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Report on the 10Th Annual College of Medicine Research Dissemination

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Report on the 10Th Annual College of Medicine Research Dissemination Malawi Medical Journal; 19(1):39-65 March 2007 Report on the 10th Annual College of Medicine Research Dissemination Meeting The theme for the 2006 College of Medicine Research Dis- bility of companionship during labour”. semination Meeting was “A decade of research dissemina- tion”. In that sense, it was a celebration of another milestone The meeting attracted over 200 participants representing a for the College of Medicine. The meeting was opened by range of health-related activities going on in Malawi. Efforts the guest of honour, Dr Charles Mwansambo as Chairman to raise funds for the event were more successful than pre- of the National Health Sciences Research Committee. As in vious years and major sponsors included the Malawi-Liver- previous years, it was held at the Mahatma Ghandi Campus pool-Wellcome Trust Clinical Research Programme, Blantyre, of the College of Medicine on the day following the last day and the University of North Carolina Project, Lilongwe. The of final year student examinations. It was a very successful conference was also a focus for attention for the recently meeting. The quantity (69 this year) and quality of presenta- established College of Medicine Research Support Centre tions improved on previous years. The abstracts are set out and for renewed interest in the Malawi Medical Journal. The below. Major work of national and international relevance COM Annual Research Dissemination Meeting is a major was`presented such as beneficial impact of the Hib vaccine, health research dissemination meeting in the Malawian cal- return of chloroquine efficacy in children with malaria in endar. It is encouraging to see that the interest and partici- Ndirande and variety of work related to tackling the HIV/ pation in this important vehicle of dissemination of health AIDS epidemic. For the second year, a session was devoted research in Malawi continues to grow. Enjoy the abstracts. to a selection of year 4 student-project presentations and these were very good. Ms Grace Banda won the prize for the best medical student presentation for her work on “Accepti- Dr SM Graham, Conference Co-ordinator DCON/06/01 - National Survey of Surgical Activities and clinical officers at the district hospital in management of At The District Hospital In Malawi common acute life threatening abdominal emergencies is a C Lavy1, N Mkandawire1, C Steilechner2, A Tindal2, S realistic first step. Chimangeni3 1. Department of Surgery, University of Malawi, College of Medicine, DCON/06/02- Accelerated HIV Testing for Blantyre, Malawi. PMTCT in Maternity and Labour Wards is vital 2. Beit Cure International Hospital, Blantyre, Malawi to capture Mothers at a Critical Point in the programme at district level in Malawi 3. Malawi Against Physical Disability, Lilongwe, Malawi JJ Beltman, M Fitzgerald, L Buhendwa, M Moens, R Objectives Zachariah, J Kazima, N Alide To document surgical activities at all district hospitals MSF-Belgium, Thyolo District in Malawi in relation to human and material resources Introduction available. Mother to Child transmission (MCT) accounts for almost Materials And Methods 1 million newly infected children in Sub Saharan Africa Twenty-one district hospitals were visited by two surgical annually. Missed opportunities for HIV testing in the prenatal registrars (trainees). Using a structured questionnaire data maternity and labour wards were previously documented at were collected regarding surgical facilities at the district 63% in our hospital (1) (March 2002- September 2003). Many hospital after interviewing key officers (district health officer, HIV + mothers give birth in health facilities without previous medical officer, matron or clinical officer). The operating HIV test. Thereby missing opportunity for prevention to theatre logbooks were reviewed and all recorded surgical infant and also care for their own health. Recent audit in activities for the calendar year 2003 were analyzed. Thyolo found that infection related deaths accounted for Results 59% maternal mortality 2005. HIV was underlying factor All district hospitals had functioning operating theatres. in 100% of those tested but few were tested. We examined None of the hospitals had a resident trained surgeon. Most the impact of accelerated HIV testing in the maternity and district hospitals are manned by a single general doctor delivery wards in Thyolo District Hospital where a prevention (medical officer) and two or more paramedical officers of mother to child transmission programme (PMTCT) has (clinical officer / medical assistant). In 2003 a total of 28594 been implemented since beginning of 2002. Previously most surgical procedures were performed in the district hospitals. of the testing was done at the antenatal clinic (ANC) with a 12506 (44%) were obstetric or gynaecological procedures. prevalence of 20%. Only 821 (3%) were general surgical cases. Methods Conclusions And Recommendations Retrospective review was done from june 05 till january It appears district clinicians are happy to manage emergency 06 after programme revision in may 2005. From June obstetric and gynaecological cases but tend to refer emergency 2005 – January 2006 the PMTCT programme targeted general surgical cases. Delay in operating on abdominal women who attended for any inpatient care, including emergencies increases morbidity and mortality, thus there is high-risk pregnancies, malaria, early labour or pregnancies a strong case for improving surgical manpower and skills at for caesarean section. All admissions were offered opt out the district hospital so that these cases can be performed testing and counselling. Women who tested HIV positive at the district hospital. To have a surgeon at every district were offered nevirapine (NVP) prophylaxis intrapartum. hospital is a distant goal, however training of existing medical Their babies received a single dose of NVP within 72 hours Conference Abstracts 40 after delivery (2 mg/kg). We adopted a “One stop approach” aureus (4), Enterobacter spp (2), Klebsiella pneumoniae (1), to our antennal and maternity services (this meant that all Streptococcus pneumoniae (1) and Pseudomonas aeruginosa prevention and care services were integrated in same clinic). (1). Bronchial abnormalities consistent with Kaposi’s sarcoma CD4 test and clinical staging were also introduced in August (KS) were seen in 8 (18%) patients who had a negative BAL, 05). The one stop approach was further accelerated in all except one had visible skin KS. January 2006. Conclusion And Recommendation Results Brochoscopy and BAL sampling provided a more secure During the study period 1941 women delivered of whom diagnosis in 70% of patients who were able to tolerate the 212 were previously identified as HIV positive. (Prevalence procedure. Pneumocystis jiroveci pneumonia and pulmonary of 11%). An additional 30 (12.4%) tested HIV positive in the tuberculosis were both common in this select and severely maternity/ labour ward. With an overall annual hospital based immuno-suppressed population. Pulmonary KS was an HIV prevalence of 20% a total of 388 HIV deliveries were important non-infectious differential diagnosis. expected and 146 (37%) were missed compared with 63% in 2003. In the final month of study a 24 hour testing service was implemented which resulted in an additional 73 women DCON/06/04 - Affordable Miniaturized Flow- tested of whom 17 (24%) were HIV positive. From February cytometric CD4+ T-Cell Enumeration, The till May 20006, 918 hospital deliveries were reported. With Blantyrecount, For Clinical Use In Malawi 1,2,.3,4 1,3 1,5 1 an overall prevalence rate of 22% (revised since Jan 06) a CA MacLennan , MKP Liu , S White , F Simukonda , 1 , 6 1,7 6 total of 202 HIV + deliveries were expected. A reported 163 J Bwanali JJG van Oosterhout , MJ Moore , EE Zijlstra , 3 1,7 (81%) HIV deliveries took place in the hospital. Reduction MT Drayson , ME Molyneux of from 63% to 19% missed opportunities for HIV testing 1. MLW Clinical Research Programme, College of Medicine, University Conclusions of Malawi, Blantyre, Malawi. This additional PMTCT testing was well accepted by both 2. Department of Microbiology, College of Medicine, University of staff and patients in the hospital. Round the clock, 24 x 7 days Malawi, Blantyre, Malawi. HIV testing is vital to maintain a high PMTCT coverage for 3. MRC Centre for Immune Regulation, University of Birmingham, women delivering in district health facilities. An acceleration Birmingham, UK. in HIV testing in maternity and labour ward 24 x 7, could 4. Division of Medical Microbiology, University of Liverpool, Liverpool benefit patients by knowing the HIV status in advance UK. and will make early intervention possible, with hopefully a reduction of maternal deaths. 5. Centre for Medical Statistics and Health Education, University of Liverpool, Liverpool UK. 6. Department of Medicine, College of Medicine, University of Malawi, DCON/06/03 -Aetiology of Pulmonary Infections Blantyre, Malawi. in Adult Patients admitted to the High Dependency Unit at Queen Elizabeth Central Hospital 7. Liverpool School of Tropical Medicine, Pembroke Place, University of Liverpool, Liverpool UK. TH Hartung1, D Chimbayo1, AJ Phiri2, ME Molyneux2, EE Zijlstra1 Objectives 1. Department of Medicine, College of Medicine, Blantyre To develop an affordable accurate flow cytometric method 2. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, (BlantyreCount) for measuring absolute CD4 counts and Blantyre CD4 counts as a percentage of total lymphocyte
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