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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.

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.

ObjectivesThis study was carried out to determine the histopathological profile of cervical biopsies in a public tertiary hospital in Mzuzu, northern region of Malawi.SettingA public tertiary hospital in Mzuzu, northern region of MalawiParticipantsThis was a retrospective study of all cervical biopsy specimen reports received in a public tertiary hospital in northern Malawi over a period of 5 years from July 2013-June 2018. Eleven reports which had missing demographic and clinical data or had inconclusive results were excluded. Demographic, clinical and histopathological data was obtained from original histology reports.ResultsA total of 500 cervical biopsy reports were reviewed during the study period. The mean age of the patients was 41.99±12.5. Age ranged from 15 to 80 years. Cervicitis accounted for 46.0% (n=162) of the total nonmalignant lesions seen, followed by cervical intraepithelial neoplasm (CIN), at 24.4% (n=86) and endocervical polyp, at 20.5% (n=72). Squamous cell carcinoma (SCC) accounted for 15.6% (n=78) of the total cervical biopsies studied and 85.7% of all total malignant lesions. All malignant tumours had HIV.ConclusionOur study shows that cervicitis and squamous cell carcinoma were most common among nonmalignant and malignant cervical biopsies respectively. Since the frequency of cervical cancer is high, there is need to have well detailed national policies to be put in place to increase detection of pre-invasive lesions in order to reduce the prevalence of cervical cancer.Strengths and limitation of this study StrengthsThis paper has shownThe need for well detailed national policies to be put in place to increase detection of pre-invasive lesions, which in turn will decrease the frequency of cervical cancer in the country.The importance of intensifying cervical cancer screening programmes among women and provision of long term ART to the HIV infected which may offer an opportunity for appropriate interventions to reduce morbidity, mortality and reduce complications among these women.LimitationsThis study used available programme health facility data and histopathological reports on cervical cancer which has its own limitations, such as incompleteness and bias in the sense that information is obtained only from people who came to the facility and underwent biopsy, leaving out those that did not seek medical care and or were not biopsied and therefore cannot be generalized to the general population.The study is a single-hospital-based review and as such inadequate to draw conclusions, but it does shed some light on pathological pattern of cervical cancer in Malawi.

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.

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.