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Biomedical subjects

J Kumwenda

Publications and source records attributed to J Kumwenda.

8 recordsLinked to original sources
PubMed2003

Teaching tuberculosis control to medical undergraduates: the Malawi experience.

SETTING: National Tuberculosis (TB) Control Programme (NTP) and College of Medicine (COM), Malawi. OBJECTIVES: To develop a TB/HIV module, incorporating TB control and the DOTS strategy, for 4th year medical undergraduates. To describe 1) the way in which the module was developed, 2) the contents and structure of the module, 3) the experience of teaching the module from 2000-2002, and d) the financial costs to the NTP. DESIGN: A descriptive study. RESULTS: The TB/HIV module, including the teaching manual, resource materials and undergraduate assessments, was developed between June and December 1999 by NTP, College of Medicine, interested stakeholders and an external consultant. The module was well received by medical undergraduates. Student knowledge, based on pre-module and post-module assessments, increased to satisfactory levels. Novel aspects of teaching, which included reading chapters in class followed by student-led knowledge reviews, modular assessments and using NTP staff as facilitators, were highly rated. The cost of developing the module was 14,070 US dollars, and the recurrent annual cost of teaching the module was 900 US dollars. CONCLUSION: The results show that a national tuberculosis control programme can work effectively with an academic medical institution in teaching medical undergraduates the important principles of country-wide TB control.

Adult↗
PubMed2002

Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa.

AIMS: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. METHODS: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. RESULTS: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. CONCLUSIONS: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Clinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre, Malawi.

SETTING: Adult medical wards of a central hospital in Blantyre, Malawi. OBJECTIVE: To measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults, and to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia, and the usefulness of a diagnostic trial of anti-tuberculosis treatment. DESIGN: We prospectively examined adults admitted with fever or a history of fever. All had blood cultured for bacteria and mycobacteria, chest X-ray and sputum smears. FINDINGS: Mycobacterium tuberculosis was the commonest cause of blood stream infection (BSI), affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; it was not suspected in six (11%). Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of tuberculosis (TB) treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short-course chemotherapy, on the TB ward after 1 month was similar whether patients had mycobacteremia (21%) or not (32%). CONCLUSION: TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.

Adolescent↗
PubMed2000

Trials of anti-tuberculosis treatment in areas of high human immunodeficiency virus prevalence in sub-Saharan Africa.

Sub-Saharan Africa is bearing the brunt of the human immunodeficiency virus (HIV) pandemic, and HIV-associated tuberculosis (TB) has become a major clinical and public health problem. There is evidence that HIV-infected patients not uncommonly develop disseminated TB, and that this diagnosis is often not made ante mortem because of limited diagnostic facilities and other factors. Where diagnostic facilities are limited, a trial of anti-tuberculosis treatment with drugs specific for Mycobacterium tuberculosis may be a useful way of diagnosing disseminated TB. The case for and against 'a trial of treatment' is presented, and a suggestion is made that 'a trial of treatment' can be incorporated into the case finding package of a National TB Control Programme.

AIDS-Related Opportunistic Infections↗
PubMed1994

Retinal findings in Malawian patients with AIDS.

The purpose of this study was to determine the prevalence of retinal disease in a group of patients with AIDS in Malawi. Indirect ophthalmoscopy was performed on 99 patients with AIDS who were admitted consecutively to a medical ward at a central hospital. Necrotising retinitis was present in one eye of one patient examined. Non-infectious retinopathy was present in 13%. Retinitis is less common in AIDS patients from Africa compared with those from developed countries; it is believed that most patients die before acquiring it. Non-infectious retinopathy may also be less common.

AIDS-Related Opportunistic Infections↗
PubMed1993

Use and costs of antimicrobial drugs in medical wards of a central hospital in Malawi.

Economic constraints experienced by many African countries make it vital that reliable information is collected about the cost of patient care in health institutions. Case files and treatment charts of 509 patients admitted to non-fee paying medical wards of Queen Elizabeth Central Hospital, Blantyre, Malawi for the month of September 1992 were analysed in order to determine the amount and costs of drugs and antimicrobial agents given to inpatients. Infectious diseases accounted for 76% of all admissions. A total of 59 different drug items were used (cost U.S. $732). In all, 18 antimicrobial agents were given (31% of all drug items) at a cost of U.S. $615 (84% of all drug costs). Calculated costs of antimicrobial agents for each patient and for annual admissions (10325 in 1992) were U.S. $1.21 and U.S. $12,558 respectively. Although the present study has its limitations, it provides a rational basis for planning departmental drug budgets.

Anti-Bacterial Agents↗