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Ngwira MM, Gadama LA, Shanmugalingam R, Makris A, Hennessy A. Patients and health care workers perceived challenges in managing preeclampsia, in Malawi. Pregnancy Hypertens 2024; 35:61-65. [PMID: 38244242 DOI: 10.1016/j.preghy.2024.01.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES This study investigated perceptions of the challenges for patients and health care workers (HCW) in dealing with preeclampsia in Blantyre, Malawi. METHODS A descriptive cross-sectional formative study using semi-structured In-Depth Interviews (IDI) was conducted at Queen Elizabeth Central Hospital (QECH), Malawi. Data was analyzed using NVIVO™ software. Thematic content analysis was used to analyze and interpret the findings. Emerging themes were then developed inductively and deductively. Patients were interviewed who recently had preeclampsia. RESULTS Stress, lack of information, physical symptoms, delay in receiving care were identified challenges to better care among patients as well as the impact of poor pregnancy outcomes. Late diagnosis, staff burn out, inadequate skills and lack of resources were expressed as challenge to provide better management by the interviewed HCWs. CONCLUSION Our study showed that a diagnosis of preeclampsia is challenging to both patients and HCWs. These challenges need to be addressed carefully at all levels for optimal management of preeclampsia in Malawi, Africa and in order to improve outcomes.
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Affiliation(s)
- Memory M Ngwira
- Western Sydney University, Sydney, Australia; Kamuzu University of Health Sciences, Malawi; Heart Research Institute, University of Sydney, Sydney, Australia.
| | - Luis A Gadama
- Western Sydney University, Sydney, Australia; Kamuzu University of Health Sciences, Malawi
| | - Renuka Shanmugalingam
- Western Sydney University, Sydney, Australia; WHITU, South Western Sydney Local Health District, Sydney, Australia; South Western Sydney School of Medicine, University of New South Wales, Sydney, Australia
| | - Angela Makris
- Western Sydney University, Sydney, Australia; WHITU, South Western Sydney Local Health District, Sydney, Australia; Heart Research Institute, University of Sydney, Sydney, Australia; South Western Sydney School of Medicine, University of New South Wales, Sydney, Australia
| | - Annemarie Hennessy
- Western Sydney University, Sydney, Australia; WHITU, South Western Sydney Local Health District, Sydney, Australia; Heart Research Institute, University of Sydney, Sydney, Australia
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Tobin NH, Murphy A, Li F, Brummel SS, Fowler MG, Mcintyre JA, Currier JS, Chipato T, Flynn PM, Gadama LA, Saidi F, Nakabiito C, Koos BJ, Aldrovandi GM. Metabolomic profiling of preterm birth in pregnant women living with HIV. Metabolomics 2023; 19:91. [PMID: 37880481 PMCID: PMC10600291 DOI: 10.1007/s11306-023-02055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Preterm birth is a leading cause of death in children under the age of five. The risk of preterm birth is increased by maternal HIV infection as well as by certain antiretroviral regimens, leading to a disproportionate burden on low- and medium-income settings where HIV is most prevalent. Despite decades of research, the mechanisms underlying spontaneous preterm birth, particularly in resource limited areas with high HIV infection rates, are still poorly understood and accurate prediction and therapeutic intervention remain elusive. OBJECTIVES Metabolomics was utilized to identify profiles of preterm birth among pregnant women living with HIV on two different antiretroviral therapy (ART) regimens. METHODS This pilot study comprised 100 mother-infant dyads prior to antiretroviral initiation, on zidovudine monotherapy or on protease inhibitor-based antiretroviral therapy. Pregnancies that resulted in preterm births were matched 1:1 with controls by gestational age at time of sample collection. Maternal plasma and blood spots at 23-35 weeks gestation and infant dried blood spots at birth, were assayed using an untargeted metabolomics method. Linear regression and random forests classification models were used to identify shared and treatment-specific markers of preterm birth. RESULTS Classification models for preterm birth achieved accuracies of 95.5%, 95.7%, and 80.7% in the untreated, zidovudine monotherapy, and protease inhibitor-based treatment groups, respectively. Urate, methionine sulfone, cortisone, and 17α-hydroxypregnanolone glucuronide were identified as shared markers of preterm birth. Other compounds including hippurate and N-acetyl-1-methylhistidine were found to be significantly altered in a treatment-specific context. CONCLUSION This study identified previously known as well as novel metabolomic features of preterm birth in pregnant women living with HIV. Validation of these models in a larger, independent cohort is necessary to ascertain whether they can be utilized to predict preterm birth during a stage of gestation that allows for therapeutic intervention or more effective resource allocation.
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Affiliation(s)
- Nicole H Tobin
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Aisling Murphy
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Fan Li
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Sean S Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James A Mcintyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Judith S Currier
- Division of Infectious Diseases, Department of Internal Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Tsungai Chipato
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Patricia M Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Luis A Gadama
- Department of Obstetrics and Gynecology, Johns Hopkins Research Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Brian J Koos
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Grace M Aldrovandi
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
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Ngwira MM, Gadama LA, Shanmugalingam R, Makris A, Hennessy A. Health Care Workers and Key Policy Informant’s Knowledge of the use of Calcium and Low Dose Aspirin for Prevention of Preeclampsia in Malawian Women. Pregnancy Hypertens 2022; 30:221-225. [DOI: 10.1016/j.preghy.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
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Limani F, Garley D, Cocker D, Patel P, Patel P, Gordon S, Nyirenda M, Sakala S, Gadama LA, Dube Q, Bodole F, Mndolo KS, Mponda K, Freyne B. Lessons learnt from the rapid implementation of reusable personal protective equipment for COVID-19 in Malawi. BMJ Glob Health 2021; 6:bmjgh-2021-006498. [PMID: 34518206 PMCID: PMC8438572 DOI: 10.1136/bmjgh-2021-006498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022] Open
Abstract
The SARS-CoV-2 pandemic has challenged health systems and healthcare workers worldwide. Access to personal protective equipment (PPE) is essential to mitigate the risk of excess mortality in healthcare providers. In Malawi, the cost of PPE represents an additional drain on available resources. In the event of repeated waves of disease over several years, the development of sustainable systems of PPE is essential. We describe the development, early implementation and rapid scale up of a reusable gown service at a tertiary-level hospital in Blantyre, Malawi. Challenges included healthcare worker perceptions around the potential of reduced efficacy of cotton gowns, the need to plan for surge capacity and the need for ongoing training of laundry staff in safety and hygiene procedures. Benefits of the system included increased coverage, decreased cost and reduced waste disposal. The implementation of a reusable cotton gown service is feasible, acceptable and cost-effective in tertiary centres providing specialist COVID-19 care at the height of the pandemic. This innovation could be expanded beyond low-income settings.
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Affiliation(s)
- Fumbani Limani
- Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David Garley
- Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Derek Cocker
- Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Priyanka Patel
- Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Pratiksha Patel
- Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Stephen Gordon
- Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Respiratory Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mulinda Nyirenda
- Ministry of Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Internal Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Servace Sakala
- Hospital Information, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Luis A Gadama
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
| | - Feggie Bodole
- Nursing, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Kelvin Mponda
- Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bridget Freyne
- Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK .,Paediatrics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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von Wissmann B, Wastnedge E, Waters D, Gadama LA, Dube Q, Masesa C, Chodzaza E, Stock SJ, Reynolds RM, Norrie J, Makwakwa E, Freyne B, Campbell H, Norman JE, Wood R. Informing prevention of stillbirth and preterm birth in Malawi: development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration. BMJ Open 2020; 10:e038859. [PMID: 33234630 PMCID: PMC7689106 DOI: 10.1136/bmjopen-2020-038859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/27/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials. DESIGN Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility. SETTING Antenatal, maternity and specialist neonatal care in Malawi. RESULTS The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes. CONCLUSIONS Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research.
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Affiliation(s)
- Beatrix von Wissmann
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
- Public Health, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Elizabeth Wastnedge
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Donald Waters
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Luis A Gadama
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
| | - Clemens Masesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Elizabeth Chodzaza
- Faculty of Midwifery, Neonatal and Reproductive Health Studies, University of Malawi Kamuzu College of Nursing, Blantyre, Malawi
| | - Sarah Jane Stock
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Queen's Medical Research Institute, The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Enita Makwakwa
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Bridget Freyne
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Harry Campbell
- Centre for Global Health Research, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
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