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Singogo E, Chagomerana M, Van Ryn C, M’bwana R, Likaka A, M’baya B, Puerto-Meredith S, Chipeta E, Mwapasa V, Muula A, Reilly C, Hosseinipour MC. Prevalence and incidence of transfusion-transmissible infections among blood donors in Malawi: A population-level study. Transfus Med 2023; 33:483-496. [PMID: 37828838 PMCID: PMC11096640 DOI: 10.1111/tme.13006] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/04/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Voluntary non-remunerated blood donors (VNRBDs) are essential to sustain national blood supplies. Expanding testing capacity for the major transfusion-transmitted infections (TTI) is crucial to ensure safe blood products. Understanding trends in TTIs can inform prioritisation of resources. METHODS We conducted a retrospective cohort data analysis of routine blood donation data collected from VNRBDs by the Malawi Blood Transfusion Service from January 2015 to October 2021. Variables included age, occupation; and screening results of TTIs (HIV, Hepatitis B and C, and syphilis). We estimated both prevalence and incidence per person-year for each TTI using longitudinal and spatial logistic regression models. RESULTS Of the 213 626 donors, 204 920 (95.8%) donors were included in the final analysis. Most donors (77.4%) were males, baseline median age was 19.9 (IQR 18.0, 24.1), 70.9% were students, and over 80.0% were single at first donation. Overall TTI prevalence among donors was 10.7%, with HBV having the highest prevalence (3.4%), followed by syphilis (3.3%), then HIV (2.4%) and HCV (2.4%). Incidence per 1000 person-years for syphilis was 20.1 (19.0, 21.3), HCV was 18.4 (17.3, 19.5), HBV was 13.7 (12.8, 14.7), and HIV was 11.4 (10.6, 12.3). We noted geographical variations with the northern region having lower rates of both prevalence and incidence compared to central and southern regions. CONCLUSION The individual TTI prevalence and incidence rates from this study are consistent with Southern African regional estimates. By identifying geographical variations of TTI prevalence and incidence, these findings could potentially inform prioritisation of blood collection efforts to optimise blood collection processes.
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Affiliation(s)
| | | | - Collin Van Ryn
- Department of Biostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Effie Chipeta
- Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Mwapasa
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Muula
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Cavan Reilly
- Department of Biostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi
- Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Mndala L, Chapuma C, Riches J, Gadama L, Kachale F, Bilesi R, Mbewe M, Likaka A, Kumwenda M, Makuluni R, Maseko B, Ndamala C, Kuyere A, Munthali L, Phiri D, Monk EJM, Henrion MYR, Odland ML, Lissauer D. Effects of COVID-19 on Maternal and Neonatal Outcomes and Access to Antenatal and Postnatal Care, Malawi. Emerg Infect Dis 2023; 29:1990-1998. [PMID: 37640377 PMCID: PMC10521614 DOI: 10.3201/eid2910.230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
We used national facility-level data from all government hospitals in Malawi to examine the effects of the second and third COVID-19 waves on maternal and neonatal outcomes and access to care during September 6, 2020-October 31, 2021. The COVID-19 pandemic affected maternal and neonatal health not only through direct infections but also through disruption of the health system, which could have wider indirect effects on critical maternal and neonatal outcomes. In an interrupted time series analysis, we noted a cumulative 15.4% relative increase (63 more deaths) in maternal deaths than anticipated across the 2 COVID-19 waves. We observed a 41% decrease in postnatal care visits at the onset of the second COVID-19 wave and 0.2% by the third wave, cumulative to 36,809 fewer visits than anticipated. Our findings demonstrate the need for strengthening health systems, particularly in resource-constrained settings, to prepare for future pandemic threats.
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Puerto-Meredith S, Singogo E, Chagomerana M, Nthani T, Likaka A, Gondwe A, M’baya B, Hosseinipour MC. Systematic review of prevalence and risk factors of transfusion transmissible infections among blood donors, and blood safety improvements in Southern Africa. Transfus Med 2023; 33:355-371. [PMID: 37641525 PMCID: PMC11070456 DOI: 10.1111/tme.12988] [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] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023]
Abstract
Blood and blood products are listed as one of the essential medicines by the World Health Organization (WHO). In addition to inadequate supply, most sub-Saharan Africa (SSA) nations fail to meet their blood needs because many donated blood units are discarded because they are contaminated with transfusion-transmitted infections (TTIs). We sought to estimate the prevalence of TTIs, identify the risk factors for TTIs among blood donors, and identify the efforts and interventions that have been made to improve blood safety in Southern African nations, particularly the nations of the South African Development Community (SADC). We investigated the prevalence and risk factors for TTIs, blood safety interventions, and blood quality improvement in the SADC region from major PubMed/MEDLINE, Cochrane Library, and HINARI databases from 1 January 2011 to 31 April 2021. All investigations followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In meta-analysis, we estimated the pooled TTIs prevalence and summarised the same using forest plots. A total of 180 articles published from the SSA region were identified covering our three targeted themes: TTI prevalence, risk factors for TTIs, and blood safety improvements. Of these 180 articles, only 27 (15%) focused on the SADC region. The overall pooled TTI prevalence estimate was 2.0% (95% CI: 1.0-3.0) and hepatitis B was the most prevalent TTI in the region (prevalence = 3.0; 95% CI: 2.0-5.0). The prevalence of HIV, HCV, and syphilis was 2.0% (95% CI: 1.0-4.0), 1.0% (95% CI: 0.0-2.0), and 2.0% (95% CI: 0.0-8.0), respectively. In general, replacement donors and first-time donors were more likely to be infected with TTIs than repeat donors. Twelve articles explored blood safety research in the region; however, they vary greatly highlighting the need for consistent and more comprehensive research. Few publications were identified that were from the SADC region, indicating lack of research or resources towards improving both quantity and quality of blood donation. TTI prevalence remains one of the highest in the world and blood safety recommendations vary across the region. More effort should be directed towards developing a cohesive regional blood transfusion policy and effective blood monitoring and evaluation strategies.
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Affiliation(s)
- Sydney Puerto-Meredith
- UNC Project Malawi, Lilongwe, Malawi
- UNC-CH School of Medicine, Chapel Hill, North Carolina, USA
| | | | | | | | - Andrew Likaka
- Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi
- Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Bridon M’baya
- Malawi Blood Transfusion Services (MBTS), Blantyre, Malawi
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van Niekerk L, Fosiko N, Likaka A, Blauvelt CP, Msiska B, Manderson L. Correction to: From idea to systems solution: enhancing access to primary care in Malawi. BMC Health Serv Res 2023; 23:746. [PMID: 37438778 DOI: 10.1186/s12913-023-09798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- L van Niekerk
- London School of Hygiene and Tropical Medicine, London, UK.
- Chembe Collaborative, Los Angeles, USA.
| | - N Fosiko
- The Malawi Ministry of Health, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - A Likaka
- The Malawi Ministry of Health, Lilongwe, Malawi
| | | | - B Msiska
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - L Manderson
- University of the Witwatersrand, Johannesburg, South Africa
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van Niekerk L, Fosiko N, Likaka A, Blauveldt CP, Msiska B, Manderson L. From idea to systems solution: enhancing access to primary care in Malawi. BMC Health Serv Res 2023; 23:547. [PMID: 37231399 DOI: 10.1186/s12913-023-09349-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
Malawi, like many other countries, faces challenges in providing accessible, affordable, and quality health services to all people. The Malawian policy framework recognizes the value of communities and citizens, as co-creators of health and leaders of localized and innovative initiatives, such as social innovations.Social innovations involve and include communities and citizens, as well as bring about changes in the institutions responsible for care delivery. In this article, we describe the institutionalization process of a citizen-initiated primary care social innovation, named Chipatala Cha Pa Foni, focused on extending access to health information and appropriate service-seeking behavior.An interdisciplinary multi-method qualitative case study design was adopted, drawing on data collected from key informant interviews, observations, and documents over an 18-month period. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis. Institutional-level changes were analyzed in five key dimensions as well as the role of actors, operating as institutional entrepreneurs, in this process.A subset of actors matched the definition of operating as Institutional Entrepreneurs. They worked in close collaboration to bring about changes in five institutional dimensions: roles, resource flows, authority flows, social identities and meanings. We highlight the changing role of nurses; redistribution and decentralization of health information; shared decision-making, and greater integration of different technical service areas.From this study, the social innovation brought about key institutional and socio-cultural changes in the Malawi health system. These changes supported strengthening the system's integrity for achieving Universal Health Coverage by unlocking and cultivating dormant human-based resources. As a fully institutionalized social innovation, Chipatala Cha Pa Foni has enhanced access to primary care and especially as part of the Covid-19 response.
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Affiliation(s)
- L van Niekerk
- London School of Hygiene and Tropical Medicine, London, UK.
- Chembe Collaborative, Los Angeles, USA.
| | - N Fosiko
- The Malawi Ministry of Health, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - A Likaka
- The Malawi Ministry of Health, Lilongwe, Malawi
| | | | - B Msiska
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - L Manderson
- University of the Witwatersrand, Johannesburg, South Africa
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Mndala L, Monk EJM, Phiri D, Riches J, Makuluni R, Gadama L, Kachale F, Bilesi R, Mbewe M, Likaka A, Chapuma C, Kumwenda M, Maseko B, Ndamala C, Kuyere A, Munthali L, Henrion MYR, Masesa C, Lissauer D. Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey): data from a national maternal surveillance platform. Lancet Glob Health 2022; 10:e1623-e1631. [PMID: 36155136 PMCID: PMC9553200 DOI: 10.1016/s2214-109x(22)00359-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outcomes of omicron-associated COVID-19 in pregnancy have not been reported from low-resource settings, and data from sub-Saharan Africa before the emergence of omicron are scarce. Using a national maternal surveillance platform (MATSurvey), we aimed to compare maternal and neonatal outcomes of COVID-19 in Malawi during the omicron wave to the preceding waves of beta and delta. METHODS All pregnant and recently pregnant patients, up to 42 days following delivery, admitted to 33 health-care facilities throughout Malawi with symptomatic, test-proven COVID-19 during the second (beta [B.1.351]: January to April, 2021), third (delta [B.1.617.2]: June to October, 2021), and fourth (omicron [B.1.1.529]: December 2021 to March, 2022) waves were included, with no age restrictions. Demographic and clinical features, maternal outcomes of interest (severe maternal outcome [a composite of maternal near-miss events and maternal deaths] and maternal death), and neonatal outcomes of interest (stillbirth and death during maternal stay in the health-care facility of enrolment) were compared between the fourth wave and the second and third waves using Fisher's exact test. Adjusted odds ratios (ORs) for maternal outcomes were estimated using mixed-effects logistic regression. FINDINGS Between Jan 1, 2021, and March 31, 2022, 437 patients admitted to 28 health-care facilities conducting MATSurvey had symptoms of COVID-19. SARS-CoV-2 infection was confirmed in 261 patients; of whom 76 (29%) had a severe maternal outcome and 45 (17%) died. These two outcomes were less common during the fourth wave (omicron dominance) than the second wave (adjusted OR of severe maternal outcome: 3·96 [95% CI 1·22-12·83], p=0·022; adjusted OR of maternal death: 5·65 [1·54-20·69], p=0·0090) and the third wave (adjusted OR: 3·18 [1·03-9·80], p=0·044; adjusted OR: 3·52 [0·98-12·60], p=0·053). Shortness of breath was the only symptom associated with poor maternal outcomes of interest (p<0·0001), and was less frequently reported in the fourth wave (23%) than in the second wave (51%; p=0·0007) or third wave (50%; p=0·0004). The demographic characteristics and medical histories of patients were similar across the three waves. During the second and third waves, 12 (13%) of 92 singleton neonates were stillborn or died during maternal stay in the health-care facility of enrolment, compared with 0 of the 25 born in the fourth wave (p=0·067 vs preceding waves combined). INTERPRETATION Maternal and neonatal outcomes from COVID-19 were less severe during the fourth wave of the SARS-CoV-2 pandemic in Malawi, during omicron dominance, than during the preceding beta and delta waves. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and the National Institute for Health and Care Research. TRANSLATION For the Chichewa translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Leonard Mndala
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Edward J M Monk
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
| | - Deborah Phiri
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Jennifer Riches
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Regina Makuluni
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Luis Gadama
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | - Andrew Likaka
- Malawi Blood Transfusion Services, Blantyre, Malawi; Universidade Federal de Pernambuco, Recife, Brazil
| | - Chikondi Chapuma
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bertha Maseko
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Chifundo Ndamala
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Annie Kuyere
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Laura Munthali
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Clemens Masesa
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Lissauer
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; University of Liverpool, Liverpool, UK
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Likaka A, Damte T, Albuquerque J. State of quality in the COVID era including ongoing initiatives and priorities for improving quality in the future. IJQHC Communications 2022. [PMCID: PMC8903336 DOI: 10.1093/ijcoms/lyab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew Likaka
- Ministry of Health, Lilongwe, Malawi
- Keizo-Immunopathology Laboratory, Universidade Federal de Pernambuco, Pernambuco, Brazil
| | - Tedla Damte
- Keizo-Immunopathology Laboratory, Universidade Federal de Pernambuco, Pernambuco, Brazil
- UNICEF Malawi, Lilongwe, Malawi
| | - Jones Albuquerque
- Keizo-Immunopathology Laboratory, Universidade Federal de Pernambuco, Pernambuco, Brazil
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Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, de Albuquerque JO, de Lima Filho JL. Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study. Ren Fail 2021; 43:911-918. [PMID: 34057014 PMCID: PMC8168780 DOI: 10.1080/0886022x.2021.1933530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. METHODS We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. RESULTS The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43-20.74) and vasopressors (OR = 2.93; CI 1.28-6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23-5.45) and vasopressors (OR = 1.95; CI 1.12-3.99) were also independent risk factors for KDIGO 3 (p < 0.001). CONCLUSION Critically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.
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Affiliation(s)
- Rodrigo Bezerra
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- PROCAPE, University of Pernambuco, Recife, Brazil
| | - Flávio Teles
- Clinical Medicine Department, Federal University of Alagoas, Maceio, Brazil
| | | | | | - Andrew Likaka
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
| | | | - Jones Oliveira de Albuquerque
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Statistics and Informatics, Federal Rural University of Pernambuco, Recife, Brazil
| | - José Luiz de Lima Filho
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Biochemistry, Federal University of Pernambuco, Recife, Brazil
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Mandolo J, Msefula J, Henrion MYR, Brown C, Moyo B, Samon A, Moyo-Gwete T, Makhado Z, Ayres F, Motlou T, Mzindle N, Kalata N, Muula AS, Kwatra G, Nsamala N, Likaka A, Mfune T, Moore PL, Mbaya B, French N, Heyderman RS, Swarthout T, Jambo KC. SARS-CoV-2 exposure in Malawian blood donors: an analysis of seroprevalence and variant dynamics between January 2020 and July 2021. BMC Med 2021; 19:303. [PMID: 34794434 PMCID: PMC8601780 DOI: 10.1186/s12916-021-02187-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/26/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By August 2021, the COVID-19 pandemic has been less severe in sub-Saharan Africa than elsewhere. In Malawi, there have been three subsequent epidemic waves. We therefore aimed to describe the dynamics of SARS-CoV-2 exposure in Malawi. METHODS We measured the seroprevalence of anti-SARS-CoV-2 antibodies amongst randomly selected blood transfusion donor sera in Malawi from January 2020 to July 2021 using a cross-sectional study design. In a subset, we also assessed in vitro neutralisation against the original variant (D614G WT) and the Beta variant. RESULTS A total of 5085 samples were selected from the blood donor database, of which 4075 (80.1%) were aged 20-49 years. Of the total, 1401 were seropositive. After adjustment for assay characteristics and applying population weights, seropositivity reached peaks in October 2020 (18.5%) and May 2021 (64.9%) reflecting the first two epidemic waves. Unlike the first wave, both urban and rural areas had high seropositivity in the second wave, Balaka (rural, 66.2%, April 2021), Blantyre (urban, 75.6%, May 2021), Lilongwe (urban, 78.0%, May 2021), and Mzuzu (urban, 74.6%, April 2021). Blantyre and Mzuzu also show indications of the start of a third pandemic wave with seroprevalence picking up again in July 2021 (Blantyre, 81.7%; Mzuzu, 71.0%). More first wave sera showed in vitro neutralisation activity against the original variant (78% [7/9]) than the beta variant (22% [2/9]), while more second wave sera showed neutralisation activity against the beta variant (75% [12/16]) than the original variant (63% [10/16]). CONCLUSION The findings confirm extensive SARS-CoV-2 exposure in Malawi over two epidemic waves with likely poor cross-protection to reinfection from the first on the second wave. The dynamics of SARS-CoV-2 exposure will therefore need to be taken into account in the formulation of the COVID-19 vaccination policy in Malawi and across the region. Future studies should use an adequate sample size for the assessment of neutralisation activity across a panel of SARS-CoV-2 variants of concern/interest to estimate community immunity.
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Affiliation(s)
- Jonathan Mandolo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Jacquline Msefula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Comfort Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Brewster Moyo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Aubrey Samon
- Malawi Blood Transfusion Services (MBTS), Blantyre, Malawi
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Zanele Makhado
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Ayres
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Thopisang Motlou
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonkululeko Mzindle
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Newton Kalata
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Adamson S Muula
- Kamuzu University of Health Sciences (KUHes), Blantyre, Malawi
| | - Gaurav Kwatra
- Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | - Andrew Likaka
- Malawi Blood Transfusion Services (MBTS), Blantyre, Malawi
- LIKA-UFPE, Universidade Federal de Pernambuco, Recife, Brazil
| | - Thom Mfune
- Malawi Blood Transfusion Services (MBTS), Blantyre, Malawi
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- MRC Antibody Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridon Mbaya
- Malawi Blood Transfusion Services (MBTS), Blantyre, Malawi
| | | | - Robert S Heyderman
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Todd Swarthout
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Kondwani C Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi.
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Kamuzu University of Health Sciences (KUHes), Blantyre, Malawi.
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Kayambankadzanja RK, Likaka A, Mndolo SK, Chatsika GM, Umar E, Baker T. Emergency and critical care services in Malawi: Findings from a nationwide survey of health facilities. Malawi Med J 2020; 32:19-23. [PMID: 32733655 PMCID: PMC7366165 DOI: 10.4314/mmj.v32i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 01/09/2023] Open
Abstract
Background Globally, critical illness causes up to 45 million deaths every year. The burden is highest in low-income countries such as Malawi. Critically ill patients require good quality, essential care in emergency departments and in hospital wards to avoid negative outcomes such as death. Little is known about the quality of care or the availability of necessary resources for emergency and critical care in Malawi. The aim of this study was to assess the availability of resources for emergency and critical care in Malawi using data from the Service Provision Assessment (SPA). Methods We conducted a secondary data analysis of the SPA — a nationwide survey of all health facilities. We assessed the availability of resources for emergency and critical care using previously developed standards for hospitals in low-income countries. Each health facility received an availability score, calculated as the proportion of resources that were present. Resource availability was sub-divided into the seven a-priori defined categories of drugs, equipment, support services, emergency guidelines, infrastructure, training and routines. Results Of the 254 indicators in the standards necessary for assessing the quality of emergency and critical care, SPA collected data for 102 (40.6%). Hospitals had a median resource availability score of 51.6% IQR (42.2–67.2) and smaller health facilities had a median of 37.5% (IQR 28.1–45.3). For the category of drugs, the hospitals' median score was 62.0% IQR (52.4–81.0), for equipment 51.9% IQR (40.7–66.7), support services 33.3% IQR (22.2–77.8) and emergency guidelines 33.3% IQR (0–66.7). SPA did not collect any data for resources in the categories of infrastructure, training or routines. Conclusion Hospitals in Malawi lack resources for providing emergency and critical care. Increasing data about the availability of resources for emergency and critical care and improving the hospital systems for the care of critically ill patients in Malawi should be prioritized.
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Affiliation(s)
| | - Andrew Likaka
- Malawi Ministry of Health, Quality Management Directorate
| | | | | | - Eric Umar
- Department of Health Systems, College of Medicine
| | - Tim Baker
- University of Malawi, College of Medicine.,Queen Elizabeth Central Hospital, Department of Anaesthesia and Intensive Care.,Health System and Policy Research Group, Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Adeniran A, Likaka A, Knutsson A, Costello A, Daelmans B, Maliqi B, Burssa D, Freer J, Askew I, Bowen L, Kak L, McDougall L, Zaka N, Tunçalp Ö, Tenhoope-Bender P, Syed SB, Peterson SS, Luchesi T, Zeck W, Were W, Barker P, Naimy Z. Leadership, action, learning and accountability to deliver quality care for women, newborns and children. Bull World Health Organ 2018. [PMID: 29531422 PMCID: PMC5840625 DOI: 10.2471/blt.17.197939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Abosede Adeniran
- Child Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | - Anneka Knutsson
- United Nations Population Fund, New York, United Sates of America (USA)
| | - Anthony Costello
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Bernadette Daelmans
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Blerta Maliqi
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Joseph Freer
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ian Askew
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Lily Kak
- United States Agency for International Development, Washington DC, USA
| | - Lori McDougall
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| | - Nabila Zaka
- United Nations Children's Fund, New York, USA
| | - Özge Tunçalp
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Shamsuzzoha Babar Syed
- Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | | | | | | | - Wilson Were
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, USA
| | - Zainab Naimy
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Schier JG, Sejvar JJ, Lutterloh E, Likaka A, Katsoudas E, Karaseva YD, Tippett Barr B, Redwood Y, Monroe S. Consumption of pesticide-treated wheat seed by a rural population in Malawi. J Expo Sci Environ Epidemiol 2012; 22:569-573. [PMID: 23047320 PMCID: PMC4547766 DOI: 10.1038/jes.2012.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 03/07/2012] [Indexed: 06/01/2023]
Abstract
An outbreak of typhoid fever in rural Malawi triggered an investigation by the Malawi Ministry of Health and the Centers for Disease Control and Prevention in July 2009. During the investigation, villagers were directly consuming washed, donated, pesticide-treated wheat seed meant for planting. The objective of this study was to evaluate the potential for pesticide exposure and health risk in the outbreak community. A sample of unwashed (1430 g) and washed (759 g) wheat seed donated for planting, but which would have been directly consumed, was tested for 365 pesticides. Results were compared with each other (percentage change), the US Environmental Protection Agency's (EPA) health guidance values and estimated daily exposures were compared with their Reference dose (RfD). Unwashed and washed seed samples contained, respectively: carboxin, 244 and 57 p.p.m.; pirimiphos methyl, 8.18 and 8.56 p.p.m.; total permethrin, 3.62 and 3.27 p.p.m.; and carbaryl, 0.057 and 0.025 p.p.m.. Percentage change calculations (unwashed to washed) were as follows: carboxin, -76.6%; pirimiphos methyl, +4.6%; total permethrin, -9.7%; and carbaryl -56.1%. Only carboxin and total permethrin concentration among washed seed samples exceeded US EPA health guidance values (285 × and seven times, respectively). Adult estimated exposure scenarios (1 kg seed) exceeded the RfD for carboxin (8 × ) and pirimiphos methyl (12 × ). Adult villagers weighing 70 kg would have to consume 0.123, 0.082, 1.06, and 280 kg of washed seed daily to exceed the RfD for carboxin, pirimiphos methyl, permethrins, and carbaryl, respectively. Carboxin, pirimiphos methyl, permethrins, and carbaryl were detected in both unwashed and washed samples of seed. Carboxin, total permethrin, and carbaryl concentration were partially reduced by washing. Health risks from chronic exposure to carboxin and pirimiphos methyl in these amounts are unclear. The extent of this practice among food insecure communities receiving relief seeds and resultant health impact needs further study.
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Affiliation(s)
- Joshua G Schier
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS, Khaila T, Chilima B, Mallewa M, Kampondeni SD, Lowther SA, Capewell L, Date K, Townes D, Redwood Y, Schier JG, Nygren B, Tippett Barr B, Demby A, Phiri A, Lungu R, Kaphiyo J, Humphrys M, Talkington D, Joyce K, Stockman LJ, Armstrong GL, Mintz E. Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. Clin Infect Dis 2012; 54:1100-6. [PMID: 22357702 DOI: 10.1093/cid/cis012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216 000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border. METHODS The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). RESULTS We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n = 19), ataxia (n = 22), and parkinsonism (n = 8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE. CONCLUSIONS The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment.
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Affiliation(s)
- Emily Lutterloh
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
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