Fatch W. Kalembo

Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

Purpose. The purpose of this paper was to explore how loss to followup (LFTU) has affected the successful implementation of prevention of mother to child transmission of HIV-1 (PMTCT) programs in sub-Saharan Africa. Methods. We conducted an electronic search from the following databases PubMed, ScienceDirect, Directory of Open Access Journals (DOAJs), and PyscINFO. Additional searches were made in WHO, UNAIDS, UNICEF, Google, and Google scholar websites for (1) peer-reviewed published research, (2) scientific and technical reports, and (3) papers presented on scientific conferences. Results. A total of 678 articles, published from 1990 to 2011, were retrieved. Only 44 articles met our inclusion criteria and were included in the study. The rates of LTFU of mother-child pairs ranged from 19% to 89.4 in the reviewed articles. Health facility factors, fear of HIV-1 test, stigma and discrimination, home deliveries and socioeconomic factors were identified as reasons for LTFU. Conclusion. There is a great loss of mother-child pairs to follow up in PMTCT programs in sub-Saharan Africa. There is need for more research studies to develop public health models of care that can help to improve followup of mother-child pairs in PMTCT programs in Sub-Saharan Africa.

UGT2B17 Polymorphism and Risk of Prostate Cancer: A Meta-Analysis

Objective. Recent studies on the association between uridine diphosphosglucuronosyltransferases (UGTs) 2B17 polymorphism and risk of prostate cancer (PCa) showed inconclusive results. To clarify this possible association, we conducted a meta-analysis of published studies. Methods. We searched the published literature from PubMed, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI). According to our inclusion criteria, studies that observed the association between UGT2B17 polymorphism and PCa risk were included. The principal outcome measure was the adjusted odds ratio (OR) with 95% confidence interval (CI) for the risk of PCa associated with UGT2B17 polymorphism. Results. A total of 6 studies with 7,029 subjects (3,839 cases and 3,190 controls) were eligible for inclusion in the meta-analysis. Overall, there was a significant association between UGT2B17 polymorphism and increased risk of prostate cancer (OR = 1.74, 95% CI 1.14–2.64, P < 0.001). Similar results were found in the subgroup analyses by ethnicity and types of controls. Conclusion. This meta-analysis demonstrates that UGT2B17 polymorphism is associated with prostate cancer susceptibility, and it contributes to the increased risk of prostate cancer.

Need and acceptability of story books intended to help with the process of informing children about their HIV status in Malawi: a mixed methods study

ABSTRACT The rate of disclosure of HIV status to children living with HIV in sub-Saharan Africa remains low despite the World Health Organisation’s recommendation that children should be told about their HIV status by the age of 12 years. Authors of previous studies have identified lack of disclosure materials as the main barrier to disclosure of HIV status. This study aimed to assess the need and acceptability of a series of age-appropriate children story books intended to help with informing children about their HIV status. Questionnaires, interviews, and focus group discussions were used to collect data from caregivers, healthcare workers, and school teachers, adolescents living with HIV, and community leaders across the three administrative regions of Malawi. Information about the need and acceptability of the story books and the sociodemographic characteristics of the participants was collected using reliable instruments. Quantitative data were tabulated while thematic analysis was used to analyse qualitative data. Almost 600 participants responded to the survey questionnaire, and 19 interviews and 12 focus groups were conducted with 106 participants. Ninety-eight per cent of participants supported the idea of developing the proposed series of story books and reported that they would use the books once they are developed. Most of the participants expressed that the books will help to improve their knowledge and understanding of HIV disclosure, increase their confidence on how to disclose and help to provide consistent information about HIV disclosure to children.The results of this study show a high acceptability rate of the story books. The process of HIV disclosure to children is a very complex issue that will require the development of guidelines and materials that are rigorously evaluated prior to dissemination.

Prevalence and factors associated with malaria parasitaemia in children under the age of five years in Malawi: A comparison study of the 2012 and 2014 Malaria Indicator Surveys (MISs)

Background Malaria is the main cause of morbidity and mortality among children under the age of five years in Malawi. The aim of this study was to compare the prevalence and factors associated with malaria parasitaemia among children under the age of five years in Malawi between the 2014 and 2012 Malaria Indicator Surveys (MISs). Methodology Data on demographic factors, vector control interventions, and blood for malaria test were collected from a representative sample of children under the age of five years in Malawi through multistage cluster sampling method. Data were analysed by chi-square test and logistic regression using complex samples analysis of the Statistical Package for the Social Sciences (SPSS) version 22. Results The prevalence of malaria parasitaemia among children under the age of five years increased from 28% in 2012 to 33% in 2014 (p > 0.05). Likewise, the proportion of children using long-lasting insecticide-treated net (LLIN) increased significantly from 54% in 2012 to 65% in 2014 MIS (p < 0.05). The proportion of households that had used indoor residual spraying (IRS) was 9% for both surveys. In multivariate analysis, use of LLIN significantly predicted for malaria parasitaemia in the 2012 MIS but not in the 2014 MIS. Older children and those coming from the poorest families were significantly associated with having malaria parasites in both surveys. Conclusion The increase in the use of LLIN among children in 2014, did not result in the reduction of malaria parasitaemia in children. The use of LLIN significantly predicted for malaria parasitaemia among children in the 2012 MIS but not in the 2014 MIS. The results of this study underscore the need to increase the coverage of IRS, mosquito repellents and larvicide alongside LLINs in order to reduce the burden of malaria among children in Malawi.

International commentary on Phiri et al. ‘Registered nurses’ experiences pertaining to family involvement in the care of hospitalised children at a tertiary government hospital in Malawi’:

This commentary has been written by academics who are part of an international network of nurses who study family-centred care (FCC), the model widely used in paediatrics and children’s nursing. Called ‘International Research Network for Child and Family Centred Care’, its members are drawn from across the world and their goal is to promote evidence-based FCC. Members share and discuss articles related to FCC and nursing practice, research and policy. In 2017, an article about FCC in Malawi highlighted issues that generated debate in the group, initiating discussion around the low nurse–patient ratio of 1:84 in a children’s ward. We examine the article from several perspectives, and ask the question as to whether it is ethical to suggest that FCC should be implemented given the constraints on health priorities. Comments specifically address four important issues: a) lack of resources and the impact of this on FCC; b) lack of empowerment of family members in their child’s care; c) lack of policies to guide and support FCC; and d) the importance of nursing ethics in FCC. This discourse presents commentary written by several authors. Each section contains the thoughts of each individual author, listed per country. Fatch Kalembo, Maggie Zgambo, Linda Shields