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Biomedical subjects

L Chitsulo

Publications and source records attributed to L Chitsulo.

35 records · Page 2Linked to original sources
PubMed1994

The efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental Plasmodium falciparum infection among pregnant women in Malawi.

To define an effective and deliverable antimalarial regimen for use during pregnancy, pregnant women at highest risk of malaria (those in their first or second pregnancy) in an area of Malawi with high transmission of chloroquine (CQ)-resistant Plasmodium falciparum were placed on CQ and/or sulfadoxine-pyrimethamine (SP). Of 38 pregnant women who received CQ treatment followed by weekly CQ prophylaxis (CQ/CQ) for at least 45 days prior to delivery, 32% had placental malaria infection, compared with 26% of 50 pregnant women who received a treatment dose of SP followed by weekly CQ prophylaxis (SP/CQ), and only 9% of 71 pregnant women who received a two-dose SP regimen (SP/SP; given once during the second trimester and repeated at the beginning of the third trimester) (P = 0.006, by chi-square test). During the peak transmission season from April to July, 47% of the women who received CQ/CQ had placental malaria infection at delivery, as compared with 37% of the women who received SP/CQ, and 10% of women who received SP/SP (P = 0.004, by chi-square test). Among women in their first or second pregnancy, two treatment doses of SP were highly effective in decreasing the proportion of women with placental malaria infection at delivery.

Analysis of Variance↗
PubMed1994

Use of malaria prevention measures in Malawian households.

Information on malaria prevention practices in households was obtained in a nation-wide knowledge, attitudes, and practices survey in Malawi. Of the 1,531 heads of household questioned, 55% were able to identify mosquitoes as the cause of malaria. Use of any type of malaria prevention method was reported by 52% of respondents. Among users, 47% used commercial products (insecticide, mosquito coils, bednets), and 64% used natural measures (burning leaves, dung, or wood); 11% used both. The most common commercial measure used was mosquito coils (16%) followed by insecticide spray (11%) and bednets (7%). Increasing household income and educational level of the household head were strongly correlated with use of commercial methods to prevent malaria; households with an income ranked moderate or greater were eight times more likely to have used a purchased product. Use of natural measures was correlated with lower income and educational level. Thirty-six percent of respondents reported having heard or seen information on malaria in the previous year. Use of household malaria preventive measures in Malawi is very low and income-dependent. Educational messages are required to improve understanding and use of affordable measures.

Adult↗
PubMed1994

A nation-wide malaria knowledge, attitudes and practices survey in Malawi: objectives and methodology.

A malaria knowledge, attitudes and practices survey was conducted in Malawi during April and May, 1992, to provide policy makers and program managers with information needed to design or improve malaria control programs, to establish epidemiologic and behavioral baselines, and to identify indicators for monitoring program effectiveness. Using cluster-sample survey methodology, 1531 households, in 30 clusters of 51-52 households each, were identified and members interviewed. Interviews were conducted by trained survey teams composed of young Malawian women with secondary level education. Heads of households were asked about malaria prevention methods used and about household economics; caretakers of children were asked about treatment and health seeking behavior in a recent malaria episode in a child; and women who had been pregnant in the past 5 years were asked about their antenatal clinic utilization and malaria during pregnancy. Survey results will be used to make programmatic decisions, including developing health education messages and establishing monitoring and evaluation of malaria control activities and outcomes in Malawi.

Adult↗
PubMed1994

Malaria knowledge, attitudes and practices in Malawi: survey population characteristics.

A national knowledge, attitudes and practices (KAP) survey was conducted in March-April 1992 to examine malaria illness and the people's response to illness and malaria prevention. Fifty-one households in each of 30 randomly selected communities were sampled and information was recorded from 1,531 households and 7,025 individuals. The population is characterized by low income (average household and per capita income were US $490 and $122, respectively) and low education levels (among adult women, 45% had no formal education and only 3.9% completed more than 8 years of schooling). Characteristics of the population were similar to those found in the 1987 national census, suggesting that the survey population was representative of the larger population of Malawi. Children under 5 years of age made up 15.8% of the population and had the highest rates of fever illness; these children experienced an estimated 9.7 cases/year of fever illness consistent with malaria. Although adults reported fever less frequently, women of reproductive age experienced an estimated 6.9 episodes of fever annually. The burden of malaria morbidity in this population is extremely high and occurs in all age groups.

Adolescent↗
PubMed1994

Treatment of malaria fever episodes among children in Malawi: results of a KAP survey.

Caretakers of children (< 10 years of age) were questioned about management of pediatric malarial fever episodes in a nation-wide knowledge, attitudes, and practices survey conducted in Malawi. A total of 1,531 households in 30 randomly selected clusters of 51 households each were sampled and interviewed. Overall 557 caretakers reported a fever in their child in the previous 2 weeks; 43%-judged the illness as severe. Fifty-two percent of caretakers brought their febrile children to clinic. Clinic attendance was positively correlated with young age of the child (< 4 years), severe illness, and higher socioeconomic status. Seventy-four percent of clinic attenders gave their child an antimalarial; in contrast, only 42% of those not attending clinic gave an antimalarial. Optimal therapy (administration of an antimalarial promptly and at the proper dosage) was received by only 7% of febrile children. Children taken to clinic were twice as likely to receive optimal therapy as were non-attenders. Identification of critical points in the optimal therapy algorithm and characteristics of caretakers linked with sub-optimal therapy may help malaria control programs target specific groups and health education messages to improve treatment of malaria fever episodes.

Algorithms↗
PubMed1994

Malaria and childbearing women in Malawi: knowledge, attitudes and practices.

Information on women's use of antenatal clinic (ANC) service, including malaria prevention and treatment during pregnancy, was collected during a national malaria knowledge, attitudes, and practices survey in Malawi. Among 1531 households, 809 (53%) included a woman who had carried a pregnancy past the second trimester within the past 5 years. Of these, 756 (93%) women reported at least one ANC visit during pregnancy (median = 4); 336 (42%) attended 5 or more times. Approximately half (51%) reported delivering in a hospital; 5% delivered in a clinic; 13% delivered at home with a trained birth attendant; and 28% delivered at home with only family attending. Women at increased risk for delivery complications (e.g. primigravidas and grand multigravidas) were no more likely to attend ANC or deliver in hospital than women without increased risk. The woman's level of education was the only significant predictor of initiating ANC care, continued ANC attendance, and delivery in hospital. In a setting where 43% of women pregnant within the past 5 years had received no formal education and 70% had completed less than 5 years, this survey identified a critical need for targeting health messages towards poorly educated women to ensure proper utilization of antenatal care services, including coverage with malaria prevention throughout pregnancy.

Adult↗
PubMed1994

Economic impact of malaria in Malawian households.

Household heads were questioned about household income and household expenditures on the treatment or prevention of malaria in a nationwide malaria knowledge, attitudes, and practices (KAP) survey conducted in Malawi in 1992. Very low income households with an average annual income of $68 constituted 52% of the sampled households. The primary income source for these households was farm production (92%), with the majority of goods produced consumed by the household and not available as discretionary income. Expenditure on malaria prevention varied with household income level. Only 4% of very low income households spent resources on malaria preventive measures compared to 16% of other households. In contrast, over 40% of all households, independent of income level, reported expenditures on malaria treatment. Almost half of the reported malaria cases sought treatment at a health facility at a cost of $0.21 per child case and $0.63 per adult case. The overall direct expenditure on treatment of malaria illness in household members was $19.13 per year (28% of annual income) among very low income households and $19.84 per year (2% of annual income) among low to high income households. The indirect cost of malaria, calculated on the basis of days of work lost, was $2.13 per year (3.1% of annual income) among very low income households and $20.61 per year (2.2% of annual income) among low to high income households. Very low income households carried a disproportionate share of the economic burden of malaria, with total direct and indirect cost of malaria among these households consuming 32% of annual household income compared to 4.2% among households in the low to high income categories.

Adult↗
PubMed1990

Comparison of the Teesdale glass sandwich and Kato-Katz techniques for the diagnosis of Schistosoma mansoni: a double-blind study.

In a double blind study, the Teesdale glass sandwich and Kato-Katz techniques were compared for the diagnosis of Schistosoma mansoni. From each of five stool specimens, six slide preparations were made by each method, and each slide was read independently by two readers. Examination of the differences in the number of eggs per slide by Analysis of Variance (ANOVA) showed no significant differences between methods, readers, or slides prepared from the same specimen at the 90% level of significance.

Analysis of Variance↗
PubMed1985

Egg count variability and sensitivity of a thin smear technique for the diagnosis of Schistosoma mansoni.

Variation in daily egg counts, and in counts for samples of the same stool, was investigated in children with Schistosoma mansoni and Ascaris lumbricoides infections, using a thin smear technique. The results indicated that counts vary according to the stool consistency; drier stools from the same person producing up to seven times greater counts than wet ones. The sensitivity of the technique was tested in schoolchildren living in an endemic S. mansoni area, and found to detect all infections with intensities of greater than 50 eggs per gram of stool, after examination of only one slide containing 40mg stool. The sensitivity varied with the intensity of infection. The relevance of these findings to diagnosis in field situations is discussed.

Ascariasis↗
PubMed1985

Schistosomiasis in Malawi--a review.

Prevalence data for schistosomiasis in Malawi, collected in recent years, indicated that the infection, especially Schistosoma mansoni is far more widespread than was previously thought. S. haematobium is highly prevalent in the south, while S. mansoni predominates on the Central Plateau. Both infections occur with moderate to high intensity along the lakeshore plain. Despite the high prevalence, reports of morbidity due to the infection are fewer than might be expected.

Child, Preschool↗
PubMedDate not supplied

A new focus of onchocerciasis in Mwanza District, Malawi.

Anecdotal information suggested that a new focus of onchocerciasis had recently developed in Mwanza in Malawi, a district not contiguous with Thyolo, the only district in Malawi with recognized autochthonous transmission. We carried out a survey of the northern half of Mwanza district, randomly selecting 62 villages for assessment. Two iliac crest skin snips were taken from 2215 residents over the age of 15 years; one-quarter had Onchocerca volvulus microfilariae. Prevalence increased with age and was higher overall among men than women. The age-adjusted prevalence among migrants from Thyolo was 31%. Among residents who had never been outside Mwanza, the gender-specific prevalences and microfilarial loads were similar. The intensity of infection was low. Autochthonous transmission of O. volvulus has thus been demonstrated in Mwanza and illustrates the possibility of the spread of the disease to new foci in Malawi and the surrounding countries, due to significant population shifts.

Adolescent↗
PubMedDate not supplied

Validity of mother's history regarding antimalarial drug use in Malawian children under five years old.

History obtained from parents and carers is an important, and often the only, source of information for health workers treating children for malaria, but its validity has not been well evaluated. At 2 hospitals in Malawi, we obtained malaria treatment histories from mothers of 973 ill children reported to have had fever as part of the illness. Urine samples were collected from 755 of the 973 children (78%). Of the 755, 457 (61%) were reported to have received some kind of treatment. Among those who reportedly received treatment, 79 (17%) were said to have received chloroquine and 23 (5%) a sulphonamide-containing medicine; however, when urine specimens were tested for antimalarial drugs, chloroquine was found in 182 specimens (40%) and a sulphonamide in 148 (32%). Among urine specimens collected from 291 children who were reported to have received no treatment (no report was recorded for 7 children), chloroquine was detected in 56 (19%) and a sulphonamide in 44 (15%). Although not statistically significant, mothers often reported a child as not having received an antimalarial drug if the child was younger than 12 months or had been sick for more than 3 d. The mothers' information regarding home treatment of fever in children was highly inaccurate. Malaria treatment histories, whether collected at health facilities or in surveys of knowledge, attitudes, and practices, must be interpreted with caution.

Antimalarials↗