Thesis & Dissertations

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Assessing teachers and parent’s knowledge, attitudes, perceptions and awareness on type 1 diabetes in children presenting to the children’s diabetic clinic at Queen Elizabeth Central Hospital
(2017-10-17) Kasiya, Marrianne
Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from inadequate insulin production or reduced tissue sensitivity to insulin. Type 1 diabetes is an endocrine disorder characterized by the absolute deficiency of insulin caused by the autoimmune destruction of the β cells of the pancreas. DM is a lifelong condition which requires continuous self-management by patients. Early diagnosis and improved management will reduce the risk of complications of the disease. The majority of young people with diabetes spend many hours at school and/or in some type of child care program. Trained and knowledgeable staff are essential to provide a safe school and child care environment for children with diabetes. The child’s parents/guardians and health care provider(s) should work together to provide school systems and child care providers with the information necessary to enable children with diabetes to participate fully and safely in the school and child care setting experiences. This study assessed the knowledge, attitudes, perceptions and awareness of teachers and parents of children with Type 1 diabetes presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This study employed a mixed methods research design to data collection, analysis and interpretation integrating qualitative and quantitative approaches. Twenty-three parents attending QECH diabetic children’s clinic in the under-five department and 65 teachers from different primary and secondary schools around Blantyre Urban were interviewed. Majority of the respondents explained that diabetes mellitus was concerned with how overly increased or reduced sugar levels affected the way the body carried out its normal functions.Teachers were more general about the disease, while parents were more particular in defining the disease; 67% of the teachers were willing to host diabetic children in their class compared to 33% who were not willing. It was however clear that the teachers had no confidence in handling such conditions. Fifteen of the 25 parents reported that the school was limited in capacity and expressed concern over their children’s performance. The findings highlight the importance of diabetic education for both the teachers and the parents. The study has identified the need to take into account the major differences between children and their care givers in managing Type 1 Diabetes and also the need to invest considerable amount of efforts and resources aimed at supporting Type 1 diabetic children by establishing school clinics or ensuring the presence of school nurses in schools
Open Access
Perceptions of HIV positive women on integrated health service delivery’s efficiency: A review of public health facilities of Lilongwe district, Malawi
(2019-05-15) Chauya, Ivy Violet
The study reviews perceptions of HIV positive women on Integrated Health Service Delivery (IHSD) efficiency focusing on HIV integration with other health services. HIV/AIDS has proved to be a global health concern impacting more on poor countries and vulnerable populations like women and children. The study aimed at exploring perceptions of HIV positive women aged 18 and above on IHSD’s efficiency in public health facilities of Lilongwe district, Malawi. Specifically describing the nature of IHSD, examining their knowledge and perceptions of IHSD. This study used a cross-sectional qualitative in-depth study design where 18 HIV positive clients and 6 KIs from 6 health facilities were purposively sampled: 2 from rural, 2 urban and other 2 from peri urban. Three clients and 1 KI were interviewed in each health facility. Data collected was analyzed using themes. Codes were developed bearing in mind the purpose of the study. The researcher identified the themes by isolating data that was significant and interesting in relation to the study objectives. The results focused on whether IHSD is effectively and efficiently being implemented, focusing on the 4 conceptual models of PATH that include patient centeredness, health operations, the health system as well as inter-sectoral initiatives. It was revealed that the public health facilities of Malawi are not fully implementing effective and efficient IHSD as perception of clients in the 4 conceptual models proved inadequate to deliver quality IHSD. The challenges of inadequate resources i.e. trained staff, equipment, drugs, poor infrastructure forcing the health workers to refer clients to other departments/health facilities to access a service does not please most clients as it entails a waste of time and money. HIV positive women also perceive IHSD as a good and helpful service, however, they expressed dissatisfaction with delays in the delivery services due to late commencement of work and continuous referrals done for them to access a service. This is also attributed to inadequate resources as few health workers fail to adequately support the increased number of clients. There is need for government to provide effective governance to mobilize resources and improve on resource availability, enforce laws that protect the scarce resources and strengthen collaborations within and between sectors to ensure effective and efficient implementation of IHSD in the public health facilities of Malawi
Open Access
Burden and predictors of metabolic syndrome in adolescents and young adults in Blantyre district, Malawi.
(2020-02-07) Mwakhwawa, Queen
Metabolic syndrome (MetS) is a major public health concern as it is on the rise in developing countries. However, there is limited regional and national data specifically in adolescents to help drive interventions against MetS. To describe the burden and predictors of MetS in adolescents and young adults in Blantyre district. This was a cross-sectional study that used secondary data. MetS related risk factors from socio-demographic characteristics, anthropometric indices and body composition by deuterium dilution technique (DDT) were assessed. MetS was diagnosed using 1) the international diabetes federation (IDF) criteria by the presence of three or more of the following components: raised blood pressure (BP), raised fasting blood glucose (FBG), reduced high density lipoprotein (HDL), raised triglycerides and larger waist circumference (WC), 2) Metabolic syndrome severity score (MSSS) using these inputs: age, gender, race, weight, height, FBG, BP and HDL on an online calculator. Multivariate logistic regressions were applied to identify MetS -associated risk factors. The study enrolled 371 adolescents and young adults aged 10-28 years The most prevalent MetS component was raised FBG at 31.3 % and reduced HDL at 30 % while the least common component was raised blood pressure BP at 3%. The overall prevalence of MetS was 3.1% by MSSS and 2.5% by IDF criteria and all participants had mild MetS. There was no difference in MetS prevalence by all socio-demographic characteristics and anthropometric indices including history of treatment for acute malnutrition except for waist to height ratio (WHtR). High WHtR and excess fat % were associated with MetS in unadjusted regression analysis with Odds Ratio (OR) 95% Confidence interval (CI)) of 5.18 (0.33,0.91) and 8.87 (1.91,41.08) respectively. After adjusting for sex, age, maternal occupation, WHtR and WHR, participants with excess fat % had 6 times more risk of MetS compared to those with no excess fat%, OR (CI) of 5.88, (1.37,35.4). Conclusions: MetS was relatively rare in this population at 3% prevalence. Abnormal body composition, especially presence of excess fat% increases the odds of presence of MetS.
Open Access
Assessing factors that hinder effective utilisation of family planning services by perinatally HIV infected adolescents in Chiradzulu district
(2020-03-01) Siyasiya, Gloria
Adolescents who have perinatal HIV are equally sexually active and a higher proportion of them is becoming pregnant and bears children. This is happening when family planning services are being provided at the teen clubs where they access HIV services. The study aimed at assessing reasons why these adolescents are not utilizing the family planning services that are being offered. The objectives of the study were to: establish perinatally HIV infected adolescents’ knowledge of the importance of family planning, identify sexual and reproductive health services available for perinatally HIV adolescents, determine the support system that is available for perinatally HIV infected adolescents and determine the challenges that the perinatally HIV infected adolescents face during care.This qualitative study was conducted at Chiradzulu District Hospital and Namitambo Health Centre from March to May 2019. The researcher recruited19 adolescents aged 15-19 years, who were perinatally infected with HIV and were aware of their HIV status. The results showed that most perinatally HIV infected adolescents are aware of the importance of family planning. Additionally, it was found that misconceptions about and side effects of some family planning methods are the main reason for non-contraceptive use.Parents/guardians are the main source of support but they do not have adequate knowledge about reproductive health issues relating to the adolescents, hence fail to provide the needed support. The study also showed that the majority of the adolescents who have a romantic relationship disclosed their HIV status to their partners. The findings also revealed that there is to involve parents and traditional leaders in issues of sexual and reproductive health so that they know the kind of support they could provide to their adolescent children. Additionally, improving the sexual and reproductive health information and services for adolescents will help create contraceptive demand by these adolescents.
Open Access
Investigating the status of menstrual hygiene Management absorbent interventions in Malawi – A situation analysis in the schools of Malawi
(2020-03-01) Masanda, Anna Sylvia
Menstrual Hygiene Management (MHM) is a challenge in low and middle income countries (LMICs) due to limited resources. Despite presence of various MHM absorbent interventions1 in Malawi, anecdotal evidence and grey literature suggest that women and girls still face MHM challenges. This study was aimed at investigating the status of Menstrual Hygiene Management interventions in the schools of Malawi. In order to meet the set objective, a desk review of relevant MHM policies/guidelines governing MHM interventions on absorbents and infrastructure were reviewed. To get more details on the available interventions, relevant stakeholders at central and district level were contacted and schools benefiting from MHM interventions were visited to appreciate integration of MHM in WASH infrastructure interventions. 118 schools were selected using convenient sampling from selected 14 districts in the country. This study found that Malawi has no standalone policy on MHM and there are no designated infrastructure standards for MHM facilities. The research found 56 organizations that are working on MHM interventions where all of them have a component on absorbent MHM but only 12 also have a component on MHM infrastructure. Despite existence of efforts in integrating MHM in other policies, there is a need for a clear policy to govern MHM interventions in Malawi. Malawi should consider having a live database that should be updated from time to time that will help targeted interventions
Open Access
An exploration of the relationship between herbal medicine use and anti-retro viral therapy adherence among people living with HIV in Blantyre, Malawi.
(2020-03-01) Noniwa, Thokozani
Antiretroviral Therapy(ART) adherence is defined as being able to consistently take 95% of the prescribed Antiretroviral(ARV) drugs by an HIV infected person. According to the World Health Organisation(WHO), most people living with HIV and AIDS in Africa use also herbal medicines to treat opportunistic infections and obtain symptomatic relief. The main objective of this research was to explore potential relationship between use of herbal medicine and Antiretroviral Therapy adherence among People Living with HIV. Specifically, the study was designed to determine use of herbal medicine among People Living with HIV, establish patterns of herbal medicine use, explore potential interruption to ART medication due to herbal medicine use and determine associated factors for herbal medicine use among People Living with HIV. The study adopted the phenomenological study design. Data was collected through individual in-depth interviews. Purposive sampling was used to select study participants. Data analysis was done using thematic content analysis. This analysis was done guided by the study objectives to generate emerging themes. Three main themes emerged from the data. The themes framed through the lens of HIV and AIDS care included: (1) patients’ perspectives on ART medication, (2) herbal medicine use in relation to HIV infection and ART adherence, and (3) perceived quality of medical care. Subthemes were discussed under each of the main themes. This study has shown that herbal medicines are widely being used by People Living with HIV and this consequently interrupts their adherence to Antiretroviral Therapy. Some of the People Living with HIV use the herbal medicines separately from ARVs while some use them concomitantly with ARVs. Inadequacies in the health system delivery have also shown to promote use of herbal medicine among People Living with HIV. This has largely affected ART adherence as some of them default ART around the time that they switch to herbal medicine
Open Access
The impact of demographic and socio-economic characteristics on feeding and caring practices for children under two years in rural Malawi
(2020-03-01) Kalepa, Josephine
UNICEF conceptual framework on the causes of malnutrition shows clear link between socio-economic and demographic characteristics with inadequate dietary intake and diseases which are immediate causes of malnutrition. This study was carried out to determine the impact of caregiver’s demographic and socio-economic characteristics on child dietary intake and health seeking behaviour for children less than two years in rural Malawi to inform the design of health and nutrition programs targeting rural population. This was a cross-sectional study based on secondary analysis of data collected through International Lipid-Based Nutrient Supplements (iLiNS-DOSE) Project from June 2009 to December 2013. A total of 1932 caregivers and children were included in analysis. Logistic regression model was used to investigate the effect of socio-economic and demographic characteristics on minimum dietary diversity and care-giver’s health seeking behaviour for common childhood illnesses. Only 2.5% of the children were able to meet minimum dietary diversity (≥4food groups) at 6 months. Care givers that had attained complete primary education were 2 times more likely to meet child minimum dietary diversity as compared to caregivers with no education [OR 2.5 (95% CI:0.27,24.8)]. The odds of practicing appropriate care seeking behaviour increased by 0.07 for caregivers aged 18 to 24 years [ OR 1.07 (95% CI: 0.40,2.83) Interventions aimed at improving the socio-economic status of rural households in Malawi can greatly improve children dietary diversity.
Open Access
An exploration of the relationship between herbal medicine use and anti-retro viral therapy adherence among people living with HIV in Blantyre, Malawi.
(2020-03-01) Noniwa, Thokozani
Antiretroviral Therapy(ART) adherence is defined as being able to consistently take 95% of the prescribed Antiretroviral(ARV) drugs by an HIV infected person. According to the World Health Organisation(WHO), most people living with HIV and AIDS in Africa use also herbal medicines to treat opportunistic infections and obtain symptomatic relief. The main objective of this research was to explore potential relationship between use of herbal medicine and Antiretroviral Therapy adherence among People Living with HIV. Specifically, the study was designed to determine use of herbal medicine among People Living with HIV, establish patterns of herbal medicine use, explore potential interruption to ART medication due to herbal medicine use and determine associated factors for herbal medicine use among People Living with HIV. The study adopted the phenomenological study design. Data was collected through individual in-depth interviews. Purposive sampling was used to select study participants. Data analysis was done using thematic content analysis. This analysis was done guided by the study objectives to generate emerging themes. Three main themes emerged from the data. The themes framed through the lens of HIV and AIDS care included: (1) patients’ perspectives on ART medication, (2) herbal medicine use in relation to HIV infection and ART adherence, and (3) perceived quality of medical care. Subthemes were discussed under each of the main themes. This study has shown that herbal medicines are widely being used by People Living with HIV and this consequently interrupts their adherence to Antiretroviral Therapy. Some of the People Living with HIV use the herbal medicines separately from ARVs while some use them concomitantly with ARVs. Inadequacies in the health system delivery have also shown to promote use of herbal medicine among People Living with HIV. This has largely affected ART adherence as some of them default ART around the time that they switch to herbal medicine
Open Access
Acceptability of integrating HIV early infant diagnosis (EID) into under-five outreach immunization clinics in Lilongwe rural areas in Malawi
(2020-03-01) Makanda, Mphatso
Human Immunodeficiency Virus (HIV) disease progresses quickly in children. Without treatment, 50% of the children living with HIV die before 2 years of age. Hence, HIV exposed infants are recommended to have an Early Infant Diagnosis (EID) at 4-6 weeks of age. This is so that infected children are identified and started on treatment timely. However, it has been observed that 29% of HIV exposed infants receive EID test late in Malawi. Hence, there is need to identify better strategies to increase EID testing rates at 6 weeks. This study aimed at assessing acceptability of integrating EID into under-five outreach immunization clinics in Lilongwe rural areas among mothers of under-five children. This was an observational, analytical, cross sectional study. It used quantitative study methods to answer the researched question. A questionnaire was used to collect data from study participants. The data was analyzed using Stata version 14. We enrolled 100 mothers in the study regardless of their HIV status. Almost all of them (99%) indicated that the integration of EID in immunization clinics is important. The majority of them (96%) also indicated that they would accept their infants to have an HIV EID test at outreach immunization clinics. Availability of HIV test providers was reported to be the number one facilitator of the integration and it was seconded by the availability of infrastructures at the immunization clinics. The study also found out that unavailability of HIV testing providers have the greatest potential of hindering the integration of HIV EID in immunization clinics seconded by unavailability of shelter at the outreach immunization clinics. Integration of HIV early infant diagnosis into under-five outreach immunization clinics of Lilongwe rural areas is acceptable among mothers of under-five children. The integration can aid in increasing EID test rates of HIV exposed infants at 6 weeks of age.
Open Access
Assessment of factors associated with linkage to care amongst adults accessing HIV services at Bwaila hospital, Lilongwe district, Malawi.
(2020-03-01) Gondwe, Clifton Muvwala
Despite the policy progress made in Malawi about HIV and AIDS, the prevalence rate remains among the highest in the world. Despite many people being tested HIV positive not all have been linked to HIV care. Linkage to care is a crucial early step in successful HIV treatment. Linkage to HIV care is still a challenge in Malawi as 32% is not yet linked to care. This group may pose a threat of transmitting the infection to the population. Currently the country is striving to meet the 90.90.90 UNAIDS target The main objective of the study was to assess factors associated with linkage to care amongst adults accessing HIV services at Bwaila Hospital in Lilongwe District.This was a descriptive cross-sectional study that employed qualitative methods. Eighteen in-depth interviews were conducted with clients above 18 years old and 2 focus group discussions with Health Providers at Bwaila Hospital. Purposive sampling method was used to recruit study participants. Thematic analysis was used to analyze data. Findings indicate that linkage to care is affected by one‟s perception towards Antiretroviral Therapy initiation, physical escort of clients by providers, integration of services, existence of support partners, shortage of staff leading to high workload, poor coordination of services at the facility and distance to the facility. Interventions aimed at improving linkage to care in HIV services should focus on integration of health services. In addition, additional human resource and ease of access to health services should also be considered
Open Access
Community-suggested approaches for improving immunisation coverage and equity among under-five children in hard-to-reach areas and under-performing facilities in Nkhata-Bay and Mchinji districts in Malawi
(2020-03-01) Kapachika, Arnold
In Malawi, immunisation coverage for all basic vaccinations for children age 12- 23 months is 76%, below the WHO target of 80%. Some districts have been consistently under performing (less than 80% in immunisation coverage) and have low-performing health facilities located in hard to reach areas. However, limited information exists on community-proposed strategies for improving immunisation coverage and equity. Objectives: The study was aimed at identifying approaches suggested by the communities and care-givers for improving immunisation coverage and equity in under-five children in hard-to reach areas and low-performing facilities in Mchinji and Nkhata-Bay districts.The study was a cross-sectional mixed methods design. Qualitative data was collected from 6 Focus Group Discussions (FGDs) and 32 In-depth Interviews (IDI) with primary care-givers, community health volunteers (CHVs), traditional leaders and members of Health Centre Advisory Committees (HCACs) and was analysed using thematic content analysis. Quantitative data was extracted from household survey done in March, 2019 and descriptive analysis was done using STATA version 13. Suggested approaches were; task-shifting of immunisation to CHVs, establishing more outreach clinics, male involvement, involving community health action groups (CHAG) in follow-ups on care-givers who missed immunisation, and ensuring consistent immunisation clinics. Immunisation challenges gathered were: long distance and competing priorities for care givers, lack of transport for health workers and volunteers, and illicit charging for immunisation by health workers. Knowledge of care-givers of vaccines was low. Immunisation programmes should consider task-shifting of administering vaccines to community health volunteers, introducing more outreach clinics, ensure no cancelation of immunisation clinics, and promote male involvement and community engagement in immunisation services.
Open Access
Psychosocial care for road traffic injury patients: An exploration of service provision to patients attending Orthopaedic Clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi.
(2022-03-01) Grace, Chigalu, Chingwalu
Every year the lives of approximately 1.35 million people globally, are cut short as a result of a road traffic crash. Road traffic accidents are responsible for different types of injuries and disabilities which affect the individual’s quality of life as they may suffer limitations in physical, social and mental well- being. However, the nursing practice at QECH does not focus much on psychosocial wellbeing of patients. This study therefore, explored the provision of psychosocial services to patients with road traffic injuries attending Orthopaedic clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi. Literature shows that psychosocial care in patients with orthopaedic injuries is important as it involves collaboration between health care professionals as well as multidisciplinary care. This was a qualitative study employing a phenomenological design which focused on nurses, caregivers and patients. A purposively selected sample of 20 adult patients, who were attending adult orthopaedic clinic at QECH were interviewed. The sample was selected from orthopaedic patients attending clinic at QECH. Data analysis was done manually by following principles of thematic content analysis. Psychosocial issues are not recognized and nurses focus their care on Bio-physiological issues. Over 75% of the participants felt that delay to go to theatre lengthened their stay in hospital which further affected the patients psychosocially since their financial resources became depleted more and more. Holistic approach to patients’ care is necessary to provide psychosocial care to orthopaedic trauma patients. There should be development of standardized guidelines which will include psychosocial care in dealing with orthopaedic trauma patients.
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Assessment of health worker’s knowledge and utilization of partograph to diagnose fetal distress during labor at Bwaila Hospital, in Lilongwe Malawi
(2022-03-01) Chiwala, Luke
World Health Organization recommended the partograph in management of women during labor to improve maternal and neonatal outcomes. Despite gains made in reducing maternal health, neonatal deaths from complications of labor and delivery persists. Quality of care and the use of the partograph in labor can help to avert deaths from labor complications. The way health workers use that partograph to diagnose fetal distress during labor needs to be investigated. This facility based cross-sectional study was conducted at Bwaila hospital using both qualitative and quantitative methods. A total of 911 partographs of births at Bwaila for the month of April and May 2020 were reviewed. Fifteen (15) midwives in the maternity ward were interviewed. Descriptive statistics and logistic regression were used to analyze quantitative data. Thematic analysis was applied to analyze data from in-depth interviews. Midwives had good knowledge about the partograph. Utilization of partographs and diagnosis of fetal distress was poor. Meconium-stained liquor (AOR=2.33; 95% CI =1.51-3.59, p<0.001), vacuum extraction (AOR=4.64; 95% CI= 1.61-13.58, p=0.004), Crossing alert line (AOR=1.70; 95% CI =1.09-2.66, p=0.020)., Male sex (AOR=1.75; 95% CI=1.17-2.62, p=0.006) and Birth Weight (AOR= 0.9992234; 95% CI= 0.9988441 - 0.9995922, p <0.001) were factors associated with birth asphyxia. Improving staffing levels, consistent supportive supervision, availability of equipment and supplies, in-service trainings on labor management and partograph, introduction of incentives, improving inter-professional collaboration, are necessary to improve quality. Partograph needs to be reviewed and modified to meet context needs. Electronic fetal monitoring should be used in busy setting.
Open Access
Understanding factors that moderate the relationship between family poverty and depression among adolescents aged 10 to 16 years in rural districts of Balaka, Mchinji and Rumphi.
(2022-03-01) Munthali, Denis, Edmond
Adolescence is a critical stage in human development where physical, cognitive, and psychosocial growth takes place. Poverty is linked to adolescent depression. In Malawi, it is estimated that depression affects 16.9% of adolescents aged 10 to 16 years old. The objectives of the study were to assess the relationship between wealth index status and depression among adolescents and determine if this relationship is moderated by Adverse Childhood Experiences (ACEs) in the districts of Rumphi, Balaka and Mchinji. This study used cross-sectional secondary data collected in 2017 by Malawi Longitudinal Study of Families and Health-ACE (MLFSH-ACE). Logistic regression model was used to assess the relationship between wealth status and depression among adolescents. Odds ratios were generated to measure the association between wealth status and depression. ACEs factors were added to the model to test for moderation. The mean age in years was 13.2(±1.70) and 51% of the sample was female, 49% Male. School attendance among adolescents was at 91%. Adolescents from high wealth index households had lower odds of depression compared with adolescents from low wealth index households (aOR= 0.73, 95% CI: 0.56-0.95). Adolescents from a lower wealth index households have high odds of depression compared to adolescents from low wealth index households. In Developing countries, wealth index data can be used in identifying high risk households for adolescent’s depression and formulate appropriate interventions.
Open Access
Spectrum of intestinal pathogens and their clinical presentation in HIV-positive patients with diarrhoea at Queen Elizabeth Central Hospital adult medical wards
(2022-03-01) Nachipo, Patrick
Diarrhoea is one of the most common conditions in people living with HIV (PLWHIV) in Malawi. However, there is limited data on the aetiology of diarrhoea and the specific clinical presentations in this population and setting. The aim of this study was to identify pathogens associated with diarrhoea in PLWHIV. Specifically, the study wanted to determine the prevalence of cryptosporidiosis and other enteric pathogens and to describe their clinical presentations This was a cross-section observational study at the Queen Elizabeth Central Hospital (QECH), a referral hospital in Blantyre, nested within a Phase 2A clinical trial of treatment of cryptosporidiosis in PLWHIV. Identification of the infectious agents in stool was done by Gastrointestinal (GI) TaqMan Array testing. We performed descriptive analyses on the prevalence of specific intestinal pathogens in PLWHIV presenting with diarrhoea comparing those with and without cryptosporidiosis. We also described the clinical presentations associated with the pathogens. We recruited 20 adults with diarrhoea caused by cryptosporidiosis and 10 controls without diarrhoea and cryptosporidiosis. The median CD4+ T-lymphocyte count was 21 cells/microlitre for the cases and 419 cells/microlitre for the controls (p<0001). The most common pathogens isolated among the cases were enteroaggregative Escherichia coli (EAEC)-65% (95% CI 40.78 to 84.6%), enterotoxigenic Escherichia coli (ETEC) (60%), Shigella spp. (60%) and Encephalitozoon bieneusi (40%). Among the controls, the most common pathogens isolated were Blastocystis in 87.5% (95% CI 47.35% to 99.68%), Shigella spp. in 75% (95% CI 34.91% to 96.81%), enteropathogenic Escherichia coli (EPEC) in 50 % (95% CI 15.70% to 84.30%) and ETEC in 50%. There was statistically significant difference in the prevalence of Blastocystis, being more common in the controls than the cases (87.5% and 30% respectively, p=0.0107). There was no statistically significant difference in the median number of pathogens isolated from one individual between the cases and the controls, 6.5 pathogens/person among the cases and 3.5 pathogens/person among the controls (p=0.2714). The most common clinical features identified were anorexia, nausea, abdominal pain and vomiting. 95% of the cases had used antibiotics prior to admission (95% CI 50.90 to 91.34). Our study showed that PLWHIV and diarrhoea with cryptosporidium, have low CD4 counts. They also have other enteric pathogens including EAEC, EPEC, ETEC, Shigella spp., E. bienuesi and Giardia. It also showed that Blastocystis is a common pathogen in HIV reactive patients, with and without diarrhoea. Anorexia, nausea, abdominal pain and vomiting were the common accompanying symptoms in patients with chronic diarrhoea. We also found that the use of antibiotics in chronic diarrhoea was prevalent.

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