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Background: Individuals who are non-adherent to treatment have higher rates symptom recurrence, higher hospital readmission and poor quality of life. Methods: A cross-sectional analytical study was conducted at Nkhoma Mission Hospital, Lilongwe Malawi. Survey approach and total population sampling were used. MARS was used to assess medication adherence. Results: The prevalence of non-adherence to clinic appointment and medication was 64% (n=58) and 46.2% respectively. Females were 4.7 times more likely to miss clinic appointments than males (B =-1.555, Exp (B)=0.221, p=0.029), clients not married were 15 times more likely not to adhere to clinic appointments (B=2.722, Exp(B)=25.12, p=0.002) and clients who visited a mobile clinic were more likely to miss appointments (B =-1.762, Exp (B)=0.172, p=0.020). Psychotic patients had a higher adherence to medication (B=1.753, t=2.041, p=0.044). Conclusion:It is important to address factors that influence non-adherence to avoid relapse.

INTRODUCTION: A diverse group of neuroscience nurse experts discussed stroke nursing research at the 5th International Neuroscience Nursing Research Symposium. Panel experts from Singapore, India, Australia, New Zealand, the Philippines, Malawi, Germany, Palestine, Kenya, Japan, and the United States collaborated to examine similarities and differences in nurse-led stroke research conducted in their home countries. This article reflects panel insights on challenges and opportunities for nurse-led stroke research. DISCUSSION: The research challenges discussed include nursing independence, the processes of informed consent and randomization process, obtaining adequate independent funding, recruiting research subjects, and working with vulnerable groups. The major opportunities to leverage and improve stroke nursing research include facilitating the nurse investigator role, information digitalization, improving health literacy, and collaboration between nurse researchers. SUMMARY: We are living in a volatile, uncertain, complex, and ambiguous world, and the COVID-19 pandemic has accentuated many challenges. There is a need to allow for creativity around recruitment and conducting stroke research. The use of technology reduces travel needs and mitigates many safety, financial, and transportation-related problems. Although the pandemic has highlighted the challenges faced when conducting stroke-related research, there are remarkable similarities in opportunities to improve outcomes.

Helminth infections result from either ingestion or contact with contaminated fecal matter. To date, there is insufficient evidence as to whether helminths have influence on HIV-1 specific immune responses as literature results are indeterminate. We evaluated the effect of helminth infections on HIV disease progression through the monitoring of 2 outcomes: (1) plasma HIV-1 RNA Viral load (V/L) and (2) Cluster of Differentiation (CD4+) T-lymphocyte count amongst helminth-HIV-1 co-infected persons. We hypothesized that (1) concurrent helminth infections may damage immune control, resulting in escalating VL and reduced CD4+ T-lymphocyte count (2) and that, subject to successful treatment, a decrease in plasma VL could slow down disease progression. We reviewed 2032 citations, evaluated 432 abstracts, and read 10 articles (See PRISMA diagram). The methodologies were appraised using a Mixed Method Appraisal Tool (MMAT). At enrolment, plasma VL were significantly higher in individuals with helminths (5.01 log10 vs. 3.41 log10, p < 0.001). The magnitude of effect ranged from 5.28 log10 copies/mL at baseline and 4.67 log10 copies/mL, (p < 0.05) after treatment and a trend for 0.61 log10 lower VL. All but one RCT reported decline in plasma VL and significant interactions were seen in the successfully treated groups (p < 0.001). CD4+ T-lymphocyte count values were not significantly different in the co-infection groups relative to those with HIV-infection alone. This evidence supports that WaSH and HIV/AIDS co-programming could promote health of PLWHA. We suggest large scale trials for future studies. This systematic review registration number is CRD42022364296.

Introduction: People incarcerated in Malawi's detention facilities face a lot of problems. The most common challenges are overcrowding, poor sanitation, and lack of access to basic needs such as adequate food, bedding, clothing, security, and health care. In addition, young people are vulnerable to sexual abuse. Methods: A qualitative approach using an exploratory study design was used to explore the experiences of incarcerated young people in semi-urban prisons. Ethical approval for the study was obtained from Malawi’s National Health Science Research Committee. Two focus group discussions (FGD) were conducted; involving six young incarcerated people aged 18 in each group. Focused groups followed a semi-structured interview guide; data was analyzed using thematic analysis. Results: The following four themes emerged from the data: prisoner-on-prisoner sexual violence; the need for communication regarding sexual violence; trauma associated with incarceration; and youth surviving prison life. The young incarcerated people reported being given incentives such as extra food and adequate sleeping space in exchange for sexual favours with adult incarcerated people or individuals with leadership roles. The sexually abused victims have had some difficulties in reporting the incidences due to a non-existent reporting system for such matters to prison authorities. Conclusions: This study reveals that the prison environment in Malawi is unsafe, particularly for young incarcerated people who are at an increased risk of being victims of sexual violence. The young people reported being more likely to be sexually abused when accommodated together with adult prisoners. Unfortunately, the perpetrators of sexual abuse are typically incarcerated adults in supervisory roles. Therefore, young people need special protection in prisons. We recommend that the youths should be separated from adults according to the United Nations Office on Drugs and Crime (UNODC) recommendations. The correction officers should prevent the young inmates from having sight or physical contact with adult incarcerated people while in housing units. We further recommend that prisons establish systems where abused inmates can report abuse without fear of retribution.

Constant exposure to poor sanitation contribute to the environmental enteric dysfunction-a disorder that is frequently implicated as a cause of linear growth failure. We aimed to evaluate the efficacy of water, sanitation, and hygiene (WaSH) interventions on linear growth amongst children aged 0-24 months. We reviewed fourteen studies retrieved from AMED, CINAHL, DOAJ, PubMed, PsycINFO, Google Scholar, and EMBASE databases following guidelines developed by PROSPERO and COCHRANE. The screening process was summarized using a PRISMA flow diagram, and the methodologies were critically appraised by a Mixed Method Appraisal Tool. No difference was seen in mean height for age Z-score (0.01, 95% CI-0.16 to 0.18) between children who received WaSH interventions and those who did not. Only 5 studies reported a significant association between WaSH and child linear growth (P < 0.001). All combination intervention studies include in this review did not establish any significant benefit of WaSH and nutrition integration. Although robust sanitation coverage could be an important component amongst proven interventions to stimulate linear growth, stunted growth is embedded within myriad determinants beyond improved sanitation. More research is needed to quantify the complementary effect of WaSH and nutrition co-programming. This systematic review was registered in the PROSPERO database with registration number CRD42022322462.

BackgroundUnsafe sanitation disproportionally affects the most vulnerable groups in society such as HIV-exposed infants (HEI) and people living with HIV/AIDS (PLWHA). Whilst there is emerging body of evidence on benefits of integration of Water, Sanitation and Hygiene (WaSH) and HIV/AIDS, experiences from sub-Saharan Africa has shown that there is insufficient research on what WaSH and HIV/AIDS mainstreaming means in practice for these two sectors. In view of inadequate national integration policies, guidelines and frameworks, the potential health improvements achievable by WaSH investment on HIV may fail to substantially improve the desired health outcomes. Therefore, the question that this systematic review tries to resolve is: What is the combined effect of improved water supply interventions and cotrimoxazole preventive therapy on frequency and severity of diarrhea among HIV exposed infants and PLWHA? MethodsWe examined existing literature on effect of co-trimoxazole and improved water supply interventions on diarrhea amongst PLWHA and HEI. We systematically searched for articles in PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptance practice developed by PROSPERO and COCHRANE for systematic search and selection of studies. A PRISMA flow diagram was used to explain on the number of articles retrieved, retained, excluded and justifications for every action. Relevant articles and abstracts were gathered, reviewed and prioritized by thematic outcomes of interest. A Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the methodology that was used. All studies that sought to establish the efficacy of co-trimoxazole alongside other proven forms of healthcare preventive packages for HEI and PLWHA such as improved water supply and hygiene interventions were selected for evaluation.ResultsImproved water supply interventions and co-trimoxazole prophylaxis together reduced diarrhea episodes by 67% (IRR _ 0.33, 95% CI 0.24–0.46, P < 0.0001), days with diarrhea (5.5 versus 10.5 days per person-years; IRR_0.46, 95% CI_0.32–0.66, P < 0.0001), and days of work or school lost due to diarrhea. The combined interventions resulted in 27% risk reduction in HIV disease progression whilst safe water alone was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among HIV exposed infants aged ≤2 years (LPR = 0.47, 95% CI: 0.30–0.73, P < 0.001) and 54% among all household members (LPR = 0.46, 95% CI: 0.30–0.70, P < 0.001). The overall quality of evidence of studies examining mortality was determined to be poor due to lack of clarity and the limited number of studies reporting mortality as an outcome. ConclusionImproved water supply interventions and sanitation uptake improves health. An expanded WaSH response in fighting HIV amongst infants is critical to prevent multiple opportunistic infections that can accelerate mother to child transmission of the virus and rapid disease progression.RegistrationThe protocol was published in the PROSPERO database with registration number CRD42021240512.

ObjectiveOrbito-ocular cancers are a common cause of morbidity and mortality in our population, yet these cancers have not been adequately described in Malawi. This study sought to describe the burden and histopathological profile of orbito-ocular cancers in Northern Malawi.Methods and AnalysisA retrospective review of pathology reports was done. Descriptive analyses were performed to summarise patients’ demographic and clinical characteristics, and histopathological results. A binary logistic regression was used to explore the association between demographic variables, site of lesion and cancer.Results210 pathology reports of orbito-ocular biopsies were reviewed. 60.0% of patients were female. The majority (39.5%) of patients were in the 31 to 40 age group but overall mean age (±SD) was 34.81±15.9 years. Cancer was diagnosed in 84 (40.0%) patients. Squamous cell carcinoma constituted the majority (82.1%) of cancers followed by retinoblastoma at 7.1%. Orbito-ocular cancers were associated with HIV infection (OR5.9, 95% CI 2.0 to 17.2) and intraocular tumours were 8.3 times (OR 8.3, 95% CI 2.0 to 33.8) more likely to be malignant. However, squamous cell carcinoma was the only type of cancer found in patients with HIV infection and mostly affected the conjunctiva, constituting 94.4% of cancers affecting this site. Retinoblastoma on the other hand only affected children less than 10 years of age.ConclusionCancer constituted a substantial proportion of orbito-ocular lesions in our study population, with conjunctiva being the common site. This calls for improved capacity to prevent, diagnose and manage orbito-oracular cancers in Northern Malawi and similar settings.

BackgroundIn 2016 the Malawi government embarked on several interrelated health sector reforms aimed at improving the quality of health services at all levels of care and attain Universal Health Coverage by 2030. Patient satisfaction with services is an important proxy measure of quality. We assessed patient satisfaction at a tertiary hospital in Northern Malawi to understand the current state in the country. MethodsWe conducted exit interviews with patients aged18 years and above using a 28 statement interviewer administered questionnaire. Patients were asked to express their level of agreement to the statements on a five-point Likert scale – strongly disagree to strongly agree, corresponding to scores of 1 to 5. Overall patient satisfaction was calculated by summing up the scores and diving the sum by the number of statements. Scores >3 constituted satisfaction while scores ≤3 constituted dissatisfaction. Patient self-rated satisfaction was determined from a single statement that asked patients to rate their satisfaction with services on a five-point Likert scale. We also solicited inputs from patients on aspects of hospital care that needed improvement. Responses were reviewed and grouped into themes. Recurring themes are presented according to frequencies.ResultsOverall patient satisfaction was 8.4% (95% CI: 5.2% - 12.9%). Patient self-rated satisfaction was 8.9% (95% CI: 5.5% - 13.4%). Patients raised six major issues that dampened their healthcare seeking experience including health workers reporting late to work, doctors not listening to patients concerns and neither examining them properly nor explaining the diagnosis, shortage of medicines, diagnostics and medical equipment, unprofessional conduct of health workers, poor sanitation and cleanliness, and health workers behaviour of favouring or priotising their relatives and friends over other patients.ConclusionWe found very low levels of patient satisfaction, suggesting that quality of services in the public health sector is still low. It is therefore critical to accelerate and innovate the Ministry of Health’s quality improvement initiatives to attain Malawi’s health goals.

Objective The aim of this study was to characterize Covid-19 cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. Methods We used a retrospective case control study design to provide a detailed account of cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. A total of 441 patients were included in the study in the ratio of one case to two controls (1:2), matched by age. Results Deaths due to Covid-19 varied with hypertensive condition with more deaths registered in hypertensive patients. Clinical signs and symptoms in Covid-19 patients varied greatly between hypertensive and non-hypertensive patients, with a leaning favouring the latter. The risk of death due to Covid-19 among hypertensive patients increased with age and meaningfully associated with underlining comorbidities such as HIV, TB, cardiovascular, and liver disease. Conclusion Our study reveals predictive factors for mortality in COVID-19 hypertensive patients that can be used by policy makers and health care practioners to identify those at a higher risk and determine proper treatment approach to achieve best possible clinical outcomes.

Background Proper handwashing technique can reduce the mortality of a child. This study aimed to evaluate the impact of a school-based hand hygiene program on the handwashing compliance of children and school absenteeism in Southern Africa. Methods We conducted a 2-arm cluster randomized trial in which 6 private primary schools were allocated randomly to either intervention (3 schools) or control (3 schools) groups. The intervention group consisted of implementing a series of planned activities and measures of hand hygiene program over 9 months. Parameters of primary and secondary outcomes were estimated with generalized estimating equations. Results There were no significant between-group differences in demographic characteristics. The knowledge scores in the intervention group were significantly higher than the scores in the control group, and the technique scores in the intervention group were significantly higher than the scores in the control group after baseline. Further, after the third month, the cleanliness scores in the intervention group were significantly higher than the scores in the control group. In addition, the number of sick leave days decreased in the intervention group. Conclusions The impact of the school-based hand hygiene program was positive. It can be used in both the planning and development of a hand hygiene protocol to increase the handwashing compliance rate of schoolchildren and to reduce school absenteeism in developing countries.

Aim To explore the experiences of schoolchildren, school personnel and parents who participated in a school-based hand hygiene programme implemented by nurses in Malawi. Background There is low uptake of hand hygiene practice in developing countries due to limited resources available and no standardized hand hygiene policy. Introduction Current health policies acknowledge the advantage of investing in disease prevention and health promotion among young children in Malawi. School nurses should adopt good evidence-based practice in promoting school-based hand hygiene programmes which remain a challenge in Malawi. Methods In this descriptive qualitative study, 10 focus group discussions were conducted with 23 females and 14 males including schoolchildren, school personnel and parents participating in a school-based hand hygiene programme. The programme was implemented by nurses in three primary schools between May and July 2017 in Malawi. Data from these discussions were coded and analysed using thematic analysis. Findings The school-based hand hygiene programme was well received by participants. Four themes illustrated effective strategies in implementing the hand hygiene programme from the participants' view, including 'Being committed', 'Sharing responsibilities', 'Disseminating good practice' and 'Appreciating assets'. These are essential resources and strategies that school nurses need to mobilize and integrate when they advocate handwashing policy by delivering hygiene promotion activities. Discussion School nurses play a significant role in helping to achieve United Nation's Sustainable Development Goal 3 through promoting hand hygiene to minimize transmission of diseases and reduce mortality rate. Conclusion and implications for nursing and health policy An evidence-based protocol based on study findings is beneficial for school nurses in formulating handwashing policies. It is important for developing countries to formulate the much-need policies for primary care practices.

Constant exposure to poor water, sanitation and hygiene (WaSH) contribute to environmental enteric dysfunction; a disorder that is frequently implicated as a cause of linear growth failure. We aimed to evaluate the efficacy of WaSH on linear growth amongst children aged 0-59 months. We reviewed fourteen (14) studies retrieved from AMED, CINAHL, DOAJ, PubMed, PsycINFO, Google Scholar, and EMBASE databases following guidelines developed by PROSPERO and COCHRANE. The screening process was summarized using a PRISMA flow diagram, and the methodologies were critically appraised by a Mixed Method Appraisal Tool. The following search terms were employed in the search strategy: sanitation and/or improved water supply and/or WaSH and/or stunting and/or linear growth and/or environmental enteric dysfunction. No difference was seen in mean height for age Z-score (0.01, 95% CI-0.16 to 0.18) between children who received WaSH interventions and those who did not. Only five (5) studies reported a significant association between WaSH and child linear growth (P < 0.001). All combination intervention studies included in this review did not establish any significant benefit of WaSH and nutrition integration, presumably due to methodological limitations and a short duration of exposure to the interventions. Although robust sanitation coverage could be an important component amongst proven interventions to stimulate linear growth, stunted growth is embedded within myriad determinants beyond improved WaSH. More research is needed to quantify the complementary effect of WaSH and nutrition co-programming. This systematic review was registered in the PROSPERO database with registration number CRD42022322462.

We estimated the seroprevalence of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre‐prints that reported anti‐SARS‐CoV‐2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty‐three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti‐SARS‐CoV‐2 antibodies in Africa was 22% (95%CI: 14–31) with very high heterogeneity (I 2 = 100%, p

Background: Even though EBP is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes and use of registered nurses-midwives practicing in central hospitals in Malawi. Methods: The descriptive, cross-sectional research design was conducted with a convenient sample of 183 nurse-midwives (response rate of 86%). The study used a questionnaire to collect data. Data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarize overall knowledge levels, attitudes and use of nurse-midwives as percentages based on their scores from the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson’s correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives. Results: The average scores (mean±SD) of evidence-based practice amongst nurse midwives were 78.7±19.6 for attitude, 70.6±15.1 for knowledge levels, 57.8±23.for use, and 68.9±14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P=0.02). Research experience was associated with higher scores in nursing use (P=0.005), and higher overall evidence based practice were associated with both research experience (P=0.035) and educational qualification (P=0.004). Nurse-midwives attitude was affected by clinical experience (P=0.006) and the hospital where nurse-midwives worked (P=0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals Conclusion: It is important to develop the knowledge/skills of nurse midwives in order to enhance evidence based practice amongst nurse midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, Ministry of Health policy makers, Nurses and Midwives Council of Malawi and donors to enhance implementation of EBP.

BackgroundEven though evidence based practice (EBP) is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes, and use of registered nurse-midwives practicing in central hospitals across Malawi.MethodsThe descriptive, cross-sectional research design was conducted with a randomly selected sample of 183 nurse-midwives (response rate of 87.9%). The study used a paper version questionnaire to collect the data. The data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarise overall knowledge levels, attitudes, and use of nurse-midwives as percentages based on their scores on the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson’s correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives.ResultsThe average scores (mean±SD) of evidence-based practice amongst nurse-midwives were 78.7 ± 19.6 for attitude, 70.6 ± 15.1 for knowledge levels, 57.8 ± 23 for use, and 68.9 ± 14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P= 0.02). Research experience was associated with higher scores in nursing use (P= 0.005), and higher overall evidence-based practice were associated with both research experience (P= 0.035) and educational qualification (P= 0.004). Nurse-midwives attitude was affected by clinical experience (P= 0.006) and the hospital where nurse-midwives worked (P= 0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals.ConclusionIt is important to develop the knowledge or skills of nurse midwives in order to enhance evidence-based practice amongst nurse-midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, policy makers at the Ministry of Health and Nurses and Midwives Council of Malawi to enhance implementation of EBP.

Background: A caring environment in nursing education is one of the most essential factors for empowering students, which is achieved through trust and open academic communication.Aim: To explore the experiences of faculty caring and uncaring behaviours on students learning from the perspective of university nursing and midwifery students. Methods: Descriptive phenomenology was used to collect data from 10 nursing and midwifery students who were purposively selected at a baccalaureate nursing and midwifery school at a public university in Malawi. Data were collected through semi-structured interviews from August 24th, 2015 to September 30th, 2015 and analysed using Colaizzi’s (1978) method. Ethical considerations were followed. European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431 January 2021 edition Vol.17, No.3 www.eujournal.org 206 Results: Two sub-themes which emerged under the main theme of experiences of faculty caring behaviours which were: (1) Increased motivation (2) Increased confidence and Competence, whilst three sub-themes which emerged under the main theme of experiences of faculty uncaring behaviours were: (1) Poor performance (2) A risk to patients (3) Feeling helpless and embarrassed. Conclusion: Experiences of students with caring and uncaring faculty had an influence on students learning, personal well-being and on their ability to effectively care for their patients. The study recommends that faculty members should critically analyse their actions and embrace those caring behaviours that facilitate the process of creating a conducive learning environment. In addition, there is need to develop a clear policy stipulating the role of student personal advisors and how students can engage them.

Poor sanitary practices are common amongst many food handlers posing a health risk to consumers. Maintenance of high quality water is one of the most important aspects of ensuring consumer safety. Therefore, regular water testing is critical in public food outlets where bacterial contamination may cause outbreak of disease. The study aimed at analyzing water samples obtained from the formal and informal food outlets for the presence of fecal coliforms that are indicative of poor sanitation that result in foodborne infections amongst consumers. Using a cross-sectional design, water samples from participating food outlets (N=40) were analyzed using the membrane filtration method. Samples were filtered, under vacuum, through a cellulose acetate membrane of 0.45 μm pore size. Fecal coliforms exceeding permissible range were detected in 15 test samples (N=40). The median (IQR) concentrations of fecal coliforms (FC/100ml) in dishwashing water was 1(136) and 145(340) for the formal and informal food outlets respectively. The median (IQR) for drinking water was 0(0) with a minimum and maximum range of 0 and 14 FC/100mls. The study established a positive correlation between fecal coliforms and electrical conductivity, and total dissolved solids (p

Background World Health Organisation (WHO) has approved and recommended several public health measures to halt the Coronavirus Disease 2019 (COVID-19) pandemic. The implementation of recommended interventions vary between higher income and Low and Middle-Income Countries (LMICs). The economical constraints within LMICs posed challenges in accessing resources for COVID-19 prevention. The study aimed to identify the workable community-based interventions being utilised in LMICs.Main body We applied systematic review approach for this study. Included articles were searched in eight online databases. The analysis was guided by the acceptable of best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles using pre-defined search terms. Furthermore, a PRISMA flow diagram was used to show the number of articles retrieved, retained, excluded with rationales given for every action. Studies conducted on community-based intervention for preventing COVID-19 and levels of knowledge, attitudes and practice (KAP) on community-based intervention for preventing COVID-19 regardless of the design were included. A mixed method appraisal tool (MMAT) was used to appraise studies.Six studies from LMICs were included for detail analysis after the systematic review screening process from 10,100 articles. The quality assessment using MMAT tool appraised these articles were all in highest quality. Among the six articles, 10 community-based interventions were implemented in LMICs. The three key workable and implemented interventions are: use of masks, social distance and hand wash. The review identified varying levels of KAP between LMICs and social-demographical factors affecting KAP in these settings.Conclusion This systematic review has identified the community-based interventions implemented in LMICs to prevent COVID-19 during the pandemic and key factors affecting the level of KAP among the population. This study re-affirms the importance of effective and suitable implementation of the identified interventions. More studies need to be conducted in LMICs to establish the effectiveness and adoption of the implemented and recommended interventions.

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.

Background The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives’ experiences and perception of the clinical learning environment in Malawi. Methods A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed. Results A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = p = Conclusion Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

BackgroundOrbito-ocular lesions are common cause of morbidity and mortality in our population yet, there is paucity of data on their pattern which is crucial for developing an effective strategy for prevention, timely detection and management. This study sought to describe the burden and histopathological pattern of orbito-ocular lesions at Mzuzu Central Hospital (MCH) over a period of five years (July 2013 to June 2018). MethodsA retrospective review of the clinicopathological profile of orbito-ocular lesions diagnosed at MCH was done. Demographic, clinical and histopathological data was obtained from original histology reports. Data analysis was conducted using Stata, version 13.0 (Stata Corp. LP, College Station, TX, United States of America). Descriptive analyses were performed to summarize patients’ sociodemographic and clinical characteristics, and histopathological analysis results.ResultsTwo hundred and fourteen (214) patients’ records of orbito-ocular lesions were reviewed. Patients were predominantly females 60.3%. The overall mean age was 34.81± 15.93 years. Conjunctiva was the most common site of orbito-ocular lesion accounting for 65.0% of the cases. This was followed by lid and adnexa (16.4 %) and intraocular lesions (9.3 %). Malignant lesions were the most prevalent (39.3%), followed by degenerative conditions (25.2%), other benign lesions (15.0%), Conjunctival Intraepithelial Neoplasia (CIN) (8.4%), pyogenic and inflammatory conditions (8.4 %). The burden of cancer among males was 45.9% while in female was 34.9%. Malignant lesions were common in HIV infected patients 64.1%. There was bimodal distribution of orbito-ocular malignancies, one in the first decade of life and the other in third and fourth decade of life. Among cancers cases (84), squamous cell carcinoma, retinoblastoma, Kaposi Sarcoma and lymphoma contributed to 82.1%, 8.3%, 2.4% and 1.2% respectively. Kaposi sarcoma was found only in patient with HIV infection.ConclusionCancer constituted a substantial proportion of orbito-ocular lesions in our study population with squamous cell carcinoma being the most common malignancy in adults and retinoblastoma in children. Degenerative disease contributed a high proportion of non-malignant lesions. Therefore, there is need for appropriate strategies to improve preventive, diagnostic and management capacity for orbito-ocular lesions at MCH.

Background A low cost and simple handwashing and enabling technology such as tippy-taps may provide adequate water sources, handwashing stations and motivation for people to prioritise handwashing. This systematic review aimed to establish the use, benefits, adoption and effectiveness of enabling technology; tippy-tap handwashing station, in resource-limited settings.Methods We systematically searched for articles in the PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases using a search strategy as predefined in the protocol registered with the PROSPERO database. Data were extracted and the quality of studies was appraised by the Mixed Method Appraisal Tool.Results Twenty articles met the eligibility criteria. The use of tippy-taps for handwashing by household members or school children was reported by authors of 16 studies, and it ranged from 2.7% to 80%. The availability of tippy-taps increased handwashing and use of soap among participants. Furthermore, the majority of people who were oriented to tippy-taps or recruited to tippy-tap studies built their tippy-tap stations even after the promotional activities or programs ended. In one study, tippy-taps were found to be effective in preventing episodes of stomach pain among participants.Conclusion Tippy-tap handwashing station could help in promoting handwashing practice in resource constraint settings. Future studies are needed to evaluate the effectiveness of tippy-tap hand washing station on preventing water and hygiene-related infections.

Background High prevalence rates of people living with HIV (PLHIV) are more predominant in sub-Saharan Africa compared to any region globally. Nonetheless, many people in the region have little access to safe water and live in poor sanitation environment. This region is, therefore, faced with a challenge in protecting PLHIV from infectious diseases that are transmitted through unhygienic conditions. Aim This systematic review was conducted to identify effective community-based interventions for the prevention of diarrhoea among PLHIV in sub-Saharan Africa. Methods Studies included in this systematic review were sought from PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ, Web of science, WHO Global Index Medicus Library, Cochrane and ProQuest (GeoRef). Articles were appraised using MMAT scale. Results From a search finding of 3,849 articles, only nine papers whose participants were people living with HIV and had incidence or prevalence of diarrhoea as an outcome met our inclusion criteria. Community-based interventions such as water treatment and safe storage were associated with 20% -53% reduction in diarrhoea episodes among PLHIV. The review has also demonstrated that the impact of hand hygiene and health education on the prevention of diarrhoeal infections is not adequately assessed. Conclusion Future studies are, therefore, warranted to assess the effect of hand hygiene and health education interventions on prevention and reduction of diarrhoea in PLHIV in Sub-Saharan Africa.