the extent to which age-for-grade heterogeneity contributes to subsequent grade repetition at early and later stages of school. Using data from a demographic surveillance site in Karonga district, northern Malawi, a cohort of 8174 respondents (ages 5-24 years) in primary school was followed in 2010 and subsequent grade repetition observed in 2011.

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Introduction: HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women.

Methods: Using data from the Karonga Health and Demographic Surveillance Site in Malawi from 2005 to 2014, we used total and age-specific fertility rates and Cox regression to assess associations between HIV and ART use and fertility.

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Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women's fertility intentions and anthropometric data of children. Using the prospective information on fertility intention we assessed whether unintended children are more likely to be stunted than intended children.

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Objective: Verbal autopsies (VAs) are interviews with a relative or friend of the deceased; VAs are a technique used in surveillance sites in many countries with incomplete death certification. The goal of this study was to assess the accuracy and validity of data on HIV status and antiretroviral therapy (ART) usage reported in VAs and their influence on physician attribution of cause of death.

Design: This was a prospective cohort study.

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Background: Malawi introduced pneumococcal conjugate vaccine (PCV13) and monovalent rotavirus vaccine (RV1) in 2011 and 2012 respectively, and is planning the introduction of a second-dose measles vaccine (MV). We assessed predictors of availability, uptake and timeliness of these vaccines in a rural Malawian setting.

Methods: Commencing on the first date of PCV13 eligibility we conducted a prospective population-based birth cohort study of 2,616 children under demographic surveillance in Karonga District, northern Malawi who were eligible for PCV13, or from the date of RV1 introduction both PCV13 and RV1.

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Background: Improved life expectancy in high HIV prevalence populations has been observed since antiretroviral therapy (ART) scale-up. However, it is unclear if the benefits are sustained, and the mortality among HIV-positive individuals not (yet) on ART is not well described. We assessed temporal change in mortality over 9 years in rural Malawi.

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Background: Little is known about the pattern or risk factors for deaths from external causes in sub-Saharan Africa: there is a lack of reliable data, and public health priorities have been focussed on other causes. This study assessed the prevalence and risk factor for deaths from external causes in rural Malawi.

Methods: We analysed data from 2002-2012 from the Karonga demographic surveillance site which covers ~35,000 people in rural northern Malawi.

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Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data.

Objective: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia.

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Background: Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps.

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Background: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information.

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Article Synopsis
  • Under-five mortality is declining, but neonatal death rates remain stagnant; the study focused on how maternal HIV status affects child mortality in rural Malawi since antiretroviral therapy became widely available.
  • The research included 6,913 children born between 2006-2011, with mortality rates analyzed through a Poisson model that adjusted for various factors; findings revealed higher mortality rates for children born to HIV-positive mothers, especially in postneonatal and older age groups.
  • The main causes of neonatal deaths were birth injuries, neonatal sepsis, and prematurity, while older children mainly died from infections and diseases like malaria and pneumonia; improving HIV care for mothers could enhance child survival, but more efforts are needed to lower neonatal mortality rates.
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