African Journals Online
Malawi Medical Journal

The Journal of the College of Medicine
and  Medical Association of Malawi

Volume 13, No 3, June 2001
Abstracts

Title: The prevalence, intensity and ecological determinants of helminth infection among children in an urban and rural community in Southern Malawi 
Author: KS Phiri 

Rapid urbanisation and poor town planning in Malawi has been associated with poor environmental hygiene and sanitation. The aim of the present study was to investigate the prevalence, intensity and some potential risk factors of intestinal helminth infections among children aged 3 - 14 years in an urban and rural community in Southern Malawi. A randomised cross-sectional survey was conducted in July, 1998. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from households in both areas. Stool samples were collected from 273 children in the urban community and 280 in the rural. There was a significant difference (p<0.001) in the prevalence of helminth infections between the urban and rural communities, 16.5% and 3.6% respectively. Most of the infections were light (93.2% for Ascaris lumbricodes, 85.7% for hookworm). Large variance to mean ratios of egg intensity within age groups and the total study population suggested a high degree of aggregation of the parasites in the communities. Multiple logistic regression analysis showed that certain groups of children in the urban community were much more likely to develop helminth infection. They included children who had pools of water/sewage around houses (OR = 3.0, 95% CI = 1.4 - 5), did not wear shoes (OR = 7.1, 95% CI = 2.7 - 19.2), did not attend school (OR = 2.8, 95% CI = 1.2 - 6.5), had mothers who had 4 to 8 years of education (OR = 5.2, 95% CI = 2.0 - 14.0), had mothers below 35 years of age (OR = 4.09, 95% CI = 1.39 -16.28) and living in an urban community (OR = 5.3, 95% CI = 2.6-12.1). Efforts to reduce helminth infections should focus on reducing exposures. 

Title: Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital 
Authors: RM Banda, AS Muula, GR Gwaza, DC Namarika, KC Ng'oma, FE Chintolo, H Yamakazi, AP Muyco. 

A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics. 



Title: The impact of HIV infection on the clinical presentation of severe malnutrition in children at QECH 
Authors: L Kessler, H Daley, G Malenga, SM Graham 

A study was undertaken in a central nutritional rehabilitation unit (NRU) in southern Malawi to assess the impact of HIV infection on clinical presentation
and case fatality rate. The HIV seroprevalence for 250 severely malnourished children over 1 year of age was 34.4% and the overall mortality was 28%. HIV infection was significantly more associated with marasmus (62.2%) than with kwashiorkor (21.7%) [p<0.0001]. Clinical and radiological features were not helpful in distinguishing HIV infected from non HIV infected children. The in-hospital case fatality rate was significantly higher for HIV infected children (38.4%) compared to severely malnourished children without HIV infection (22.7%) [p<0.05]. Though HIV infection contributes to the high mortality experienced in NRU's in Malawi, we argue that more remediable contributing factors still need to be addressed. 

Title: An audit of deliveries and outcome at Queen Elizabeth Central Hospital, Blantyre, in 1999 
Authors: C Kalumbi, E Tadesse. 

A one-year audit of deliveries at Queen Elizabeth Central Hospital, Blantyre, was undertaken for 1999. The main objective of the audit was to obtain baseline
data on forms of deliveries and pregnancy outcome. A total of 12,293 births occurred during the study period. Of these, 11,565 were singleton deliveries, 349 twin deliveries and 10 triplets. Characteristics of singleton deliveries were analysed further when data were available. The age distribution of the mothers ranged from 10 to 55 years with a mean age of 23.4 years. Of 10,314 singleton deliveries, 8710 (84.4%) were spontaneous vertex deliveries, 1121 (10.8%) were caesarian section, 304 (2.94%) were vacuum extraction and 169 (1.63%) were assisted breech deliveries. Breech deliveries had the worst outcome. The maternal mortality rate for the year 1999 was 1224 per 100,000 live births and the perinatal mortality rate was 49.3 per 1000 live births. 

Title: Buruli ulcer in Malawi - a first report 
Author: OO Komolafe 

One hundred and sixty-one specimens swabbed from as many patients with chronic wounds/ulcers over a period of eight months yielded 3 acid-alcohol fast bacilli
(AFB) organisms that slowly grew only at 320C on Lowenstein-Jensen (LJ) medium producing creamy-yellow colonies between 39 and 45 days post-incubation.
Mycobacterial organisms harvested from culture were strongly positive when subjected to both catalase spot test and catalase heat stability test indicating the
presence of Mycobacterium ulcerans, the aetiological agent of Buruli ulcer.