Voluntary counselling, HIV testing and adjunctive cotrimoxazole are associated with improved TB treatment outcomes under routine conditions in Thyolo District, Malawi

SETTING

Two rural districts in Malawi: Thyolo, where voluntary counselling and human immunodeficiency virus (HIV) testing (VCT) is offered to all tuberculosis (TB) patients and adjunctive cotrimoxazole to HIV positives, and Mulanje, where no such interventions are offered.

OBJECTIVES

For all TB patients registered in 2001: 1) to determine the uptake of VCT and cotrimoxazole in Thyolo, and 2) to compare treatment outcomes between Thyolo and Mulanje.

DESIGN

A cohort study using routinely collected programme data.

RESULTS

There were 1239 TB patients in Mulanje and 1103 in Thyolo. In Thylo, 1064 (97%) patients consented to VCT, 1006 were HIV tested (91%) and 761 (69%) were started on cotrimoxazole a median of 4 days from registration; 77% of patients tested in Thyolo were HIV-positive. For all TB patients, in Thyolo and Mulanje, treatment success was respectively 75% and 61% (P < 0.001); death was 21% and 25% (P = 0.026); and other outcomes were 4% and 14% (P < 0.001). The adjusted relative risks of treatment success (1.23), death (0.84) and other outcomes (0.26) in Thyolo were significantly different from those in Mulanje (P < 0.001).

CONCLUSION

VCT and adjunctive cotrimoxazole is well accepted by TB patients in Thyolo and, with other HIV care and support services, is associated with good treatment outcome indicators for the National Tuberculosis Programme. This intervention is being expanded to other districts in Malawi, and other African countries should consider a similar approach to the dual HIV-TB epidemic.

Vaccine hesitancy in Malawi: a threat to already-made health gains

Malawi faces a growing concern about vaccine hesitancy. This threatens to undermine significant strides in the fight against infectious diseases in the country. Vaccine hesitancy in Malawi is driven by multiple factors. This short communication discusses the extent of vaccine hesitancy in Malawi and its main drivers according to SAGE's (Strategic Advisory Group of Expert) 3Cs (confidence, complacency and convenience) model of vaccine hesitancy. As an escalating health concern, it is imperative to address it urgently. It is imperative to address it urgently through comprehensive and sustainable awareness campaigns that should aim to increase acceptance and demand for vaccines.

Behavioral and Socio-Economic Determinants of Antimicrobial Resistance in Sub-Saharan Africa: A Systematic Review

Introduction

Antimicrobial resistance (AMR) is currently one of the twenty-first century's biggest threats to public health. Addressing AMR is often operationalized as requiring 'behavior change' of clinicians and patients and improving the drug development pipeline. Few studies and interventions have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and their varied economic, social and political organizations. This systematic review aimed to gather and review the available data on the behavioral and socio-economic determinants of AMR in sub-Saharan Africa (SSA).

Methods

Articles were sourced from PubMed using search terms across five domains: "Antimicrobial resistance", "Sub-Saharan Africa", "Behavioral", "Socio-economic", and specific SSA country names. References were also reviewed for relevant data. This systematic review included original studies published in English between 2015 and 2023, focusing on behavioral and socio-economic factors influencing AMR in human populations in SSA, with AMR as a key outcome.

Results

This systematic review identified 30 studies, with 83% (n=25) focusing on self-medication and antibiotic use practices, 67% (n=20) on healthcare providers' practices and knowledge, and 60% (n=18) on community knowledge and perceptions of AMR while 50% (n=15) of studies explored various socio-economic factors. The common themes that emerged from these studies included inadequate evidence-based prescription practices (63%, n=19), financial barriers to accessing antibiotics (50%, n=15), poor community awareness of AMR (53%, n=16), regulatory challenges in antibiotic sales and distribution (47%, n=14), and healthcare infrastructure limitations, including deficient diagnostic capabilities and antimicrobial stewardship programs (40%, n=12).

Conclusion

This review's findings provide crucial insights into the behavioral and socioeconomic patterns influencing AMR in sub-Saharan African populations. For AMR interventions to be effective, there is a need for a thorough understanding of people's behaviors and practices about AMR knowledge and antimicrobial use which will help in developing more targeted interventions and policies to address inappropriate antimicrobial use and the spread of AMR.

Caregiver acceptance of human papillomavirus vaccine for their female children in Chileka, Blantyre, Malawi

Introduction

Malawi is one of the countries enduring an enormous burden of cervical cancer. Human Papillomavirus (HPV) vaccination offers a feasible and effective tool for reducing the burden. Such a prospect however, is being impeded by low uptake rates of the HPV vaccine in the country. This study, therefore, sought to identify barriers to caregiver acceptance of the HPV vaccine for their female children in Chileka, Blantyre, Malawi and to establish the consequential willingness to vaccinate their children.

Methodology

A cross-sectional study was conducted using qualitative methods. We conducted 6 Focus Group Discussions (FGDs) with 4 groups of women and 2 groups of men in 4 villages located in a semi-urban area, Chileka, Blantyre. The guiding questionnaire was designed to draw out two main outcomes: barriers to caregiver acceptance of the HPV vaccine and willingness to vaccinate children. The data was analysed by thematic analysis by an inductive approach using NVivo software version 11.

Results

Lack of knowledge on cervical cancer and HPV vaccination coupled with numerous misconceptions are the main barriers discouraging the population from accepting the HPV vaccine. Consequently, there was little desire to get their children vaccinated against HPV. Though responsibility to get the children vaccinated was mainly attributed to women, men argued that they need to have a final say in their children's vaccination.

Conclusion

In the wake of the revealed barriers and low acceptance of the HPV vaccine, it is imperative to organize effective and sustainable awareness programmes for the improvement of the HPV vaccine's uptake.