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Journal articles on the topic 'Children – Diseases – Malawi'

Author: Grafiati

Published: 4 June 2021

Last updated: 2 February 2022

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1

Cornick, Jennifer E., Dean B. Everett, Caroline Broughton, et al. "InvasiveStreptococcus pneumoniaein Children, Malawi, 2004–2006." Emerging Infectious Diseases 17, no. 6 (2011): 1107–9. http://dx.doi.org/10.3201/eid1706.101404.

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Cornick, Jennifer E., Dean B. Everett, Caroline Broughton, et al. "InvasiveStreptococcus pneumoniaein Children, Malawi, 2004–2006." Emerging Infectious Diseases 17, no. 6 (2011): 1107–9. http://dx.doi.org/10.3201/eid/1706.101404.

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3

Bondo, Austin, Bejoy Nambiar, Norman Lufesi, et al. "An assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey in Malawi." Gates Open Research 2 (August 2, 2018): 37. http://dx.doi.org/10.12688/gatesopenres.12837.1.

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Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in Malawi from November 2011 using a three dose primary series at 6, 10, and 14 weeks of age to reduce Streptococcus pneumoniae-related diseases. To date, PCV13 paediatric coverage in Malawi has not been rigorously assessed. We used household surveys to longitudinally track paediatric PCV13 coverage in rural Malawi. Methods: Samples of 60 randomly selected children (30 infants aged 6 weeks to 4 months and 30 aged 4-16 months) were sought in each of 20 village clinic catchment ‘basins’ of Kabudula health area, Lilongwe, Malawi between March 2012 and June 2014. Child health information was reviewed and mothers interviewed to determine each child’s PCV13 dose status and vaccine timing. The survey was completed six times in 4-8 month intervals. Survey inference was used to assess PCV13 dose coverage in each basin for each age group. All 20 basins were pooled to assess area-wide vaccination coverage over time, by age in months, and adherence to the vaccination schedule. Results: We surveyed a total of 8,562 children in six surveys; 82% were in the older age group. Overall, in age-eligible children, two-dose and three-dose coverage increased from 30% to 85% and 10% to 86%, respectively, between March 2012 and June 2014. PCV13 coverage was higher in the older age group in all surveys. Although it varied by basin, PCV13 coverage was consistently delayed: median ages at first, second and third doses were 9, 15 and 21 weeks, respectively. Conclusion: In our rural study area, PCV13 introduction did not meet the Malawi Ministry of Health one-year three-dose 90% coverage target, but after 2 years reached levels likely to reduce the prevalence of both invasive and non-invasive paediatric pneumococcal diseases. Better adherence to the PCV13 schedule may reduce pneumococcal disease in younger Malawian children.

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Ntenda, Peter Austin Morton, Thomas Gabriel Mhone, and Owen Nkoka. "High Maternal Body Mass Index Is Associated with an Early-Onset of Overweight/Obesity in Pre-School-Aged Children in Malawi. A Multilevel Analysis of the 2015-16 Malawi Demographic and Health Survey." Journal of Tropical Pediatrics 65, no. 2 (2018): 147–59. http://dx.doi.org/10.1093/tropej/fmy028.

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Abstract Background Overweight/obesity in young children is one of the most serious public health issues globally. We examined whether individual- and community-level maternal nutritional status is associated with an early onset of overweight/obesity in pre-school-aged children in Malawi. Design Data were obtained from the 2015-16 Malawi Demographic and Health Survey (MDHS). The maternal nutritional status as body mass index and childhood overweight/obesity status was assessed by using the World Health Organization (WHO) recommendations. To examine whether the maternal nutritional status is associated with overweight/obesity in pre-school-aged children, two-level multilevel logistic regression models were constructed on 4023 children of age less than five years dwelling in 850 different communities. Results The multilevel regression analysis showed that children born to overweight/obese mothers had increased odds of being overweight/obese [adjusted odds ratio (aOR) = 3.11; 95% confidence interval (CI): 1.13–8.54]. At the community level, children born to mothers from the middle (aOR: 1.68; 95% CI: 1.02–2.78) and high (aOR: 1.69; 95% CI: 1.00–2.90) percentage of overweight/obese women had increased odds of being overweight/obese. In addition, there were significant variations in the odds of childhood overweight/obesity in the communities. Conclusions Strategies aimed at reducing childhood overweight/obesity in Malawi should address not only women and their children but also their communities. Appropriate choices of nutrition, diet and physical activity patterns should be emphasized upon in overweight/obese women of childbearing age throughout pregnancy and beyond.

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Sundet, Mads, Joanna Grudziak, Anthony Charles, Leonard Banza, Carlos Varela, and Sven Young. "Paediatric road traffic injuries in Lilongwe, Malawi: an analysis of 4776 consecutive cases." Tropical Doctor 48, no. 4 (2018): 316–22. http://dx.doi.org/10.1177/0049475518790893.

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This was a retrospective review of all children aged ≤16 who were treated in the casualty department at the central hospital in Lilongwe, Malawi, between 1 January 2009 and 31 December 2015. A total of 4776 children were treated for road traffic injuries (RTIs) in the study period. There was an increase in incidence from 428 RTIs in 2009 to a maximum of 834 in 2014. Child pedestrians represented 53.8% of the injuries, but 78% of deaths and 71% of those with moderate to severe head injuries. Pedestrians were mostly injured by cars (36%) and by large trucks, buses and lorries (36%). Eighty-four (1.8%) children were brought in dead, while 40 (0.8%) children died in the casualty department or during their hospital stay. There has been a drastic increase of RTIs in children in Lilongwe, Malawi. Child pedestrians were most affected, both in terms of incidence and severity.

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Weston-Simons, J. S., and C. Lavy. "Guardians' attitudes to children with physical disabilities in Malawi." Tropical Doctor 35, no. 3 (2005): 190–91. http://dx.doi.org/10.1258/0049475054620851.

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Macedo, Ana, Lorraine Sherr, Mark Tomlinson, Sarah Skeen, and Kathryn Roberts. "Parental Bereavement in Young Children Living in South Africa and Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 78, no. 4 (2018): 390–98. http://dx.doi.org/10.1097/qai.0000000000001704.

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8

Ntenda, Peter Austin Morton, Owen Nkoka, Andrè Wendindonde Nana, et al. "Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015–16 Malawi demographic and health survey." Transactions of The Royal Society of Tropical Medicine and Hygiene 113, no. 9 (2019): 534–44. http://dx.doi.org/10.1093/trstmh/trz029.

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Abstract Background Between 2010 and 2015, the percentage of children 12–23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. Methods Using data from the 2015–16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12–23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. Results Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. Conclusions Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study.

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Mathanga, Don P., Katherine E. Halliday, Mpumulo Jawati, et al. "The High Burden of Malaria in Primary School Children in Southern Malawi." American Journal of Tropical Medicine and Hygiene 93, no. 4 (2015): 779–89. http://dx.doi.org/10.4269/ajtmh.14-0618.

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Trainor, Eamonn, Ben Lopman, Miren Iturriza-Gomara, et al. "Detection and molecular characterisation of noroviruses in hospitalised children in Malawi, 1997-2007." Journal of Medical Virology 85, no. 7 (2013): 1299–306. http://dx.doi.org/10.1002/jmv.23589.

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11

Nightingale, Rebecca. "Non-communicable respiratory disease in Malawi: a systematic review and meta-analysis." Malawi Medical Journal 32, no. 2 (2020): 64–73. http://dx.doi.org/10.4314/mmj.v32i2.3.

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BackgroundNon-communicable respiratory diseases are important contributors to morbidity and mortality in sub-Saharan African countries such as Malawi. AimTo conduct a systematic review of the available literature relating to chronic respiratory disease in Malawi. MethodsWe conducted a systematic protocol-driven literature search of key scientific databases including Scopus and Medline. Papers were independently assessed for eligibility by two authors and included if they reported objective measures (including self-reported standard symptoms) of chronic respiratory disease and were conducted in Malawi. A meta-analysis of available estimates was then conducted. We re-analysed data from three of these studies in a secondary data analysis to allow for between-study comparisons. ResultsOur search identified 393 papers of which 17 (5 involving children and 12 involving adults) met the inclusion criteria. Wheeze was the symptom most frequently reported in children in the community (12.1%), hospital (11.2%) and HIV clinic (8.1%) settings. Cough was the symptom most frequently reported by adults in the community (3–18%). Spirometric abnormalities varied substantially between studies. For example, in adults, airflow obstruction varied between 2.3% and 20% and low forced vital capacity (FVC) varied between 2.7% and 52.8%. ConclusionWe identified a high burden of chronic respiratory symptoms and abnormal spirometry (particularly low FVC) within paediatric and adult populations in Malawi. The estimates for country-wide burden related to this disease were limited by the heterogeneity of the methods used to assess symptoms and spirometry. There is an urgent need to develop a better understanding of the determinants and natural history of non-communicable respiratory disease across the life-course in Malawi.

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Ngwalangwa, Fatsani, Clifford Katumbi, Queen Dube, et al. "The Association of Low Blood Glucose and Low Serum Cortisol Levels in Severely Ill Children Admitted to Tertiary Referral Hospitals in Malawi: A Case-Control Study." American Journal of Tropical Medicine and Hygiene 105, no. 3 (2021): 846–51. http://dx.doi.org/10.4269/ajtmh.21-0040.

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ABSTRACT. Low blood glucose concentrations < 5 mmol/L in severely ill children presenting to hospitals in low-income countries are associated with mortality. Adrenal insufficiency with low cortisol levels may contribute to low blood glucose concentrations. Understanding the association between low cortisol and low blood glucose may assist in improving guidelines for management of severely ill children. The study aimed to determine the association between low serum cortisol and low blood glucose in severely ill children. A matched case-control study of children aged 1 month to 15 years was conducted at two tertiary hospitals in Malawi. Cases were children with blood glucose < 5 mmol/L. Two age-matched controls with blood glucose of ≥ 5–15 mmol/L were enrolled per case. Low cortisol was defined as serum cortisol of < 25 µg/dL (690 nmol/L) and adrenal insufficiency as serum cortisol of < 10 µg/dL (276 nmol/L). A total of 54 cases and 108 controls were enrolled with, median age of 2.8 years (interquartile range [IQR]: 1.7–4.4). The median cortisol level was 58.7 µg/dL (IQR: 42.3–61.8) in cases and 40.9 µg/dL (IQR: 33.7–51.2) in controls (P = 0.911). The proportion of low cortisol was 4/54 (7.4%) in cases and 9/108 (8.3%) in controls. Logistic regression shows no association between low cortisol and low blood glucose (adjusted odds ratio: 0.33; 95% confidence interval, 0.04–3.02). Results suggest that there is no association between low cortisol and low blood glucose among severely ill children presenting to hospitals in Malawi. The reason for low blood glucose needs further investigation.

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MORSE, T. D., R. A. B. NICHOLS, A. M. GRIMASON, B. M. CAMPBELL, K. C. TEMBO, and H. V. SMITH. "Incidence of cryptosporidiosis species in paediatric patients in Malawi." Epidemiology and Infection 135, no. 8 (2007): 1307–15. http://dx.doi.org/10.1017/s0950268806007758.

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SUMMARYWe determined the incidence of cryptosporidiosis in children aged <5 years presenting with diarrhoea in an urban and rural hospital-based setting in Malawi. Stools were collected over a 22-month period during both rainy and dry seasons. A range of microscopic methods were used to determine the presence ofCryptosporidiumspp. oocysts. Species determination was by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) of oocyst-extracted DNA using 18S rRNA and COWP gene loci.Cryptosporidiumspp. oocysts were seen in 5·9% (50/848) of samples, of which 43 amplified by PCR–RFLP indicated the following species:C. hominis,C. parvum,C. hominis/C. parvum,C. meleagridisandC. andersoni. Seven samples could not be amplified by PCR. Wider species diversity was found in the rural setting, and may be a result of increased malnutrition and zoonotic exposure in this area. Improvements in water, sanitation, household hygiene and animal control are required to reduce the incidence of infection in this population.

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Coalson, Jenna E., Lauren M. Cohee, Jenny A. Walldorf, et al. "Challenges in Treatment for Fever among School-Age Children and Adults in Malawi." American Journal of Tropical Medicine and Hygiene 100, no. 2 (2019): 287–95. http://dx.doi.org/10.4269/ajtmh.18-0687.

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Taha, T. E., D. R. Hoover, S. Chen, et al. "Effects of Cessation of Breastfeeding in HIV-1-Exposed, Uninfected Children in Malawi." Clinical Infectious Diseases 53, no. 4 (2011): 388–95. http://dx.doi.org/10.1093/cid/cir413.

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Peterson, Ingrid, Atupele Kapito-Tembo, Andrew Bauleni, et al. "Overdiagnosis of Malaria Illness in an Endemic Setting: A Facility-Based Surveillance Study in Malawi." American Journal of Tropical Medicine and Hygiene 104, no. 6 (2021): 2123–30. http://dx.doi.org/10.4269/ajtmh.20-1209.

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Abstract.In endemic settings where asymptomatic malaria infections are common, malaria infection can complicate fever diagnosis. Factors influencing fever misdiagnosis, including accuracy of malaria rapid diagnostic tests (mRDTs) and the malaria-attributable fraction of fevers (MAF), require further investigation. We conducted facility-based surveillance in Malawi, from January 2012 through December 2013 in settings of high perennial (Chikhwawa), high seasonal (Thoylo), and moderate seasonal (Ndirande) malaria transmission. Consecutive patients presenting to outpatient departments were screened; those with suspected malaria illness were tested by mRDT or routine thick-smear microscopy. Test positivity rates (TPRs), positive predictive value (PPVs) of mRDTs, and MAFs were calculated by site, age, and season. Of 41,471 patients, 10,052 (24.2%) tested positive for malaria. The TPR was significantly greater in Chikhwawa (29.9%; 95% CI, 28.6–30.0) compared with Thyolo (13.2%; 95% CI, 12.5–13.7) and Ndirande (13.1%; 95% CI, 12.2–14.4). The overall PPV was 77.8% (95% CI, 76.8–78.7); it was lowest among infants (69.9%; 95% CI, 65.5–74.2) and highest among school-age children (81.9%; 95% CI, 80.3–83.4). Malaria infection accounted for about 50% of fevers in children younger than 5 years old with microscopy-confirmed Plasmodium falciparum infection, and less than 20% of such fevers in school-age children. Outpatient settings in Malawi had a high burden of malaria illness, but also possible overdiagnosis of malaria illness. Interventions to reduce malaria transmission and rapid testing for other common febrile illness may improve diagnostic clarity among outpatients in malaria endemic settings.

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Cunliffe, Nigel A., Winifred Dove, Jailosi S. Gondwe, et al. "Detection and characterisation of human astroviruses in children with acute gastroenteritis in Blantyre, Malawi." Journal of Medical Virology 67, no. 4 (2002): 563–66. http://dx.doi.org/10.1002/jmv.10139.

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Ng'ambi, Wingston, Tara Mangal, Andrew Phillips, et al. "Factors associated with healthcare seeking behaviour for children in Malawi: 2016." Tropical Medicine & International Health 25, no. 12 (2020): 1486–95. http://dx.doi.org/10.1111/tmi.13499.

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Dove, Winifred, Nigel A. Cunliffe, Jailosi S. Gondwe, et al. "Detection and characterization of human caliciviruses in hospitalized children with acute gastroenteritis in Blantyre, Malawi." Journal of Medical Virology 77, no. 4 (2005): 522–27. http://dx.doi.org/10.1002/jmv.20488.

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Bennett, Aisleen, Louisa Pollock, Khuzwayo C. Jere, et al. "Duration and Density of Fecal Rotavirus Shedding in Vaccinated Malawian Children With Rotavirus Gastroenteritis." Journal of Infectious Diseases 222, no. 12 (2019): 2035–40. http://dx.doi.org/10.1093/infdis/jiz612.

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Abstract Quantifying rotavirus shedding among vaccinated individuals will aid understanding of vaccine indirect effects. Serial stool samples were collected from 196 children who presented with rotavirus gastroenteritis to health facilities in Blantyre, Malawi, and were tested for rotavirus using a VP6 semi-quantitative, real-time polymerase chain reaction. The median duration of fecal shedding was 28 days (95% CI, 19–28). The median copy numbers for peak shedding were 1.99 × 107 (interquartile range, 3.39 × 106 to 6.37 × 107). The fecal viral load was positively associated with disease severity and negatively associated with serum anti-rotavirus immunoglobin A. High and persistent rotavirus shedding among vaccinated children with breakthrough disease may contribute to ongoing transmission in this setting.

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Fox, James M., Robert Newton, Marija Bedaj, et al. "Prevalence of hepatitis C virus in mothers and their children in Malawi." Tropical Medicine & International Health 20, no. 5 (2015): 638–42. http://dx.doi.org/10.1111/tmi.12465.

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Cunliffe, Nigel A., Winifred Dove, Baoming Jiang, et al. "Detection of group C rotavirus in children with acute gastroenteritis in Blantyre, Malawi." Pediatric Infectious Disease Journal 20, no. 11 (2001): 1088–90. http://dx.doi.org/10.1097/00006454-200111000-00018.

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Nkoka, Owen, Ting-Wu Chuang, and Yi-Hua Chen. "Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi." American Journal of Tropical Medicine and Hygiene 100, no. 6 (2019): 1454–65. http://dx.doi.org/10.4269/ajtmh.18-0900.

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Ngwalangwa, Fatsani, Chikondi H. A. Phiri, Queen Dube, Josephine Langton, Helena Hildenwall, and Tim Baker. "Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi." American Journal of Tropical Medicine and Hygiene 101, no. 3 (2019): 670–75. http://dx.doi.org/10.4269/ajtmh.19-0127.

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Gulia, Jyoti, Newton Kumwenda, Qing Li, and Taha E. Taha. "HIV Seroreversion Time in HIV-1-Uninfected Children Born to HIV-1-Infected Mothers in Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 46, no. 3 (2007): 332–37. http://dx.doi.org/10.1097/qai.0b013e3181576860.

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Purcell, Laura N., Meghan Prin, John Sincavage, Clement Kadyaudzu, Michael R. Phillips, and Anthony Charles. "Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi." Journal of Tropical Pediatrics 66, no. 6 (2020): 621–29. http://dx.doi.org/10.1093/tropej/fmaa025.

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Abstract Introduction The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting. Methods We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality. Results Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10–2.26, p &lt; 0.001], hemoglobin &lt; 10 g/dl (RR 1.58, 95% CI 1.08—2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80–4.23, p &lt; 0.001). Conclusions Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi.

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El-Mallawany, Nader Kim, William Kamiyango, Jimmy Villiera, et al. "Kaposi Sarcoma Herpesvirus Inflammatory Cytokine Syndrome–like Clinical Presentation in Human Immunodeficiency Virus–infected Children in Malawi." Clinical Infectious Diseases 69, no. 11 (2019): 2022–25. http://dx.doi.org/10.1093/cid/ciz250.

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Abstract We describe 7 human immunodeficiency virus–infected Malawian children with Kaposi sarcoma who met criteria for Kaposi sarcoma herpesvirus (KSHV) inflammatory cytokine syndrome. Each presented with persistent fevers, bulky lymphadenopathy, massive hepatosplenomegaly, and severe cytopenias. Plasma analyses were performed in 2 patients, both demonstrating extreme elevations of KSHV viral load and interleukin 6.

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Dorward, J. A., J. K. Knowles, and I. M. Dorward. "Treatment of Severe Anaemia in Children in a Rural Hospital." Tropical Doctor 19, no. 4 (1989): 155–58. http://dx.doi.org/10.1177/004947558901900404.

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In a rural hospital in Malawi a protocol was developed for the treatment of severely anaemic children to improve the chances of survival of children with haemoglobin levels of 5 g/dl or less (referred to here as severe anaemia), and also to reduce the risks of transmission of human immunodeficiencyvirus (HIV) by blood transfusion in a unit where the routine screening of donated blood for HIV positivity is not available. Comparison of the results of applying the protocol (using digoxin, frusemide and selective delayed transfusion) with the results of using a widely accepted regimen of routine transfusion of all children with haemoglobin (Hb) of 5 g/dl or less suggests that stabilization of a severely anaemic child's cardiac state before transfusion improves the chances of survival. Many children with very low haemoglobin values do not then require transfusion, thus avoiding the dangers of transfusing blood that is potentially HIV positive. Those who do need transfusion withstand the procedure better.

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Mohanraj, Ushanandini, Maija Jokinen, Rajita Rayamajhi Thapa, et al. "Human Protoparvovirus DNA and IgG in Children and Adults with and without Respiratory or Gastrointestinal Infections." Viruses 13, no. 3 (2021): 483. http://dx.doi.org/10.3390/v13030483.

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Three human protoparvoviruses, bufavirus (BuV), tusavirus (TuV) and cutavirus (CuV), have recently been discovered in diarrheal stool. BuV has been associated with diarrhea and CuV with cutaneous T-cell lymphoma, but there are hardly any data for TuV or CuV in stool or respiratory samples. Hence, using qPCR and IgG enzyme immunoassays, we analyzed 1072 stool, 316 respiratory and 445 serum or plasma samples from 1098 patients with and without gastroenteritis (GE) or respiratory-tract infections (RTI) from Finland, Latvia and Malawi. The overall CuV-DNA prevalences in stool samples ranged between 0–6.1% among our six patient cohorts. In Finland, CuV DNA was significantly more prevalent in GE patients above rather than below 60 years of age (5.1% vs 0.2%). CuV DNA was more prevalent in stools among Latvian and Malawian children compared with Finnish children. In 10/11 CuV DNA-positive adults and 4/6 CuV DNA-positive children with GE, no known causal pathogens were detected. Interestingly, for the first time, CuV DNA was observed in two nasopharyngeal aspirates from children with RTI and the rare TuV in diarrheal stools of two adults. Our results provide new insights on the occurrence of human protoparvoviruses in GE and RTI in different countries.

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Laughton, Barbara, Mmule Ratswana, Itziar Familiar, et al. "Validity of Neuropsychological Testing in Young African Children Affected by HIV." Journal of Pediatric Infectious Diseases 13, no. 03 (2018): 185–201. http://dx.doi.org/10.1055/s-0038-1637020.

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Introduction Western-constructed neuropsychological tests have been used in low- and middle-income countries to assess the impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan African setting. Methods IMPAACT P1104S was a 2-year observational study performed at six clinical sites (South Africa—three sites, Malawi, Uganda, and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children between the ages of 5 and 11 years: HIV-infected (HIV), HIV-exposed but uninfected (HEU), and HIV unexposed and uninfected (HU). Descriptive statistics compared sociodemographic characteristics among children at sites. Instruments included the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) cognitive ability, Test of Variables of Attention (TOVA) attention/impulsivity, Bruininks–Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) motor proficiency tests, and Behavior Rating Inventory for Executive Function (BRIEF) executive function problems. Test characteristics were assessed using intraclass and Spearman's nonparametric correlations, linear regression, and principal factor analyses. Results Of the 611 participants, 50% were males and mean age ranged from 6.6 to 8 years. In Malawi, Uganda, and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 and 0.71. Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 total points score. Strong and significant associations between individual measures of growth, disability, and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared with HEU and HU participants, even after controlling for age, sex, and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores. Conclusion The KABC, TOVA, BRIEF, and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.

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Kobayashi, Miwako, Laura C. Steinhardt, Monica P. Shah, et al. "Quality of Case Management for Pneumonia and Diarrhea Among Children Seen at Health Facilities in Southern Malawi." American Journal of Tropical Medicine and Hygiene 96, no. 5 (2017): 1107–16. http://dx.doi.org/10.4269/ajtmh.16-0945.

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Huibers, Minke H. W., Peter Moons, Nelson Maseko, et al. "Multiplex Real-time PCR Detection of Intestinal Protozoa in HIV-infected Children in Malawi." Pediatric Infectious Disease Journal 37, no. 9 (2018): 910–15. http://dx.doi.org/10.1097/inf.0000000000001924.

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Purcell, Laura, Natasha Ngwira, Jared Gallaher, Bruce Cairns, and Anthony Charles. "Characteristics and outcomes in paediatric patients presenting with congenital colorectal diseases in sub-Saharan Africa." Tropical Doctor 49, no. 4 (2019): 256–59. http://dx.doi.org/10.1177/0049475519851010.

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In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age ≤ 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 ± 2.7 years) and 51 had anorectal malformations (ARM) (1.8 ± 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes.

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Morse, Tracy, Kondwani Chidziwisano, Elizabeth Tilley, et al. "Developing a Contextually Appropriate Integrated Hygiene Intervention to Achieve Sustained Reductions in Diarrheal Diseases." Sustainability 11, no. 17 (2019): 4656. http://dx.doi.org/10.3390/su11174656.

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Diarrheal disease in under-five children remains high in Sub-Saharan Africa; primarily attributed to environmental pathogen exposure through poorly managed water, sanitation, and hygiene (WASH) pathways, including foods. This formative study in rural Malawi used a theoretical base to determine the personal, social, environmental, and psychosocial factors that are to be considered in the development of an integrated intervention for WASH and food hygiene. Using a mixed methods approach, a stakeholder analysis was followed by data collection pertaining to 1079 children between the ages of four to 90 weeks: observations (n = 79); assessment of risks, attitudes, norms and self-regulation (RANAS) model (n = 323); structured questionnaires (n = 1000); focus group discussions (n = 9); and, in-depth interviews (n = 9) (PACTR201703002084166). We identified four thematic areas for the diarrheal disease intervention: hand washing with soap; food hygiene; feces management (human and animal); and, water management. The contextual issues included: the high level of knowledge on good hygiene practices not reflected in observed habits; inclusion of all family members incorporating primary caregivers (female) and financial controllers (male); and, endemic poverty as a significant barrier to hygiene infrastructure and consumable availability. The psychosocial factors identified for intervention development included social norms, abilities, and self-regulation. The resulting eight-month context specific intervention to be evaluated is described.

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Aizire, Jim, Alla Sikorskii, Lillian Wambuzi Ogwang, et al. "Decreased growth among antiretroviral drug and HIV-exposed uninfected versus unexposed children in Malawi and Uganda." AIDS 34, no. 2 (2020): 215–25. http://dx.doi.org/10.1097/qad.0000000000002405.

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Ginsburg, Amy Sarah, Tisungane Mvalo, and Susanne May. "Repeat assessment of physical examination findings among HIV-uninfected children in Malawi with chest-indrawing pneumonia." International Journal of Infectious Diseases 110 (September 2021): 371–73. http://dx.doi.org/10.1016/j.ijid.2021.07.073.

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Iturriza-Gómara, Miren, Khuzwayo C. Jere, Daniel Hungerford, et al. "Etiology of Diarrhea Among Hospitalized Children in Blantyre, Malawi, Following Rotavirus Vaccine Introduction: A Case-Control Study." Journal of Infectious Diseases 220, no. 2 (2019): 213–18. http://dx.doi.org/10.1093/infdis/jiz084.

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Sabin, Lora, Maxton Tsoka, Mohamad I. Brooks, and Candace Miller. "Measuring Vulnerability Among Orphans and Vulnerable Children in Rural Malawi: Validation Study of the Child Status Index Tool." JAIDS Journal of Acquired Immune Deficiency Syndromes 58, no. 1 (2011): e1-e10. http://dx.doi.org/10.1097/qai.0b013e3182254298.

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Weigel, Ralf, Sam Phiri, Fred Chiputula, et al. "Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi." Tropical Medicine & International Health 15, no. 8 (2010): 934–44. http://dx.doi.org/10.1111/j.1365-3156.2010.02561.x.

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Hungerford, Daniel, Khuzwayo C. Jere, Naor Bar-Zeev, John P. Harris, Nigel A. Cunliffe, and Miren Iturriza-Gómara. "Epidemiology and genotype diversity of norovirus infections among children aged <5 years following rotavirus vaccine introduction in Blantyre, Malawi." Journal of Clinical Virology 123 (February 2020): 104248. http://dx.doi.org/10.1016/j.jcv.2019.104248.

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41

Boivin, Michael J., Miriam Chernoff, Lee Fairlie, et al. "African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus." Clinical Infectious Diseases 71, no. 7 (2019): e105-e114. http://dx.doi.org/10.1093/cid/ciz1088.

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Abstract Background Children living with human immunodeficiency virus (HIV) are at neuropsychological risk for cognitive and motor dysfunction. However, few prospective, multi-site studies have evaluated neuropsychological outcomes longitudinally among perinatally infected African children who received early antiretroviral treatment (ART). Methods We enrolled 611 children aged 5 to 11 years at 6 sites (South Africa [3], Zimbabwe, Malawi, Uganda). Of these, there were 246 children living with HIV (HIV+) who were initiated on ART before 3 years of age in a prior clinical trial comparing nevirapine to lopinavir/ritonavir (International Maternal Pediatric Adolescent Acquired Immunodeficiency Syndrome Clinical Trials [IMPAACT] P1060); 183 age-matched, exposed but uninfected (HEU) children; and 182 unexposed and uninfected (HUU) children. They were compared across 3 assessment time points (Weeks 0, 48, and 96) on cognitive ability (Kaufman Assessment Battery for Children, second edition [KABC-II]), attention/impulsivity (Tests of Variables of Attention [TOVA]), motor proficiency (Bruininks-Oseretsky Test, second edition [BOT-2]), and on the Behavior Rating Inventory of Executive Function (BRIEF). The cohorts were compared using linear mixed models, adjusting for site, child’s age and sex, and selected personal/family control variables. Results The HIV+ cohort performed significantly worse than the HEU and HUU cohorts for all KABC-II, TOVA, and BOT-2 performance outcomes across all 3 time points (P values &lt; .001). The HUU and HEU cohorts were comparable. For the KABC-II planning/reasoning subtests, the HIV+ children showed less improvement over time than the HUU and HEU groups. The groups did not differ significantly on the BRIEF. Conclusions Despite initiation of ART in early childhood and good viral suppression at the time of enrollment, the HIV+ group had poorer neuropsychological performance over time, with the gap progressively worsening in planning/reasoning. This can be debilitating for self-management in adolescence.

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White, Valerie A., Susan Lewallen, Nicholas Beare, Kondwani Kayira, Richard A. Carr, and Terrie E. Taylor. "Correlation of retinal haemorrhages with brain haemorrhages in children dying of cerebral malaria in Malawi." Transactions of the Royal Society of Tropical Medicine and Hygiene 95, no. 6 (2001): 618–21. http://dx.doi.org/10.1016/s0035-9203(01)90097-5.

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Osterholt, Dawn M., Alexander K. Rowe, Mary J. Hamel, et al. "Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre district, Malawi." Tropical Medicine and International Health 11, no. 8 (2006): 1147–56. http://dx.doi.org/10.1111/j.1365-3156.2006.01666.x.

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Mathanga, Don P., Carl H. Campbell, Terrie E. Taylor, Robin Barlow, and Mark L. Wilson. "Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anaemia among children in urban Malawi." Tropical Medicine and International Health 11, no. 9 (2006): 1367–74. http://dx.doi.org/10.1111/j.1365-3156.2006.01684.x.

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Poole, Helen, Dianne J. Terlouw, Andrew Naunje, et al. "Schistosomiasis in pre-school-age children and their mothers in Chikhwawa district, Malawi with notes on characterization of schistosomes and snails." Parasites & Vectors 7, no. 1 (2014): 153. http://dx.doi.org/10.1186/1756-3305-7-153.

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Hart, John D., Khumbo Kalua, Jeremy D. Keenan, Thomas M. Lietman, and Robin L. Bailey. "Effect of Mass Treatment with Azithromycin on Causes of Death in Children in Malawi: Secondary Analysis from the MORDOR Trial." American Journal of Tropical Medicine and Hygiene 103, no. 3 (2020): 1319–28. http://dx.doi.org/10.4269/ajtmh.19-0613.

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47

Witek-McManus, Stefan, James Simwanza, Alvin B. Chisambi, et al. "Epidemiology of soil-transmitted helminths following sustained implementation of routine preventive chemotherapy: Demographics and baseline results of a cluster randomised trial in southern Malawi." PLOS Neglected Tropical Diseases 15, no. 5 (2021): e0009292. http://dx.doi.org/10.1371/journal.pntd.0009292.

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Malawi has successfully leveraged multiple delivery platforms to scale-up and sustain the implementation of preventive chemotherapy (PCT) for the control of morbidity caused by soil-transmitted helminths (STH). Sentinel monitoring demonstrates this strategy has been successful in reducing STH infection in school-age children, although our understanding of the contemporary epidemiological profile of STH across the broader community remains limited. As part of a multi-site trial evaluating the feasibility of interrupting STH transmission across three countries, this study aimed to describe the baseline demographics and the prevalence, intensity and associated risk factors of STH infection in Mangochi district, southern Malawi. Between October-December 2017, a community census was conducted across the catchment area of seven primary healthcare facilities, enumerating 131,074 individuals across 124 villages. A cross-sectional parasitological survey was then conducted between March-May 2018 in the censused area as a baseline for a cluster randomised trial. An age-stratified random sample of 6,102 individuals were assessed for helminthiasis by Kato-Katz and completed a detailed risk-factor questionnaire. The age-cluster weighted prevalence of any STH infection was 7.8% (95% C.I. 7.0%-8.6%) comprised predominantly of hookworm species and of entirely low-intensity infections. The presence and intensity of infection was significantly higher in men and in adults. Infection was negatively associated with risk factors that included increasing levels of relative household wealth, higher education levels of any adult household member, current school attendance, or recent deworming. In this setting of relatively high coverage of sanitation facilities, there was no association between hookworm and reported access to sanitation, handwashing facilities, or water facilities. These results describe a setting that has reduced the prevalence of STH to a very low level and confirms many previously recognised risk-factors for infection. Expanding the delivery of anthelmintics to groups where STH infection persist could enable Malawi to move past the objective of elimination of morbidity, and towards the elimination of STH. Trial registration: NCT03014167.

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Chinkhumba, Jobiba, Andrew Tomkins, Theresa Banda, Catherine Mkangama, and Pamela Fergusson. "The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi." Transactions of the Royal Society of Tropical Medicine and Hygiene 102, no. 7 (2008): 639–44. http://dx.doi.org/10.1016/j.trstmh.2008.04.028.

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Molyneux, Elizabeth, Amanda Walsh, Amos Phiri, and Malcolm Molyneux. "Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996–97." Tropical Medicine & International Health 3, no. 8 (1998): 610–18. http://dx.doi.org/10.1046/j.1365-3156.1998.00278.x.

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Fetzer, Bradley C., Mina C. Hosseinipour, Portia Kamthuzi, et al. "Predictors for mortality and loss to follow-up among children receiving anti-retroviral therapy in Lilongwe, Malawi." Tropical Medicine & International Health 14, no. 8 (2009): 862–69. http://dx.doi.org/10.1111/j.1365-3156.2009.02315.x.

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