Evaluation of Tele-Education in Malawi for Detection of Macular Features Using Optical Coherence Tomography.

Purpose: The study aimed to assess the reliability of tele-education in training a Malawian ophthalmology resident to interpret optical coherence tomography (OCT) images of patients with macular conditions.

Methods: This was a retrospective analysis of 1000 macula-centered OCT image series from 1000 eyes of 1000 consecutive patients from Malawi, which involved initial interpretation by a German retina specialist (observer 1) (T). Observer 1 then trained a Malawian resident (observer 2) via email, and observer 2 independently interpreted images at T, followed by face-to-face training in Malawi and reinterpretation at T and T (3-month intervals).

Avoidable factors associated with maternal death from postpartum haemorrhage: a national Malawian surveillance study.

Background: Despite strong evidence-based strategies for prevention and management, global efforts to reduce deaths from postpartum haemorrhage (PPH) have failed, and it remains the leading cause of maternal mortality. We conducted a detailed review of all maternal deaths from 33 facilities in Malawi to identify health system weaknesses leading to deaths from PPH.

Methods: Data were collected regarding every maternal death occurring across all district and central hospitals in Malawi.

The aetiology and antimicrobial resistance of bacterial maternal infections in Sub-Saharan Africa-a systematic review and meta-analysis.

Background: Understanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap.

Methods: Microbiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases.

Cyclone Freddy and its impact on maternal health service utilisation: Cross-sectional analysis of data from a national maternal surveillance platform in Malawi.

Climate change poses a significant threat to women's health in sub-Saharan Africa, yet the impact of climate change on maternal health is rarely reported in the region. Using an existing Maternal Surveillance Platform (MATSurvey), we estimated the immediate impact of Cyclone Freddy on maternal health care service indicators in Malawi. We analysed facility-level data for pregnant women up to 42 weeks post-partum using the national MATSurvey database.

Development of a diagnostic predictive model for determining child stunting in Malawi: a comparative analysis of variable selection approaches.

Background: Childhood stunting is a major indicator of child malnutrition and a focus area of Global Nutrition Targets for 2025 and Sustainable Development Goals. Risk factors for childhood stunting are well studied and well known and could be used in a risk prediction model for assessing whether a child is stunted or not. However, the selection of child stunting predictor variables is a critical step in the development and performance of any such prediction model.

Prevalence of and factors associated with HIV testing among adolescent girls and young women in South Africa: Evidence from the South Africa Demographic and Health Survey 2016.

Background: Adolescent girls and young women (AGYW) remain vulnerable to HIV, with a higher incidence rate than their male counterparts.

Objectives: To determine the prevalence of and factors associated with HIV testing among AGYW in South Africa (SA).

Methods: A cross-sectional design was used to analyse the South Africa Demographic and Health Survey 2016.

Trends and factors associated with adverse pregnancy outcomes in Zimbabwe, 2005 - 2015.

Background: Adverse pregnancy outcomes, including abortions, miscarriages and stillbirths, are common in developing countries such as Zimbabwe.

Objective: To determine the trends and factors associated with adverse pregnancy outcomes.

Methods: This article is a secondary data analysis of three repeated cross-sectional Zimbabwe Demographic and Health Surveys to assess adverse pregnancy outcomes among women of reproductive age (15 - 49 years old) who fell pregnant during the study period.

Treatment preferences among people at risk of developing tuberculosis: A discrete choice experiment.

Diagnosing and treating people with bacteriologically-negative but radiologically-apparent tuberculosis (TB) may contribute to more effective TB care and reduce transmission. However, optimal treatment approaches for this group are unknown. It is important to understand peoples' preferences of treatment options for effective programmatic implementation of people-centred treatment approaches.

Two decades of malaria control in Malawi: Geostatistical Analysis of the changing malaria prevalence from 2000-2022.

Background: Malaria remains a public health problem in Malawi and has a serious socio-economic impact on the population. In the past two decades, available malaria control measures have been substantially scaled up, such as insecticide-treated bed nets, artemisinin-based combination therapies, and, more recently, the introduction of the malaria vaccine, the RTS,S/AS01. In this paper, we describe the epidemiology of malaria for the last two decades to understand the past transmission and set the scene for the elimination agenda.

Enhanced tuberculosis diagnosis with computer-aided chest X-ray and urine LAM in adults with HIV admitted to hospital (CASTLE study): A cluster randomised trial.

Background: People with HIV (PHIV) admitted to hospital have high mortality, with tuberculosis (TB) being the major cause of death. Systematic use of new TB diagnostics could improve TB diagnosis and might improve outcomes.

Methods: We conducted a cluster randomised trial among adult PHIV admitted to Zomba Central Hospital, Malawi.

Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi.

This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi's three districts of Zomba, Dowa and Nkhatabay.

Child acute illness presentation and referrals at primary health clinics in Malawi: a secondary analysis of ASPIRE.

Objectives: We aimed to assess the prevalence, presentation and referral patterns of children with acute illness attending primary health centres (PHCs) in a low-resource setting.

Design, Setting And Participants: We conducted a secondary analysis of ASPIRE. Children presenting at eight PHCs in urban Blantyre district in southern Malawi with both recorded clinician and mHealth (non-clinician) triage data were included, and patient records from different data collection points along the patient healthcare seeking pathway were consolidated and analysed.

Community-level variation in TB testing history in Blantyre, Malawi.

Equitable access to TB testing is vital for achieving global diagnosis and treatment targets, but access to diagnostic services is often worse in poorer communities. The SCALE (Sustainable Community-wide Active case-finding for Lung hEalth) survey estimated TB prevalence in Blantyre City, Malawi, and recorded previous engagement with TB services. To explore local variation in the prevalence of ever-testing for TB in Blantyre and investigate potential socio-economic drivers.

Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE).

Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC).

Uptake of diabetic retinopathy screening at a secondary level facility in Malawi.

Diabetic retinopathy (DR) is a common microvascular complication of long-standing diabetes mellitus (DM). DR screening is a cost-effective intervention for preventing blindness from DR. We conducted a cross-sectional study to investigate the uptake and the predictors of uptake of annual DR screening in an opportunistic DR screening programme at a secondary-level diabetes clinic in Southern Malawi.

Bayesian spatial modelling of intimate partner violence and associated factors among adult women and men: evidence from 2019/2020 Rwanda Demographic and Health Survey.

Background: Intimate partner violence (IPV) remains a global public health concern for both men and women. Spatial mapping and clustering analysis can reveal subtle patterns in IPV occurrences but are yet to be explored in Rwanda, especially at a lower small-area scale. This study seeks to examine the spatial distribution, patterns, and associated factors of IPV among men and women in Rwanda.

Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019-20: Substantial decline compared to 2013-14 national survey.

Recent evidence shows rapidly changing tuberculosis (TB) epidemiology in Southern and Eastern Africa, with need for subdistrict prevalence estimates to guide targeted interventions. We conducted a pulmonary TB prevalence survey to estimate current TB burden in Blantyre city, Malawi. From May 2019 to March 2020, 115 households in middle/high-density residential Blantyre, were randomly-selected from each of 72 clusters.

Community acceptability of public health measures during the coronavirus pandemic in Malawi: a cross-sectional survey of knowledge, attitudes, and practices.

Background: The knowledge, attitudes, and practices (KAP) of people during the coronavirus pandemic are pivotal to the uptake of recommended preventative strategies.

Objective: This paper describes the Malawian KAP related to coronavirus and associated public health measures.

Methods: This was a multi-site cross-sectional survey where data was collected through personal one-on-one interviews in nine Malawian districts over 3 weeks (5-25 October 2020).

Interventions to reduce deaths in people living with HIV admitted to hospital in low- and middle-income countries: A systematic review.

People living with HIV (PLHIV) admitted to hospital have a high risk of death. We systematically appraised evidence for interventions to reduce mortality among hospitalised PLHIV in low- and middle-income countries (LMICs). Using a broad search strategy with terms for HIV, hospitals, and clinical trials, we searched for reports published between 1 Jan 2003 and 23 August 2021.

Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study.

Objectives: We studied neonates with suspected early-onset sepsis (EOS, sepsis developing in the first 72 hours after delivery) in Malawi to (1) describe clinical characteristics and microbiological findings, (2) identify which patient characteristics may be associated with pathogen positivity on blood culture, and (3) describe mortality and its potential determinants.

Design: Prospective observational study (May 2018-June 2019).

Setting: Neonatal ward in Queen Elizabeth Central Hospital, the largest government hospital in Malawi.

Utility of Xpert MTB/RIF Ultra and digital chest radiography for the diagnosis and treatment of TB in people living with HIV: a randomised controlled trial (XACT-TB).

Background: TB is a leading cause of morbidity among HIV positive individuals. Accurate algorithms are needed to achieve early TB diagnosis and treatment. We investigated the use of Xpert MTB/RIF Ultra in combination with chest radiography for TB diagnosis in ambulatory HIV positive individuals.