Epidemiology & Biostatistics

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Open Access
Maternal and fetal outcome of hypertension related pregnancy and their associated risk factors in Adigrat General Hospital, Northern Ethiopia, hospital based retrospective cohort study
(Kamuzu University of Health Sciences, 2020-03-01) Lijalem, Naomi
This was a quantitative retrospective cohort study and Presence of hypertensive (exposure) was assessed retrospectively from medical records of mothers who visited the obstetric ward in Adigrat General Hospital, Tigray regional state, northern Ethiopia from January 1 2017- December 30 2019. Hypertensive disorders of pregnancy are the most common causes of adverse maternal & perinatal outcomes. Conducting such studies would support to have great design policies and strategies in preventing unfavorable outcome. The General objective of this study was to determine maternal and fetal outcome and risk factors associated with pregnancy related hypertensive disorder who receive obstetric care in Adigrat General Hospital, Eastern Tigray, and Northern Ethiopia from January 2017 to December 2019. The data were collected using data extraction sheet and entered in to Epi info and analyzed in SPSS version 25. Strength of association was measured using odds ratio and 95% confidence intervals. The p-value <0.05 was set for statistical significance. I have found huge burden of maternal and perinatal death and complications, which makes it a big priority for the health system. A total 314 records of pregnant women was included in the study, 164 had developed HDP, but due to incompleteness and twin gestation, 14 records of those with HDP were excluded from the analysis, this resulted in the HDP prevalence of 50% (150/300). The dominant type of HDP in pregnant women studied was Preeclampsia. Majority of the study participants (90.33%) tested negative for HIV and more than ninety percent of the participants (94.67%) had Anti natal follow up. Majority of pregnant women (62.67%) underwent Spontaneous Vaginal Delivery (SVD) of which (38.7%) had HDP. Prevalence of chronic medical illness in participants was as follows, Proteinuria (72.0 %), DM (22%), CHD (3.33%), Renal failure (2.7%). The proportion of the type of HDP chronic hypertension in pregnant women (preeclampsia, Eclampsia, super imposed preeclampsia, and gestational hypertension) were 42.00%, 25.3%, 7.30%, 12.0% and 13.30% respectively. The most frequent type of antihypertensive drug given to the mothers with HDP was hydralazine (87.3%) and mgso4 (59.3%). On a logistic regression analysis, several factors were found to be associated with HDP, these included age (OR 0.15; 95% CI, 0.09-0.25, P≤0.001), education (OR 0.43; 95% CI, 0.32-0.58; P≤0.01), occupation (OR 0.65; 95% CI, 0.51-0.84; P≤0.001), residency (OR 14.24; 95% CI, 7.95-25.53; P≤0.001), HIV status (OR 16.24; 95% CI, 3.78-69.69; P≤0.001), parity (OR 0.19; 95% CI, 0.99-0.39; P≤0.001), mode of delivery (OR 3.87; 955 CI, 2.59-5.78; P≤0.001) and diabetes mellitus (OR 17.37; 95% CI, 7.22-41.84; P≤0.001). Out of the total 6,856 deliveries, 164 (2.4%) had HDP of which 14 were excluded. out of the 150 study participants with HDP majority of them 93 (62%) were in the age range of 15-35 years. More than half of respondents with HDP (68.7%) place of residence is in rural.
Open Access
Short birth interval and its determinants of reproductive-age women in Ethiopia: Multilevel regression model
(Kamuzu University of Health Sciences, 2020-12-01) Kelel, Henna Umer
A birth interval is the length of time between two successive live births. World Health Organization is recommended that individuals and couples should wait for at least 2–3 years between births to reduce the risk of adverse maternal and child health outcomes. Short birth interval also has a negative consequence on perinatal, neonatal, and child health outcomes. This study aimed to assess the level and determinants of the short birth interval among reproductive-age women in Ethiopia. National population-based cross-sectional study design was employed. The total weighted sample included in the analysis was 6,155 women who have given birth five years preceding the survey. Multilevel Logistic regression models (bivariate and multivariate) were used to assess the association between dependent and independent variables. In multiple multilevel logistic regressions those variables' P-value <0.05 was considered as a statistically significant variable for short birth interval and presented with 95% CI and AOR. The prevalence of short birth interval was 48.5%, [95% CI, 47.18- 49.69]. The predictors associated with short birth intervals like rural residence [AOR=1.4, 95% CI: 1.1,1.7], women's being Muslim religion (AOR=2.3, 95% CI: 1.9-2.7), women whose age at first birth from 18 to 34 years [AOR=1.2, 95% CI:1.1, 1.4, p<0.001] were found to be statistically significant determinants of short birth interval. Half of the women have reported the short birth interval experience in Ethiopia. The main factors for short birth intervals were women who lived in rural settings, women being religious, and women age at first marriage. These factors addressed through the maternal and child health program should intensify their program on influencing mothers by giving information about the necessity of using modern contraceptives in spacing children.
Open Access
Assessing the relationship between adverse childhood experiences (ace) and high HIV risk behaviours among male and female adolescents: A cross sectional study in Balaka, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Kaponda, Alice Siyenunu
Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) are a range of events (that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours eg sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks eg multiple sexual partners and infrequent condom use. The study assessed the relationship between reported adverse childhood experiences and sexual risk behaviours among adolescents’ in Balaka district. This was a cross-sectional study design. It used secondary data from the Malawi Longitudinal Study of Families and Health (MLSFH) study. This study used data from the 2017/2018 data collection wave which interviewed adolescents aged between 10-19. Logistic regression analysis was performed in STATA v14 to assess the association between ACEs and HIV risk behaviours (multiple sexual partners and infrequent condom use). Adolescents who reported having exposed to physical abuse were 1.5771 times likely to have multiple sexual partners as compared to those who were not exposed to reported physical abuse (OR=1.5771, Cl = 0.7879 – 3.1566 at 95%) and AOR was 1.4245 among the exposed. Adolescents exposed to physical abuse and sexual abuse had 1.3019 and 1.4048 respectively risk of not Infrequently use condoms amongst the exposed than in the non-exposed. No association was found between reported emotional abuse and infrequent condom use (OR=1). The study revealed that there was an association between ACEs and sexual risk behaviours. There is a need to institutionalise comprehensive sexuality education from lower primary age groups, not confined to the limited coverage of life skills as at present.
Open Access
A comparative study of sanitation and hygiene of boreholes in open defecation free and open defecation communities in Phalombe district, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Jella, Chimwemwe Dickson
Community-led total sanitation has the potential to improve sanitation and hygiene in different key areas such as environmental sanitation which include borehole sanitation. However, it is not clear if being open defecation free affects borehore sanitation and hygiene. The main objective of the study was to compare the status of sanitation and hygiene of boreholes in open defecation free and open defecation communities in Phalombe District. Thus, this study wanted to establish if sanitation and hygiene of boreholes was dependent on open defecation free status of an area. This was a comparative descriptive cross-sectional study. We used checklist to observe borehole surrounding, questionnaire to collect additional information of the borehole and we also collected a 100ml water sample for faecal coliform analysis. The study was conducted in two Traditional Authorities in Phalombe which were purposefully identified: Jenala (open defecation free) and Nkhulambe (open defecation). We randomly sampled 27 boreholes in Traditional Authority Jenala and 27 in Traditional Authority Nkhulambe. Our total sample size was fifty-four (54) boreholes. We used Fisher’s exact test to determine the difference of sanitation and hygiene of boreholes between these areas. Cleanliness of borehole surrounding, risk to borehole groundwater bacteriological contamination, functionality status of water point committees and coverage of contaminated boreholes were not different in the two Traditional Authorities with p-values of 0.116, 0.136, 0.382 and 0.078 respectively. Despite the many benefits such as increased coverage of pit latrines realized through implementation of Community Led Total Sanitation approach, it has not improved sanitation and hygiene parameters of borehole facilities in Phalombe district.
Open Access
The prevalence of diabetes mellitus and its risk factors among non-governmental organization drivers in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Mtila, Yusuf
The health status of professional motor vehicle drivers potentially affects public safety. Continued exposure to stress and sitting for long periods increase the risk of obesity and hypertension in professional drivers. We adapted the WHO STEPwise approach to chronic disease risk factor surveillance tool to conduct a district based cross-sectional survey between October to December 2020 among professional drivers of non-governmental organization institutions aged 25 -65 years. The prevalence of raised impaired blood glucose was 6.4% (N= 6) among the drivers. Female drivers were 0.91 times less likely to be diagnosed with diabetes than their male counterparts. The mean Body Mass Index for the drivers was 5.39 kg/m2 (95% CI 24.2-26.6). Raised blood pressure was observed in 19 drivers (20.2%). Drivers with high blood pressure were more likely to be diabetic than those with optimal blood pressure levels. (OR = 1.03, 95% CI: 3.98 - 25.07). The mean total blood cholesterol, including those currently on medication for raised cholesterol was determined at 6.4 mmol/L (95% CI, 6.0-6.7,). We found the prevalence of raised cholesterol to be 44% (N= 41) among the drivers. Drivers of motor vehicles have a disproportionately high prevalence of diabetes mellitus from national average estimates. Promotion of a healthy lifestyle, workplace diabetes awareness, screening, and treatment programs could prevent and control this public health problem among drivers.
Open Access
Assessing the relationship between adverse childhood experiences (ace) and high hiv risk behaviours among male and female adolescents: a cross sectional study in Balaka, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Kaponda, Alice Siyenunu
Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) are a range of events (that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours eg sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks eg multiple sexual partners and infrequent condom use. The study assessed the relationship between reported adverse childhood experiences and sexual risk behaviours among adolescents’ in Balaka district. This was a crosssectional study design. It used secondary data from the Malawi Longitudinal Study of Families and Health (MLSFH) study. This study used data from the 2017/2018 data collection wave which interviewed adolescents aged between 10-19. Logistic regression analysis was performed in STATA v14 to assess the association between ACEs and HIV risk behaviours (multiple sexual partners and infrequent condom use). Adolescents who reported having exposed to physical abuse were 1.5771 times likely to have multiple sexual partners as compared to those who were not exposed to reported physical abuse (OR=1.5771, Cl = 0.7879 – 3.1566 at 95%) and AOR was 1.4245 among the exposed. Adolescents exposed to physical abuse and sexual abuse had 1.3019 and 1.4048 respectively risk of not Infrequently use condoms amongst the exposed than in the non-exposed. No association was found between reported emotional abuse and infrequent condom use (OR=1). The study revealed that there was an association between ACEs and sexual risk behaviours. There is a need to institutionalise comprehensive sexuality education from lower primary age groups, not confined to the limited coverage of life skills as at present.
Open Access
Survival of low birth weight babies admitted at district and private hospitals in Chiradzulu, Malawi: A retrospective cohort study
(Kamuzu University of Health Sciences, 2021-02-01) Zgambo, Austin Chibisa
In Malawi, there are limited studies that have studied the survival of low birth weight (LBW) babies in public hospitals and no studies have studied or compared with the survival of LBW babies in private hospitals. Understanding LBW survival and factors associated with mortality would facilitate the identification of better strategies to improve their management at health facility level. The objective of the study was to compare the survival rate of LBW babies admitted to public versus private hospital in Chiradzulu district, Malawi; and identify maternal and newborn factors associated with mortality in the two hospitals. A retrospective cohort study of LBW babies admitted to Chiradzulu District Hospital (CZDH) and St. Joseph’s Private Mission Hospital (SJPMH) from 2018 to 2019. Data were collected using a data extraction checklist from the nursery ward admission registers. Kaplan Meier curves were used to estimate the survival rate. A Cox proportional hazard model was fitted to identify factors associated with mortality in LBW babies. Records for 1,343 LBW babies (698 from CZDH and 645 from SJPMH) were available for analysis. The overall survival was 87% and it was higher at SJPMH compared to CZDH (96% versus 79%; p<.001). Delivery through vacuum extraction (VE) (adjusted hazard ratio (AHR): 11.18; 95% CI: 1.37–95.98), diagnoses of respiratory distress syndrome (RDS) (AHR: 2.12; 95% CI: 1.05–4.27) and asphyxia (AHR: 2.40; 95% CI: 1.44–4.01) increased the risk of mortality. Admission weight of the baby ranging from 1,500 to 2,499 g (AHR: 0.18; 95% CI: 0.08–0.38), and Apgar score 7 – 10 at 5 minutes (AHR: 0.48; 95% CI: 0.27–0.86) were the protective factors against mortality. Interventions to improve survival among the LBW babies should focus on managing deliveries through VE, babies diagnosed with RDS and asphyxia.
Open Access
The association between severely deranged vital signs and Dysglycaemia in severely ill children admitted to Queen Elizabeth Central Hospital (QECH), Blantyre Malawi
(Kamuzu University of Health Sciences, 2021-07-01) Mayani, Ednas Billiat
Abnormal blood glucose level commonly occurs in children presenting to the hospitals in low income settings. The presence of low blood glucose levels could be a marker of disease severity. Vital signs are routinely checked in sick children and most settings use a combination of deranged vital signs to determine disease severity. Blood glucose is a quick, bed side test and could serve as a complementary indicator of disease severity in low resource settings. The study aims to determine the association between the presence of severely deranged vital signs and dysglycaemia in severely ill children admitted to a tertiary hospital in Malawi. This was a crosssectional study which used secondary data from Paediatric department collected from December 2016 to January 2019. Multinomial logistic regression was used to determine the association between severely deranged vital signs and dysglycaemia. A total of 5247 children, aged 0 to 18years were recruited into the study. 353(6.7%) had lowglycaemia,105(2.0%) had hypoglycaemia and 771(14.7%) had hyperglycaemia. The presence of any severely deranged vital sign, specifically, hypoxia (oxygen saturation <90%) and coma score of<2 were associated with both hypoglycaemia and hyperglycaemia. The Adjusted Odds Ratio (AOR) for the association of any severely deranged vital sign with hypoglycaemia was 1.76(95% CI 1.2–2.6) and 1.5(95% CI 1.3–1.8) with hyperglycaemia. Hypoxia had odds ratio of 2.0(95% CI 1.2–3.4) for hypoglycaemia and 1.5 (95% CI 1.2–1.9) for hyperglycaemia whilst for reduced coma score the odds was 6.5(95% CI 4.2–10.2) and 2.3(95% CI 1.8–2.9) respectively. The results have shown that the presence of any severely deranged vital sign is associated with dysglycaemia especially hypoglycaemia and hyperglycaemia. As such dysglycaemia might be used as a complementary marker of disease severity in low resource settings.
Open Access
Facilitators and barriers of same-day linkage to ART Care of newly diagnosed HIV adults in health facilities: A cross sectional study from primary health facilities in urban Malawi
(Kamuzu University of Health Sciences, 2022-03-01) Chihana, Rachel
The Malawi national HIV guidelines recommend same-day antiretroviral therapy (ART) initiation. In Malawi, only 88.6 % of those that tested HIV positive are on ART(1). Factors that facilitate and hinder successful linkage to ART among newly-diagnosed HIV-positive individuals have not been fully described. The study described client based, health system and health facility infrastructural factors of successful same-day ART initiation at two health centers in Blantyre, Malawi. A crosssectional study was conducted at South Lunzu (semi-urban) and Limbe (urban), in Blantyre City, from March to July 2020. Eligibility criteria included: recently diagnosed HIV infection and age ≥18 years. A structured questionnaire and checklist were used for data collection. The study outcome was same day ART initiation which was verified by checking health passport books of study participants. About 321 participants gave informed consent. Their mean age (standard deviation) was 33(10) and 59% were females. Of these participants, 315 (98.2%) were successfully initiated on same day ART. Four of the six participants who failed to initiate ART reported that they were not mentally prepared to do so. Most study participants had very positive views of the service delivery and infrastructure at the facilities which may have facilitated linkage to care. Primary health facilities supported by expert clients successfully linked to ART newly diagnosed HIV positive clients. Mental unpreparedness likely contributed to unsuccessful linkage to ART. Good health facility service delivery and conducive infrastructure appeared to facilitate linkage to ART.
Open Access
Factors associated with mortality among paediatric tuberculosis patients in Blantyre and knowledge, attitudes and practice on tuberculosis transmission among parents and guardians of children with tuberculosis at Ndirande Health Centre in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2022-03-01) Kishombe, Mable Cynthia
Although there is highly effective treatment, tuberculosis (TB) remains a leading cause of death in children. In 2018, 1.2 million deaths from TB among HIV-negative individuals and 251,000 deaths among HIV-positive people were estimated. Identifying patients at risk of death during TB treatment should be a priority for proper management. It helps in assessing the needs and identifying potential interventions that contributes to the End TB Strategy of reducing TB mortality by 95%. The study assesses factors associated with mortality amongst paediatric TB patients in Blantyre and knowledge, attitude and beliefs of TB disease transmission among parents/guardians of children. This was a cross-sectional study using retrospective records review of data extracted from Helse Nord Tuberculosis Initiative (HNTI) for different health facilities in Blantyre district and a primary data collection in assessing the knowledge, attitude and practice of the parents/guardians of children with TB and those with cough for more than a week at Ndirande Health Centre in Blantyre. The proportion of deaths was similar among males and females (5.1% compared to 5.6% respectively, with a P-value of 0.73). The death was higher among children of age group of 1 to 5 years with a death proportion of 6.9% compared to older children of 5-14 years (5.0%) although the results were not statistically significant P-value 0.374. Deaths numbers was higher among HIV positive children as 6.6% HIV positive children died comparing to 4.1 HIV negative patients who died with a P-value of 0.194. For the KAP study, parents/guardians had poor knowledge, attitudes and practices towards TB disease as of 150 participants interviewed in the primary data, 54.7% scored poor in knowledge, 68.7% had poor attitude and 22.0% displayed poor practices towards TB disease. There is a need to develop some effective techniques to educate the public on TB and improve the detection and management of tuberculosis in children.

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