Abstracts from the 2022 Kamuzu University of Health Sciences Research Dissemination Conference

O1.A001406.   LONG ACTING CABOTEGRAVIR: UPDATED EFFICACY AND SAFETY RESULTS FROM HPTN 084

Author(s): S. Delany-Moretlwe 1, J.P. Hughes 2, P. Bock 3, S. Dadabhai 4, D. Gadama 5, P. Hunidzarira 6, S. Innes 7, D. Kalonji 8, J. Makhema 9, P. Mandima 6, C. Mathew 1, J. Mpendo 10, P. Mukwekwerere 6, N. Mgodi 6, P. Nahirya Ntege 11, C. Nakabiito 12, H. Nuwagaba-Biribonwoha 13, R. Panchia 14, F. Angira 15, N. Singh 8, B. Siziba 6, E. Spooner 8, J. Farrior 16, S. Rose 16, R. Berhanu 1, Y. Agyei 17, S.H. Eshleman 17, M.A. Marzinke 17, E. Piwowar-Manning 17, S. Beigel-Orme 2, S. Hosek 18, A. Adeyeye 19, J.R. Rooney 20, A. Rinehart 21, B. Hanscom 2, M. Cohen 22, M. Hosseinipour 5,22, for the HPTN 084 study team

Affiliation(s):

1. University of the Witwatersrand, Wits RHI, Johannesburg, SA
2. Fred Hutchinson Cancer Research Center, Statistical Centre for HIV/AIDS Research and Prevention, Seattle, USA
3. University of Stellenbosch, Desmond Tutu TB Centre, Stellenbosch, SA
4. KUHeS, Johns Hopkins Research Project, Blantyre, Malawi
5. UNC Project-Malawi, Lilongwe, Malawi
6. University of Zimbabwe, Clinical Trials Research Centre, Harare, Zimbabwe
7. University of Cape Town, Desmond Tutu Health Foundation, Cape Town, SA,
8. South African Medical Research Council, HIV and other Infectious Diseases Research Unit, Durban, SA
9. Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana
10. UVRI-IAVI, Entebbe, Uganda
11. Baylor College of Medicine Children’s Foundation Uganda, Kampala, Uganda
12. Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
13. Columbia University Mailman School of Public Health, Eswatini Prevention Center, Mbabane, Eswatini
14. University of the Witwatersrand, Perinatal HIV Research Unit, Soweto, SA
15. KEMRI, Kisumu CRS, Kisumu, Kenya
16. FHI 360, Durham, USA
17. Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, USA,
18. Stroger Hospital of Cook County, Department of Psychiatry, Chicago, USA
19. National Institute for Allergy and Infectious Diseases, Division of AIDS, Washington DC, USA
20. Gilead Sciences, Foster City, USA,
21. ViiV Healthcare, Durham, USA,
22. University of North Carolina at Chapel Hill, Chapel Hill, USA    

Email: sufia@jhu.edu

Introduction: HPTN 084 is an ongoing, multisite, Phase-3 randomized, controlled trial that demonstrated the superiority of long-acting injectable cabotegravir (CAB) compared to daily oral TDF/FTC for HIV prevention in individuals assigned female at birth. The blinded trial was stopped after a planned review in November 2020. Participants were then unblinded and continued their original regimen pending open-label CAB.

Objectives: To report HIV infections in the 12-months following unblinding (detected through 12/31/21) by site, arm and central laboratory test result.

Methods:  We estimated cumulative HIV incidence for the combined primary blinded and 12-month unblinded period, by assigned study arm. Grade 2+ adverse events (AEs), injection site reactions (ISR), pregnancy incidence and outcomes are reported for the unblinded period.

Results: Twenty-three incident infections (3 CAB, 20 TDF/FTC) were detected in the 12-month unblinded period. Of these, two (1 CAB, 1 TDF/FTC) were deemed to have occurred during the blinded phase. Only one CAB case had ever received an injection. Cumulatively, 62 incident HIV infections (6 CAB, 56 TDF/FTC) were observed over 6626 person-years (HIV incidence 0.94%, 95% CI 0.72, 1.20). CAB superiority appears sustained (HR 0.11, 95% CI 0.05, 0.24). No new safety concerns were identified. For the unblinded period, 2.4% (32/1318) of the CAB group reported a Grade 2+ ISR. Overall, Grade 2+ AEs in this period were balanced by study group; 20% were related to study product (CAB 19%, TDF/FTC 21%). Two deaths in the CAB group were unrelated to study product. An additional 83 pregnancies (43 CAB, 40 TDF/FTC) occurred in the unblinded period (incidence 3.20%, 95% CI 2.56, 3.98). No congenital anomalies were reported.

Conclusions: Reductions in HIV incidence were sustained in the unblinded period. CAB continues to be superior to TDF/FTC for HIV prevention in individuals assigned female at birth.

O2.A001356. ANTIMICROBIAL RESISTANCE IN SUB-SAHARAN AFRICA: A ONE HEALTH PROBLEM? INSIGHTS FROM GENOMIC ANALYSIS OF COMMUNITY CARRIAGE EXTENDED SPECTRUM BETA-LACTAMASE PRODUCING ENTEROBACTERIACEAE FROM UGANDA AND MALAWI         

Author(s): Patrick Musicha1, Derek Cocker2, Fiona A Oruru3, Mathew A Beale4, Shevin Jacob5, Nicholas A Feasey6, Nicholas R Thomson7

Affiliations:

1. Malawi-Liverpool-Wellcome Research Programme, Kamuzu College of Health Sciences; Wellcome Sanger Institute; Liverpool School of Tropical Medicine.
2. Malawi-Liverpool-Wellcome Research Programme, Kamuzu College of Health Sciences; Liverpool School of Tropical Medicine.
3. Infectious Disease Institute, Makerere University.
4. Wellcome Sanger Institute.
5. Infectious Disease Institute, Makerere University; Liverpool School of Tropical Medicine.
6. Malawi-Liverpool-Wellcome Research Programme, Kamuzu College of Health Sciences; Liverpool School of Tropical Medicine.
7. Wellcome Sanger Institute; London School of Hygiene and Tropical Medicine.  

Email: pm13@sanger.ac.uk

Introduction: Antimicrobial resistance (AMR) is widely considered a one health problem, but this concept seems not to be supported by data emerging from high income countries. We present data from the DRUM (Drivers of AMR in Uganda and Malawi) study, which investigated transmission of extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) between humans, animals and the environment.

Methods: We sequenced 4020 whole genomes of ESBL-E from human stool, animal stool and the environmental samples, longitudinally collected at five sites in Malawi and Uganda. We performed phylogenetic analyses and clustering, in silico multilocus sequence and O-antigen typing (for K. pneumoniae), screened for AMR determinants and correlated these genotypes to sample location, ecological source and other factors.

Results: 3,149 genomes, including 2345 E. coli and 814 K. pneumoniae passed quality control. We found multiple lineages of ESBL E. coli and K. pneumoniae across isolates from both Malawi and Uganda. blaCTX-M-15 was the predominant ESBL gene in both E. coli (66.1%) and K. pneumoniae (86.6%) isolates. The genomic epidemiology of CTX-M-15 E. coli from Malawi was consistent with global CTXM-15 producing E. coli: sequence type (ST) 131 (12.2%) was the most common, followed by ST38 (7.8%) and ST3580 (5.6%). In contrast, ST10 was most common (8.9%) in Uganda, followed by ST1193 (4.6%). We identified 20 novel E. coli lineages with 5% of E. coli genomes (10.0% in Uganda and 2.8% in Malawi) untypable by MLST, an indication of unsampled diversity likely due to limited representation of African genomes. We found no significant association between clustering of isolates by lineage and sample source.

Conclusion: Our study represents the largest collection of ESBL-E genomes from sub-Saharan Africa in one study. We demonstrate that in this setting, animals and the environment are important reservoirs of human colonising ESBL-E, and provide support for one health AMR interventions.

O3.A001286.   A QUALITATIVE EXPLORATION ON STRATEGIES FOR IMPROVING UPTAKE OF POSTNATAL CARE SERVICES IN THYOLO MALAWI.   

Author(s): Alinane Linda Nyondo-Mipando1, Marumbo Chirwa1, Sangwani Salimu1, Andrew Kumitawa2, Jacqueline Nkhoma3, Tiyese Jean Chimuna3, Martin Dohlsten4, Bongani Chikwapulo5  

Affiliations:

1. Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences
2. Department of Epidemiology and Statistics, School of Global and Public Health, Kamuzu University of Health Sciences
3. UNICEF Malawi Country Office
4. Department of Maternal, newborn, child and adolescent health and ageing, World Health Organization, Geneva
5. Quality Management Directorate, Ministry of Health, Malawi

Email: lmipando@kuhes.ac.mw

Introduction: Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of the services has remained low worldwide. The rate of postnatal care uptake in Malawi is at 50%.  This study explored and prioritised the strategies for optimising the uptake of postnatal care services uptake in Thyolo, in Malawi

Methods: A qualitative descriptive study was conducted from July to December 2020 in Thyolo District, Malawi, and was followed by a nominal group technique in October 2021 to prioritise strategies for optimising uptake of PNC services. We conducted focus group discussions among postnatal mothers, fathers, Health care workers, elderly women, and grandmothers. We conducted in-depth interviews with Midwives, and Key health care workers.  We held a nominal group technique among postpartum women, men, midwives, Health Surveillance Assistants, clinicians and health managers to prioritise the main strategies for provision of PNC. All qualitative data were managed using NVivo and were analysed following a thematic approach.

Results: The strategies for optimising PNC services at the health system level include training of health providers; improving the clinic operations with attention paid to task-shifting, hours of operation, having appointment date reminders, linkage to care, and provision of free health passport books; having infrastructure for the services, and having services delivered near where end-users reside.  At the community level, the strategies include community awareness campaigns that consist of drama groups and health mentors, and male involvement.  Additionally, we found that the priority strategies include refresher training and improvement in the clinic operations especially on hours of operation, having appointment date reminders, and linkage to care.

Conclusion: Optimisation of postnatal care services will require implementation of strategies that are acceptable and relevant in the context where services are provided and community awareness is key.

O4.A001472. HIGH PREVALENCE OF DYSLIPIDAEMIA AMONG PATIENTS WITH DIABETES MELLITUS, HYPERTENSION, AND COMORBIDITY OF DIABETES MELLITUS AND HYPERTENSION AT A TERTIARY HOSPITAL IN SOUTHERN MALAWI     

Author(s): Kondwani Katundu1,2, Victoria Mukhula2, Tamara Phiri3,4, Chimota Phiri4, Florence Filisa5, Pascal Chipewa 1, George Chirambo1, 6, Mwapatsa Mipando1, 6, Henry Mwandumba1,2, Adamson Muula7, Johnstone Kumwenda3   

Affiliations:

1. Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Malawi-Liverpool Wellcome Trust Research Project, Blantyre, Malawi
3. Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
4. Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
5. Kamuzu Central Hospital, Lilongwe, Malawi
6. Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
7. Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi 

Email: kkatundu@kuhes.ac.mw

Introduction: Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor which adds additional risk for cardiovascular diseases (CVDs) in patients with hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among patients with diabetes mellitus (DM) and hypertension is not known. 

Objective: This study aimed to investigate the prevalence, biochemical characteristics, screening and management practice for dyslipidaemia among patients with DM, hypertension, and both DM and hypertension at a tertiary teaching hospital in Southern Malawi, Africa.

Methods: This was a cross-sectional study. A total of 256 adult participants (DM=100); hypertension =100; both condition = 56) were included in the cross-sectional study in 2021. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were assessed.

Results: Dyslipidaemia was prevalent in 58%, 55%, and 70% of participants with DM, hypertension, and both conditions. High low-density lipoprotein cholesterol (LDL-C) was the most common dyslipidaemia type in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2 – 4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p=0.02). Overweight or obesity, and age over 30 years were risks for dyslipidaemia in patients with DM alone (OR 1.3 (95% CI 1.1 – 1.6), p=0.04, and OR 2.2 (95% CI 1.2 – 4.7) (p<0.01) respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (OR 3.5 (95% CI 1.2 – 9.9) p <0.001). Poorly controlled hypertension was associated with a 1.8 times risk (95% CI 1.1 – 2.7) of dyslipidaemia in patients with both DM and hypertension (p<0.01). Less than 1% of the participants ever had a lipogram performed before the study and were on lipid-lowering therapy.

Conclusion: Dyslipidaemia with LDL-C derangement was highly prevalent, especially in individuals with both DM and hypertension, with poor screening and treatment for the dyslipidaemia. Screening and managing dyslipidaemia should be reinforced to reduce the risk of major cardiovascular events in this population at increased risk.

PLENARY SESSION 2 ABSTRACTS

O5.A001468.   FACTORS CONTRIBUTING TO LOW OR INCOMPLETE VACCINATION AMONG UNDER-FIVE CHILDREN IN URBAN AREAS IN MALAWI: A COMMUNITY-BASED CROSS-SECTIONAL STUDY

Author(s): Atupele Kapito-Tembo1,2, Glory Kabaghe1, Temwa Mzengeza3, Dennis Mwagomba3, and Mike Chisema3       

Affiliations:

1. Kamuzu University of Health Sciences, MAC – Communicable Diseases Action Centre
2. Kamuzu University of Health Sciences, Public health department, School of Global and Public Health
3. Malawi Ministry of Health Expanded Program on Immunisation Unit     

Email: atupelekapito@gmail.com

Introduction: In Malawi, evidence shows that vaccination coverage among under-five children is declining in the urban compared to the rural areas including data from Malawi demographic health surveys. There is a need to identify factors that are contributing to low or incomplete vaccination among under-five children in urban communities. Results would inform the development of targeted and effective interventions to improve vaccination in children in urban settings.

Objective: To identify factors contributing to low or incomplete vaccination among under-five children in urban areas in Malawi.

Methods: A community-based cross-sectional study using quantitative and qualitative methods was conducted in urban areas across Malawi. A multi-stage sampling approach was used. Eight urban areas were sampled and in each area, 2 health facilities were randomly sampled. In each facility, 11 under-five children who were under-immunised and 5 fully immunised were randomly sampled. Information on socio-demographics, immunisation status and factors affecting immunisation was collected. Eight focus group discussions (FGDs) with child caregivers were conducted. Bivariate and multivariate logistic regression were used to assess associations between immunisation and factors. Thematic analysis was conducted for qualitative data.

Results: A total of 177 under-immunised and 85 fully immunised children were enrolled. In bivariate analysis, under-immunisation was associated with: education status, source of income, level of satisfaction with services, church influence, knowledge of immunizations and schedule, and ability to attend under-five clinic monthly. In multivariate analysis, the odds of child being immunised was higher among child caregivers with: business as a source of income compared to full-time employment (OR=3.5,95%CI:1.5-8.1) and inability to attend under-five clinic monthly (OR=7.9,95%CI:2.6-24.1). During FGDs, the caregivers mentioned: having busy schedules, lack of information on newly introduced vaccines, vaccine side effects, religious beliefs and health systems factors like long waiting queues and vaccines stock-outs as the reasons contributing to children being under-immunised in the urban areas.

Conclusion: In Malawi, the child caregivers with under-immunised children in the urban settings are experiencing socio-economic and health systems challenges and issues which are contributing to low vaccination coverage. There is a need to design and implement strategies targeting the needs of urban communities.

O6.A001282.   HIGH UNTREATED HIV PREVALENCE AND HIGH SCHISTOSOMIASIS PREVALENCE DESPITE TREATMENT: FINDINGS FROM “CREATING DEMAND FOR FISHERMEN’S SCHISTOSOMIASIS HIV SERVICES” (FISH) CLUSTER-RANDOMIZED TRIAL IN MANGOCHI, MALAWI   

Author(s): Augustine Talumba Choko1*, Sekeleghe Kayuni2, Peter MacPherson1, 3, 4, Chimwemwe Kwanjo-Banda1, Anthony Butterworth1, and Elizabeth L. Corbett4

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
2. Medical Aid Society of Malawi (MASM), Blantyre, Malawi
3. Department of Clinical Sciences, Liverpool School of Tropical Medicine
4. Clinical Research Department, London School of Hygiene and Tropical Medicine

Email: chimwemwe.kwanjobanda@gmail.com

Introduction: Prevalence of untreated HIV has fallen dramatically in sub-Saharan Africa. However, people living in fishing communities remain underserved by both HIV and schistosomiasis services. We investigated the prevalence of untreated HIV and schistosomiasis from an ongoing trial.

Methods: This abstract reports process and not trial data. Conventional HIV testing and self-testing was offered to fishermen via beach clinics. Treatment with Praziquantel without testing was offered to fishermen with urine microscopy at 4 weeks to ascertain the number of eggs per 10ml urine. Prevalence estimates for untreated HIV and schistosomiasis along with 95% confidence intervals (CI) were computed using the binomial exact method.

Results: A total of 2,870 fishermen completed two study visits at the beach clinic from 34 out of 45 trial clusters. Of these, the mean age was 35.1 years (standard deviation [SD]: 12.7) while the majority 2,019/2853 (70.8%) were married. Up to 1,268/2705 (46.9%) were illiterate. Prevalence of untreated HIV was 95/2,129 (4.5%; 95% CI: 3.6; 5.4%). Every additional year in age (years) was associated with 4% increased risk of having untreated HIV risk ratio (RR) 1.04 (95% CI: 1.03; 1.06), p<0.001. Compared to married fishermen the risk of having untreated HIV was lower in those who were not married RR 0.25 (95% CI: 0.11; 0.53), p<0.001. Up to 269/2,212 (12.2%, 95% CI: 10.8; 13.6%) fishermen had schistosomiasis despite receiving treatment. There was an inverse relationship between increasing age (years) and having active schistosomiasis RR 0.99 (95% CI: 0.98; 1.00), p=0.004. The risk of having active schistosomiasis was higher among unmarried fishermen compared to fishermen who were married RR 1.31 (95% CI: 1.02; 1.67), p=0.036.

Conclusion: Despite HIV testing and schistosomiasis treatment being free we found very high untreated HIV and active schistosomiasis among fishermen. Better and early delivery of interventions in hard-to-reach groups such as fishermen are recommended.

O7.A001509. ADDRESSING NUTRITION KNOWLEDGE GAP IN AN INTEGRATED RMNCH/ECD PROJECT: EXPERIENCES OF MOTHERS2MOTHERS MALAWI    

Author(s): Tendai Mayani1, Yolande Baker2, and Bridget Malewezi1           

Affiliation(s):

1. mothers2mothers, Lilongwe, Malawi;
2. mothers2mothers, Cape Town, South Africa      

Email: Bridget.Malewezi@m2m.org

Introduction: 46% of the Malawian population is under 15, including 2.8 million children under five. Children often suffer from micronutrient deficiencies, which include anemia and zinc deficiency. Stunting is at 37.1%, and children living in rural Malawi are more affected. (UNICEF, July, 2018). MDHS 2015-16 indicates that infant and young child feeding practices are still low, only 25% of children aged 6–23 months meet their minimum dietary diversity, 29% meet their minimum meal frequency and 8% have a minimum acceptable diet).

Methods: Nutrition Facilitators (NF) were deployed to integrate nutrition in existing RMNCH/ECD projects in communities in Lilongwe district. NFs conducted mapping, pre-test assessment, delivered modular sessions with practical cooking demonstrations, established sustainable backyard gardens, and then conducted post-test assessment. Knowledge levels of 2,253 clients who were registered before and after undergoing modular sessions was uploaded on digital platform and analysed using Strata version 16.

Results: Of the 32 parameters assessing nutritional knowledge, majority (n=30) showed significant differences (p <0.05) between pre and post tests scores suggesting improvement in participant’s knowledge across the various thematic areas such as breastfeeding, infant feeding, effects of HIV on nutritional needs, nutritional supplementation during pregnancy & an improved understanding of adolescents, pregnancy and their nutritional needs. Areas where participants remained unclear and scored lower during post test assessment included whether HIV infection increases energy and nutritional needs as well as whether deworming is a strategy for anaemia control. 

Conclusion: Nutrition information can be integrated in maternal and child health programmes thus providing mothers and caregivers access to proper feeding practices of children for optimal growth.

O8.A001371. NURSE-EDUCATORS’ SELF-PERCEPTIONS IN A BSN PROGRAMME IN MALAWI: A MIXED-METHODS STUDY  

Author(s): Evelyn Chilemba1           

Affiliation(s):

1. Kamuzu University of Health Sciences, Malawi

Email: evelynchilemba@kuhes.ac.mw

Introduction: Nurse educator’s self perceptions efficacy of their teaching is key promoting learning experiences among students. Thus, nurse educators must be mindful of how their teaching tasks bring about change or transformation to their students pre existing knowledge base. To this end, the preliminary reviews and analysis in the learning processes of the BSN primed nurses at KUHES indicate a learning dissonance as the reason for the underperformance among graduate nurses. To bring about educational reform, nurse educators need to be aware of how traditional teaching methods impact their students learning experiences.

Objectives: To examine nurse educators perspectives of the processes, tools, strategies and approaches of the learning experiences among graduate nurses

Methods: Sequential mixed method design was instrumental in guiding the formulation of interview questions from the quantitative data thus, the data with significance to the nurse educators perceptions guided the conduct of in depth interviews. A sample of ten nurse educators utilizing purposive sampling participated interviews. Content analysis was used for analysing data to generate themes. Narrative generated a rich source of information about the nurse educators perceptions of and attitudes towards teaching and learning experiences.

Results: The educators self perceptions comprised five constitutive themes of “”educators”” teaching styles, “”teaching them to think”” “”resources for teaching”” “”student learning environment”” and “”strategies for improving learning to practice””. The results report the teacher centered approach was advanced where educators preferred teaching methods that depends on students numbers in class, teaching content, and the scheduled time for teaching. This is because educators believed that student learning during classroom teaching was an educators responsibility, and thus chose teacher centered approaches. Teacher centered approaches are less effective in creating opportunities for learners to reflect and become self directed in practice.

Conclusion: Teacher centered approaches are less effective in creating opportunities for learners to reflect and become self directed

O9.A001293. PREVALENCE OF SEXUALLY TRANSMITTED INFECTION IN PREGNANCY AND THEIR ASSOCIATION WITH ADVERSE BIRTH OUTCOMES; A CROSS-SECTIONAL SURVEY AND CASE-CONTROL STUDY AT QUEEN ELIZABETH CENTRAL HOSPITAL, BLANTYRE, MALAWI 

Author(s): Charlotte van der Veer1,4, Chifundo Kondoni1, Annie Kuyere1, Fatima Mtonga1, Vita Nyasulu1, George Shaba1, Chelsea Morroni2, Gladys Gadama3, Luis Gadama3, Kondwani Kawaza3, Queen Dube3, Neil French4, David Lissauer1,4, Bridget Freyne1  

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme
2. Botswana Harvard AIDS Institute Partnership
3. Queen Elizabeth Central Hospital, Blantyre, Malawi
4. University of Liverpool, Department of Children’s and Women’s Health

Email: cvanderveer@mlw.mw

Introduction: There is limited data on the epidemiology of sexually transmitted infections (STIS) and their contribution to adverse birth outcomes in Malawi. As common STI are curable, their effect on birth outcomes is highly modifiable.

Methods: We recruited pregnant women at delivery at Queen Elizabeth Central Hospital, Blantyre, Malawi between August 2021 and May 2022. A composite case definition for adverse birth outcome (ABO) included stillborn, preterm, and low birth weight (LBW) infants and infants admitted to NICU within 24 hours of birth. The next born healthy term infant was recruited as control. Multiplex PCR was performed on maternal vaginal swabs for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV). HIV and syphilis status was determined on maternal and infant serum. For syphilis, we used DPP point-of-care tests and confirmed with Rapid Plasma Reagin tests.

Results: We included 256 cases and 254 controls. Overall, we observed a maternal positivity rate of 3.1%, 2.7% and 17.1% for NG, CT and TV, respectively, and 16.5% and 17.6% seropositivity for HIV and syphilis respectively. Maternal syphilis seropositivity was significantly associated with LBW (p=0.030) and having both treponemal and non-treponemal antibodies, indicative of active disease, was associated with stillbirth (p=0.045). 25.8% of syphilis exposed live infants tested seropositive for both treponemal and non-treponemal antibodies. Four live infants met the clinical diagnosis of congenital syphilis. NG positivity associated with ABO (p=0.039), but no associations were observed for TV or CT with LBW, prematurity, stillbirth, NICU admission or ABO overall. Co-infections were common, mainly HIV/syphilis (n=25/510; 4.9%), HIV/TV (n=17/510; 3.3%) and NG/syphilis (n=6/510; 1.2%). Compared with health passport records, we detected 66 new syphilis diagnoses and 1 new HIV diagnosis.

Conclusion: Our study provides estimates for STI prevalence among pregnant women in Malawi and underscores the need for antenatal STI screening.

MALARIA EPIDEMIOLOGY, PREVENTION & TREATMENT ABSTRACTS

O10.A001399. TWENTY YEARS OF MALARIA CONTROL IN MALAWI: GEOSTATISTICAL ANALYSIS OF THE CHANGING MALARIA PREVALENCE IN MALAWI       

Author(s): Donnie Mategula1,2,3. Michael Give Chipeta1, Austin Gumbo2, Michael Kayange2, Dianne Janette Terlouw1,3   

Affiliation(s):

1. Malawi-Liverpool Wellcome Programme, Malawi
2. National Malaria Control Programme
3. Liverpool School of Tropical Medicine    

Email: dmategula@mlw.mw

Introduction: Malaria remains a public health problem in Malawi and has a serious socio-economic impact on the Malawian population.  Malaria is responsible for 25% of all outpatient visits and 37% of hospitalizations. In the past two decades, available malaria control tools have been substantially scaled up, such as insecticide-treated bed nets, artemisinin-based combination therapies, and more recently, the introduction of the malaria vaccine, the RTS, S/AS01.

Objective: To describe the epidemiology of malaria for the last two decades in order to under the past transmission and set the scene for the elimination agenda.

Methods: A collation of parasite prevalence surveys conducted between the years 2000 and 2021 was done A spatio-temporal geostatistical model was fitted to predict the yearly malaria risk for children aged 2–10 years PfPR 2–10) at 1×1 km spatial resolutions. Parameter estimation was done using the Monte Carlo maximum likelihood methods. District level prevalence estimates adjusted for population are calculated for the years 2006, 2010, 2012, 2014, 2017 and 2021

Results: There was a total of 2387 sampled unique locations from 2000 to 2021 that were identified through the data collation exercise. This represents 61,542 individuals that were sampled in the period. In general, the   PfPR2_10 was declining over the 21 years. The mean modelled national PfPR2_10 in 2006 was 13.92(95CI:7.18-23.62) and declined to 8.3(95%CI4.37 to13.99). The smoothened estimates of PfPR2_10 indicate that malaria prevalence is very heterogeneous with hotspot areas concentrated on the southern shores of the lake.

Conclusions: The last two decades are associated with a decline in malaria prevalence, highly likely associated with the scale up of control interventions. The country should move towards targeted approaches of malaria control informed my surveillance data

O11.A001445. INCIDENCE OF CLINICAL MALARIA, ACUTE RESPIRATORY ILLNESS, AND DIARRHOEA IN CHILDREN IN SOUTHERN MALAWI: A PROSPECTIVE COHORT STUDY        

Author(s): Tinashe A. Tizifa1,2, Alinune N. Kabaghe1,2 , Robert S. McCann2,3,4 , William Nkhono2 , Spencer Mtengula2 , Willem Takken 3 , Kamija S. Phiri2 , Michele van Vugt1

Affiliation(s):

1. Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
2. School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
3. aboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.
4. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA   

Email: t.tizifa@amsterdamumc.nl

Introduction: Malaria, acute respiratory infections (ARIs) and diarrhoea are the leading causes of morbidity and mortality among under-five children. Estimates of the malaria incidence are available from a previous study conducted in southern Malawi in the absence of community-led malaria control strategies; however, the incidence of the other diseases is lacking, owing to understudying and competing disease priorities. Extensive malaria control measures through a community participation strategy were implemented in Chikwawa, southern Malawi from May 2016 to reduce parasite prevalence and incidence.

Objectives: Assessment of incidence of clinical malaria, ARIs and acute diarrhoea among under-five children in a rural community involved in malaria control through community participation.

Methods: A prospective cohort study was conducted from September 2017 to May 2019 in Chikwawa district. Children aged 6–48 months were recruited from a series of repeated cross-sectional household surveys. Recruited children were followed up two-monthly for 1 year to record details of any clinic visits to designated health facilities. Incidence of clinical malaria, ARIs and diarrhoea per child-years at risk was estimated, compared between age groups, area of residence and time.

Results: 274 out of 281 recruited children had complete results and contributed 235.7 child-years. Malaria incidence was 0.5 (95% CI (0.4, 0.5)) cases per child-years at risk, (0.04 in 6.0–11.9 month-olds, 0.5 in 12.0–23.9 month-olds, 0.6 in 24.0–59.9 month-olds). Incidences of ARIs and diarrhoea were 0.3 (95% CI (0.2, 0.3)), (0.1 in 6.0–11.9 month-olds, 0.4 in 12.0–23.9 month-olds, 0.3 in 24.0–59.9 month-olds), and 0.2 (95% CI (0.2, 0.3)), (0.1 in 6.0–11.9 month-olds, 0.3 in 12.0–23.9 month-olds, 0.2 in 24.0–59.9 month-olds) cases per child-years at risk, respectively. There were temporal variations of malaria and ARI incidence and an overall decrease over time.

Conclusion: In comparison to previous studies, there was a lower incidence of clinical malaria in Chikwawa. The incidence of ARIs and diarrhoea were also low and decreased over time. The results are promising because they highlight the importance of community participation and the integration of malaria prevention strategies in contributing to disease burden reduction.

O12.A001067.  MEASURING OUTDOOR BITES OF TWO MAJOR MALARIA VECTORS IN MALAWI   

Author(s): Fred Sande1, Martin Chiumia1, Charlotte Banda1, Lusungu Chamdimba1, Ganizani Kapito1, Medson Kamwana1, Leonard Dandalo2, Don Mathanga1 and Themba Mzilahowa1

Affiliation(s):

1. Malaria Alert Centre-Communicable Disease Action Centre
2. Abt Associates, U.S President’s Malaria Initiative – VectorLink Project, Malawi    

Email: fsande@mac.kuhes.ac.mw

Introduction: Malaria is endemic in Malawi. Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are the core interventions to control malaria in the country. These tools have been attributed to reduction of malaria transmission. However, in recent years there has been a plateau in the control progress. Therefore, this study investigates outdoor vector biting behavior that are sustaining malaria transmission in Malawi. 

Methods: Seven study villages across six districts of Malawi were sampled quarterly from July 2021 to June 2022. Adult mosquitoes were collected using Human Landing Catches (HLCs) from 5:00 pm to 11:00 am. Six households from each village were selected for a single night of collection per quarter.

Results: A total of 1,827 female Anopheles mosquitoes was collected. Out of these, 58.8% (n=1,072) were Anopheles funestus s.l and 41.2% (n=752) were Anopheles gambiae s.l. with outdoor/indoor ratio of 0.5 and 2.2 respectively. Biting activity was observed throughout the night in both species. Overall, human biting rate for Anopheles gambiae s.l. outdoors (3.5 bites/person/night) were higher than indoors (1.6 bites/person/night).

Conclusion and recommendations: Anopheles gambiae s.l. predominantly fed outdoors. However, the current vector control tools primarily target endophagic and endophilic anophelines which may not be sufficient. Therefore, outdoor control tools should be explored to supplement the existing ones.

O13.A001461.  FACTORS SHAPING INDIVIDUAL NIGHT TIME EXPOSURE TO MALARIA TRANSMISSION IN MALAWI: CASE OF CHIKWAWA DISTRICT        

Author(s): Lusungu Kayira1, Federica Guglielmo2, Eleanor MacPherson2,3, Themba Mzilahowa1, and Blessings Kaunda-Khangamwa1,4

Affiliation(s):

1. Kamuzu University of Health Sciences, Malaria Alert- Communicable Diseases Action Centre, Malawi
2. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3. Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
4. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

Email: lkayira@mac.medcol.mw

Introduction: The continuous interaction between the malaria vector, the individual host, and the society, results in persistent malaria transmission despite the provision of bed nets. Changes in mosquito behaviours from indoor to outdoor biting also contribute to ongoing malaria risks due to varied outdoor activities in homes, and recreational and social-cultural gatherings.  This required a detailed understanding of who, when, and how individuals will be outdoors at night exposed to malaria vectors.

Methods: This was an explorative qualitative study. Convenience sampling was used to identify twenty community members living within the reach of the researcher for participant observations with, twenty in-depth-interviews and four focus group discussions in Chikwawa.  We recorded adults and youth above 18 years’ day-to-day activities and interactions between 1800-0600 for six weeks. A thematic analysis was conducted to identify key themes. The social-ecological model helped to understand factors influencing exposure to mosquito bites and malaria transmission.

Results: Community members were found outdoors during the night due to social-cultural, economic, recreational, and environmental factors. Women were outdoors for social and community responsibilities – cooking, attending social functions, including economic reasons, and selling farm produce to traders. Some men were outdoors guarding their farms, especially during harvesting season while others visited bars at night, thereby exposing themselves to mosquito bites. Couples went to the farms as early as 4am; tended to businesses, eat supper outdoors after 6pm, while other families chatted till after 9pm, waiting for the night to become cooler to sleep. Children played the night away from home and watched movies at video shows.

Conclusion: Social and economic responsibilities and recreational factors expose adults and youths to mosquito bites. Given the variations in social contexts and experiences, community understanding of outdoor malaria transmission is critical for the development of human-centred and integrated vector control interventions.

O14.A001336.  ASSESSING THE PREFERRED RESTING SITES OF ANOPHELES MOSQUITOES INSIDE HOUSES IN CHIKWAWA DISTRICT, MALAWI 

Author(s): Banda JS1, Kambewa, E. A1, Kaunde N1, Jones CM2,3, Reimer L3, Olanga EA1, and Mzilahowa T1 

Affiliation(s):

1. Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Malawi-Liverpool-Welcome Trust Research Program, Blantyre, Malawi
3. Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom

Email: jubanda@mac.kuhes.ac.mw

Introduction: Malaria vector control relies on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in Malawi. IRS targets mosquitoes that rest on the inside walls of dwelling structures. However, there is lack of information regarding mosquito resting behaviours inside houses. The study assessed the resting behaviours and identified the preferred resting surfaces of mosquitoes inside three common house types in Chikwawa district.

Methods: Mosquito collection was done inside 80 houses across four villages (20 thatch roofed with mud walls, 20 thatch roofed with un-plastered brick walls, and 20 iron sheet roofed with un-plastered brick walls) between August and November 2020. In each house, resting mosquitoes were sampled from multiple surfaces (roofs, walls above 1m, and walls below 1m, floors, furniture, and clothing) from 6–8 AM using Prokopack aspirators

Results: A total of 5226 female Anopheles mosquitoes were captured of which Anopheles funestus s.l. (n=3423; 65.4%) was predominant followed by An. gambiae s.l. (n=1792; 34.2%). Blood-fed mosquitoes accounted for majority of Anopheles mosquitoes captured, regardless of house type (53% – 62%). An. funestus mosquitoes were twice as likely to be found resting on the underside of roofs compared to other surfaces in grass-thatch roof mud wall (OR = 2.81, 95% CI 2.48 – 3.18, p=<0.001) and grass-thatch brick wall houses (OR = 2.26, 95% CI 2.03 – 2.56, p<0.001). A large proportion of vectors were also captured on the underside of iron roofs of brick wall houses (54 – 56%). Overall, <10% of Anopheles were found resting on non-sprayable surfaces (hanging clothes, furniture and floors).

Conclusion: Majority of malaria vectors rest on the underside of grass-thatched roofs followed by walls which underpins the application of insecticides on these surfaces. There is an opportunity to exploit this resting behaviour and earmark roofs as potential surfaces to deploy novel vector control tools.

015.A001316.  MALARIA VECTOR RESPONSE TO DIFFERENT INSECTICIDES IN MALAWI 

Author(s): M. Chiumia1, F. Sande1, L. Chamdimba1, G. Kapito1, C. Banda1, M. Kamwana1, L. Dandalo2, and T. Mzilahowa1   

Affiliation(s):

1. Malaria Alert Centre, P/Bag 360, Blantyre, Malawi
2. Malawi VectorLink Abt Associates, Lilongwe

Email: mchiumia@mac.kuhes.ac.mw

Introduction: Insecticide resistance particularly to pyrethroids has potential to compromise malaria vector control globally. In Malawi, high insecticide resistance to pyrethroids has been reported. We carried out Anopheles sp susceptibility tests against pyrethroid insecticides and new insecticides used in public health, clothianidin and chlorfenapyr in order to provide guidance to the national malaria control programme on choice of insecticides and products.

Methods: Blood-fed female Anopheles mosquitoes and larvae were sampled from Chikwawa, Salima, Kasungu, Karonga and Nkhotakota districts. WHO tube bioassays were used to test both An. funestus s.l. and An. gambiae s.l.  against deltamethrin 0.05%, permethrin 0.75%, PBO + permethrin 0.75%, alphacypermethrin 0.05%, and pirimiphos-methyl 0.25%. The CDC bottle bioassays were used to test resistance against clothianidin (4µg/bottle) and chlorfenapyr (100µg/bottle).

Results: In Chikwawa, An. gambiae s.l. was resistant to deltamethrin, permethrin and alphacypermethrin. However, it was fully susceptible to pirimiphos-methyl, chlorfenapyr and partially susceptible to clothianidin. Similarly, An. funestus s.l. remains fully susceptible to pirimiphos-methyl.  In Salima, An. gambiae s.l. was fully susceptible to clothianidin and pirimiphos-methyl, but resistant to alphacypermethrin (11.7% mortality, n=103), deltamethrin (34.6% mortality, n=105) and permethrin (33.3% mortality, n=102). In Kasungu, An. funestus s.l. were resistant to permethrin (15.5% mortality, n=103) but susceptible to PBO + permethrin (98.1% mortality, n=52) and pirimiphos methyl (98% mortality, n=54).  In Nkhotakota, An. funestus s.l. was resistant to alpha-cypermethrin (34% mortality, n=44) but remains susceptible to clothianidin (100% mortality, n=29). In Karonga, An. gambiae s.l. was susceptible to pirimiphos-methyl (100% mortality, n=111), clothianidin (100% mortality, n=107), and chlorfenapyr (98% mortality, n=94).

Conclusion: Malaria vectors were resistant to pyrethroids across all the study sites in Malawi. However, pre-exposure of An. funestus s.l. to PBO resulted in partial restoration of its susceptibility to permethrin. Therefore, the distribution of PBO-treated nets must be encouraged in Malawi. Additionally, pirimiphos methyl and clothianidin must be used for indoor residual spraying in the country.

HIV EPIDEMIOLOGY, PREVENTION & TREATMENT ABSTRACTS

O16.A001320. MALAWI’S PROGRESS TOWARDS THE UNAIDS 95-95-95 HIV TESTING AND TREATMENT TARGETS: COMPARISON OF THE 2015-16 AND 2020-21 MALAWI POPULATION-BASED HIV IMPACT ASSESSMENTS (MPHIA)   

Author(s): Nellie Wadonda1, Danielle Payne1, Alinune N. Kabaghe 1, Lyson Tenthani 2, Christina Braccio 3, Evelyn Kim 1, Mtemwa Nyangulu1, Andreas Jahn 4,6, Christine A. West3, Felix Kayigamba2, Francis M. Ogollah2, Andrew Auld1, George Bello4,6, Mansoor Farahani5, and Rose Nyirenda4       

Affiliation (s):

1. US Centers for Disease Control and Prevention, Malawi

2. ICAP at Columbia University, Malawi

3. US Centers for Disease Control and Prevention, Atlanta

4. Ministry of Health, Malawi

5. ICAP at Columbia University, New York

6. I-TECH, University of Washington, Seattle, USA

Email: ywb9@cdc.gov

Introduction: The 2015-16 Malawi Population-based HIV Impact Assessment showed notable coverage gaps in HIV diagnosis, antiretroviral therapy access and retention, and viral load suppression (VLS). Targeted interventions were implemented by the Government of Malawi, PEPFAR and other partners to close these gaps. The second MPHIA was conducted between January 2020 and April 2021 to measure progress towards the UNAIDS 90-90-90 goals. 

Methods: MPHIA is a nationally representative survey, which enrolled over 23,000 participants. Participants were interviewed and a blood sample was tested for HIV infection using the national algorithm. Results were returned to participants. All HIV positive samples were tested for viral load (VL) and presence of antiretrovirals (ARV); a suppressed VL was defined as <1,000 viral copies per milliliter. All results were weighted and self-reported awareness and treatment status were adjusted to account for ARV detection results. This analysis was restricted to participants aged 15-64 years with HIV test results.

Results: HIV prevalence decreased significantly from 10.6 % [95% confidence interval (CI): 9.9%-11.2%] in MPHIA 2015-16 to 8.9% (95% CI: 8.4%-9.5%) in MPHIA 2020-21. Awareness of HIV status among all adults increased from 76.8% (95%CI: 74.7%-79.0%) to 88.4% (95% CI: 86.7%-90.1%), with females increasing from 80.2% (95%CI: 77.8%-82.5%) to 90.4% (95%CI: 88.5%-92.2%). Among 15-24-year-olds, awareness increased from 53.7% (95%CI: 45.3%-62.0%) to 76.2% (95%CI: 69.4%-83.1%). Among all adults aware of their HIV status, ART use increased from 91.4% (95%CI: 89.8%-93.0%) to 97.8% (95%CI: 97.1%-98.5%). Viral suppression (VLS) among those on treatment increased from 91.3% (95% CI: 89.3%-93.3%) to 96.9% (95% CI: 96.0%-97.8%). Population VLS among all adults living with HIV increased from 68.3% (95%CI: 66.0%-70.7%) to 87.0% (95%CI: 85.4%-88.6%). However, VLS remained lowest in the major urban centers of Lilongwe and Blantyre cities, and among participants aged 15–24 years.

Conclusion: Targeted investments by district and subpopulation in HIV testing, ART linkage, adherence, and retention have resulted in significant progress towards achievement of the UNAIDS 90-90-90 targets. These results show that Malawi has exceeded the more recent UNAIDS 95-95-95 treatment and VLS targets. Continued targeted efforts and tailored interventions are needed to close remaining gaps, particularly among young people and in urban centers.

O17.A001085. TOWARDS ACHIEVING EPIDEMIC CONTROL, REVIEW OF MORTALITY RATES, AND TRENDS AMONG HIV-POSITIVE PATIENTS ON ANTIRETROVIRAL THERAPY IN MALAWI: A 2017–2021 RETROSPECTIVE FOLLOW-UP STUDY

Author(s): Geoffrey C Singini1, and Thulani Maphosa1      

Affiliation(s)

1. Elizabeth Glaser Pediatric AIDS Foundation      

Email: gsingini@pedaids.org

Introduction: Recently, Malawi made impressive progress to achieve the epidemic control targets. However, HIV- and AIDS-related mortality continues to be a major public health concern in the country. Thus, understanding the incidence and predictors of mortality among people living with HIV who are on antiretroviral therapy (ART) could help to improve care, treatment, and monitoring of patients living with HIV. Drawing on the recent developments about improving quality of care and health impact through innovative systems and technologies in Malawi under PEPFAR, we demonstrate the usability of data lake to understand mortality trends and associated factors among people living with HIV on ART between 2017 and 2021.

Methods: We conducted a retrospective longitudinal follow-up study on all people living with HIV who were on ART and in the electronic medical record systems from January 2017, to September 2021. Follow-up time was defined as the time between ART start and last ART visit. We censored at one year (for first year mortality incidence) and at five years (for five-year mortality incidence) after ART initiation. We used multivariable Cox regression to explore the association between mortality and sociodemographic characteristics among the patients on ART to two time periods: 2011-2016 and 2017-2021. We also fitted Kaplan-Meier curves to examine survival functions between different subgroups to explore differences in mortality trends. All tests were tested for statistical significance at p < 0.05 using Stata version 17.0 for analysis.

Results: Our analysis included 412,837 patients: 60.8 % were females and 62,392 (5.04%) died while on ART. For the deceased, the median age was 37.1 (se = 37.2) and median number of years on ART was 3.3 (se =3.3). The overall incidence rate (per 1,000 person years) was estimated as 0.475 (95% CI = 0.422–0.536), which decreased from 0.826 (95% CI = 0.720–0.948) to 0.159 (95% CI = 0.078–0.314) in 2017 and 2020 respectively. Increased mortality was observed in male patients from unadjusted HR = 2.4 (95% CI = 1.888-3.078) to adjusted HR = 6.824 (95% CI = 3.195-14.578). No significant changes were noted in hazards for tuberculosis (TB)-positive patients [unadjusted HR 9.09 (95% CI = 4.649-17.773) to adjusted HR = 6.49 (95% CI = 3.042-13.863)] and pregnant women [unadjusted HR = 0.312 (95% CI = 0.129-0.758) to adjusted HR = 0.524 (95% CI = 0.211-1.299)].

Conclusion: The mortality rate among people living with HIV on ART for the past five years in Malawi requires attention. Biological differences help in understanding mortality in these patients, with men experiencing high hazards. While efforts have been implemented to keep patients on ART and reduce mortality for TB-positive and pregnant women, more needs to be done. Further research is needed to explain these findings related to TB and pregnant patients on ART. These data may suggest the need for innovative interventions to monitor care and treatment for people living with HIV on ART that should consider patients’ biological, comorbidities, and demographic differences.

O18.A001220.  BARRIERS AND FACILITATORS TO IMPLEMENTING ADVANCED HIV DISEASE SCREENING AT RUMPHI DISTRICT HOSPITAL-MALAWI: A SEQUENTIAL EXPLORATORY STUDY     

Author(s): Brany Mithi1, Agatha Bula 2, Lester Kapanda 3, Fatsani Ngwalangwa1 and Evanson Sambala1

Affiliation(s):

1. Kamuzu University of Health Sciences

2. University of North Caroline UNC-Malawi

3. Elizabeth Glaser Pediatric AIDS Foundation

Email: branytitus@gmail.com

Introduction: One of the strategies for reducing AIDS mortality outlined in the Malawi National HIV Strategic Plan is scaling up screening for Advanced HIV Disease (AHD). However, the delivery of AHD screening package has met several implementation hindrances evidenced by low numbers of eligible clients screened for AHD. Understanding factors that influence AHD screening is necessary for a successful implementation.

Objective: This study investigated the barriers and facilitators to implementing the AHD screening package at Rumphi District Hospital, Malawi.

Methods: A sequential exploratory study was conducted using a deductive approach, guided by a consolidated framework of implementation research (CFIR). Interviews were administered to key healthcare providers (n=10), purposively selected from Antiretroviral Therapy (ART) clinic and Laboratory department. Quantitative data for newly HIV-diagnosed individuals (n=101) was extracted from ART records over two quarterly months (July –Dec, 2021).

Results: About 60.4% (n=61) of newly diagnosed HIV-positive clients were not screened for AHD using CD4 Cell count (p = 0.041). 10 CFIR constructs were found to significantly influence the implementation process. Major barriers included insufficient resources to support the expansion of AHD screening services, inadequately trained providers in screening sites, poor communication systems affecting work coordination and a long AHD screening pathway leading to clients loss to follow-up. Innovation relative advantage, external support and availability of internally appointed focal leaders emerged as major facilitators of implementation.

Conclusion: Using CFIR conceptual framework and mixed methods, we established that contextual barriers from the inner setting need special attention to improve execution of AHD screening package.

O19.A001278. UNDERSTANDING GAPS IN INDEX CASE TESTING CASCADE: EXPERIENCE FROM PARTNERS IN HOPE SUPPORTED HEALTH FACILITIES IN MALAWI   

Author(s): Khumbo Phiri1, Maria Sanena1, Eric Lungu1, John Songo1, Joep van Oosterhout1,2, Sam Phiri1, Kathryn Dovel1,2

Affiliation(s): 

1. Partners in Hope, Lilongwe, Malawi
2. Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.     

Email: khumbo@pihmalawi.com

Introduction: Index case testing (ICT) is critical to reaching the minority of people still unaware of their HIV status. Implementation challenges limit the impact of ICT in sub-Saharan Africa. We use programmatic data from Partners in Hope supported facilities in Malawi to identify gaps across the ICT cascade, and in-depth interviews (IDIs) to understand why these gaps exist.

Methods: ICT strategies were taken to scale in October 2020 at 48 facilites in two districts in Malawi, with a focus on testing sexual partners (SP) and biological children (BC) of individuals recently diagnosed with HIV or with viral load results >1000copies/ml. Programmatic ICT data from October 2020-January 2021 were reviewed from 48 facilities to assess outcomes across the ICT cascade. We conducted IDIs with a random subset of index clients, their contacts (SP and BC), and health care workers (HCWs) from four facilities who were >18 years old and engaged in ICT during the same time-period. We analyzed data using constant-comparison methods in Atlas.ti.v9.

Results: The largest gaps in the ICT cascade were: 1) not successfully tracing eligible contacts; and 2) low HIV-positivity rates among those tested. We analyzed 49 IDIs: 13 index clients, 21 contacts (13 SP, 8 BC), and 15 HCWs. Barriers to contact tracing were index clients giving inaccurate contact information due to fear of unwanted disclosure (especially for new or extra-marital partners), as well as due to poor counseling/lack of trust in HCWs, and lack of privacy at ICT screening locations. Transport challenges for HCWs hindered community tracing. Barriers to high HIV-positivity rates were testing BCs of men and testing non-eligible BCs who were easy to reach during home visits to increase test productivity.

Conclusion: Improving quality of counseling and privacy, facilitating tracing activities, and promoting fidelity of ICT protocols are key to success across the ICT cascade.

O20.A001512. ARE VENUE-BASED STRATEGIES THE TICKET TO THE LAST MILE IN HIV PREVENTION IN MALAWI?        

Author(s): Emmanuel Singogo1, Sharon S Weir2, Evaristar Kudowa1, Maganizo Chagomerana1, John Chapola1, Jessie K. Edwards2, Confidence Banda1, Gift Kawalazira3, Yohane Kamgwira3, Lucy Platt4, Brian Rice4, James Hargreaves4, and Mina Hosseinipour2 

Affiliation(s):

1. University of North Carolina Project -Lilongwe Malawi
2. University of North Carolina, Chapel Hill, North Carolina USA
3. Ministry of Health, Blantyre DHO, BPS Project
4. London School of Hygiene and Tropical Medicine

Email: emmsingo@gmail.com

Introduction: Blantyre District has the highest adult HIV prevalence in Malawi (17% overall; 22% in women) and the lowest viral suppression rate (60%).  We hypothesized that social venues patronized by people with high sexual partnerships rates could identify sub-groups currently missed. 

Objective: to compare HIV testing outcomes and characterize the clinic and venue populations.

Methods: We conducted cross-sectional bio-behavioral surveys of representative samples of individuals seeking care in government clinics (n=2313) and social venue patrons (n=1802) Jan-Mar 2022. Government clinics and venues were randomly sampled from urban and rural strata with oversampling of rural venues using sampling weights. We followed national protocols for rapid tests, recency and viral load testing.  Acute infections were identified by pooling dried blood spots.

Results: Compared to the clinic population, the venue population was more likely to: be male (68% vs 28%); aged >25 years (61% vs 51%); unmarried (62% vs 40%); drink alcohol daily (43% vs 8%); have more sexual partners in the last year (mean 16 vs 2); report a new sex partner in the past 4 weeks (42% vs 14%); and report transactional sex (52% vs 12%). HIV prevalence was higher among the venue population (19% vs 9%) but had similar viral suppression (78%).  At venues, factors associated with HIV infection include female sex (39% vs 10%); having a new partner in the past 4 weeks (28% vs 13%) and transactional sex (25% vs 13%). Clinic participants who visited venues were less likely to be virally suppressed than other PLHIV clinic participants (53% vs 81%).  Acute and recent infections were uncommon. 

Conclusion: Lower HIV prevalence and greater viral suppression suggests that Blantyre’s HIV epidemic is slowing. Outreach to venues with higher prevalence of unsuppressed infection and to young women may advance prevention goals.  Testing for acute or recent infection yielded few cases, questioning its value for surveillance.

O21.A001145. HOW DO I OPEN UP? EXPLORING FACTORS ASSOCIATED WITH COMPLETION OF INTENSIVE ADHERENCE COUNSELLING SESSIONS AMONG PATIENTS WITH HIGH VIRAL LOAD IN NENO        

Author(s): Jimmy Villiera1, Beatrice Matanje2, Chiyembekezo Kachimanga2, and Dimitri Suffrin2    

Affiliation(s):

1. Baylor College of Medicine Children’s Foundation-Malawi
2. Partners in Health-Neno  

Email: jimmyvilliera@gmail.com

Introduction: Globally, countries are working tirelessly to achieve the UNAIDS 95-95-95 treatment targets by 2030. Despite making great strides in improving HIV viral load (VL) testing capacity for treatment monitoring in the past decade, a limited number of patients with high VL complete intensive adherence counselling (IAC) sessions which delays follow-up VL testing, consequently, delaying clinical decision-making. This study explored factors associated with the non-completion of IAC sessions.

Methods:  We conducted a mixed-method study. The quantitative data were collected from patient records from the period between 1 March 2020 to 30 June 2021 in Neno district, while qualitative data were collected from purposively selected clients (high VL) and healthcare workers, through focus group discussions (FGDs) and in-depth interviews respectively. 371 patient records were analyzed, while six heterogeneous FGDs of patients with high VL were conducted.  15 healthcare workers were also interviewed. STATA software was used to analyse quantitative data while thematic analysis approach was used for qualitative data.

Results: The median age of the participants at the most recent VL in the quantitative section was 39 years, IQR (31 – 47). The median age of respondents in FGDs was 41 with an interquartile range of 37 (20 – 57). Provider’s unprofessionalism, poor partner support, and lack of private rooms for conducting IAC sessions dissuaded clients to come for subsequent IAC sessions. Overall, we found that being on ART for a longer duration (p-value = 0.02) was significantly associated with the completion of IAC sessions and viral suppression. On multivariate analysis, we found that having community health worker support (ARR = 0.62; 95% CI = 0.39 – 0.99) and longer duration on ART (ARR = 1.76; 95% CI = 1.09 – 2.83) were significant predictors of IAC completion and subsequent viral suppression.

Conclusion: Clients with high VL encounter multiple challenges that affect IAC attendance. Although personal factors play a greater role in fulfilling IAC attendance, health system factors are equally important. ART Clinics need to devise deliberate and careful approaches that target and motivate at-risk clients to complete IAC sessions and improve overall adherence. There’s an urgent need for ART clinics to designate private rooms for IAC sessions and adequately train expert clients on professionalism.

MATERNAL & CHILD HEALTH 1 ABSTRACTS

O22.A001342. PERINATAL MORTALITY AUDITS AT QUEEN ELIZABETH CENTRAL HOSPITAL

Author(s): Tamanda Hiwa1  

Affiliation(s):

1. Department of Paediatrics and Child Health, Kamuzu University of Health Sciences   

Email: hiwatamie@gmail.com

Introduction: Clinical audits provide an opportunity for the review of care being provided to patients. They assess the quality of care being provided; whether it meets the required standards and explore areas of improvement. A collaboration between the Paediatrics Department and the Obstetrics and Gynaecology Department at QECH saw the genesis of perinatal mortality audits in the early 2000s with the shared goals of improved maternal and newborn outcomes and reduced perinatal mortality rate.

Objectives:

1. To describe the conduct of perinatal audits at QECH
2. To discuss challenges and lessons learnt from the audits

Methods: A monthly meeting patronised by departmental clinicians, nurses, hospital management, program partners and medical students is conducted. Presentations are prepared and delivered by postgraduate students. Data collection is continuous in the units throughout the month. The data is cleaned and analyzed separately by the two units using Microsoft excel. A case is selected for critique and discussion, based on the challenges identified with case management on either or both ends.

Results:  Multiple challenges have been identified. These include high rates of hypothermia at admission among inborn neonates (99%) and poor documentation in unit registers and charts. The audits have also brought about an improved working relationship between the two units evidenced by good communication, availability of the neonatal team at deliveries and a reduction in the neonatal mortality rate from 20% to 11%. Nursing staff now actively contribute to the discussions.

Conclusion: The forum paved the way for the Maternal and Perinatal Death Surveillance and Response team and the two units to collaborate with the ministry of health, reproductive health unit in exploring ways to adopt these audits and pilot them at other health facilities with the hopes for future national adoption of the activity.

O23.A001227.            PROCESSES AND OUTCOMES OF STILLBIRTH AND NEONATAL DEATH AUDIT IN MALAWI         

Author(s): Mtisunge Joshua Gondwe1,2, Mamuda Aminu3, Nicola Desmond2,3 and Stephen Allen1

Affiliation(s):

1. Liverpool School of Tropical Medicine, Clinical Sciences department
2. Malawi Liverpool Wellcome Trust Clinical Research Programme
3. Liverpool School of Tropical Medicine, Department of International Public Health

Email: mgondwe@mlw.mw

Introduction: Stillbirth and neonatal death audits are valuable tools for improving the quality of care and reduce mortality from preventable causes. Many interventions aimed at improving treatment do not achieve their desired change, with few efficiently implemented and sustained due to health system constraints.

Objectives: (1) To assess the resources available to support appropriate care for newborns, the quality of stillbirth and neonatal death audit processes and identified factors in implementing audit in Malawi. (2) To provide evidence for recommendations on how the health system may better support staff so that the audit process can be improved.

Methods: A mixed methods study, guided by a conceptual framework, conducted between August 2019 to December 2020 in seven public hospitals in the southern region of Malawi. We conducted facility resource survey, reviewed hospital surveillance data, audit documents, audited deaths and action plans. We assessed maternity and nursery ward staff perceptions about audit through 35 interview questionnaires and observed 12 audit meetings to assess quality of audits. We conducted 38 semi-structured interviews and seven focus group discussions with death audit committee members to identify factors affecting audit. Quantitative data was analysed using IBM SPSS 26.0 and presented using frequencies and proportions. Qualitative analysis was guided by a theoretical model and used a thematic analysis.

Results: We found that the hospitals’ ability to provide newborn care was universally low due to inadequate Infrastructure, staff training, medications and supplies, clinical protocols and leadership support. The quality of stillbirth and neonatal death audits was poor due to challenges in audit tools and guidelines, WHO audit cycle stages, action plans and patient load. Stillbirth audits were rarely done. We found that reported factors that affected audit at the individual, facility and national level were interrelated as they were informed by each other and were related to training, staff motivation, power dynamics and autonomy, audit meetings and data support.

Conclusion:  Audits may be supported more effectively by good facility, national leadership and resource management. Implementing suggested actions has potential to improve clinical outcomes. Given that the factors that facilitate or inhibit audits are interconnected, addressing challenges at only one level is unlikely to be adequate but a comprehensive approach that addresses factors at all system levels, recognising the relationships between levels, is more likely to be successful.     

O24.A001350. PERCEPTIONS ON THE ACCEPTABILITY OF THE 2016 WHO ANC MODEL AMONG THE PREGNANT WOMEN IN PHALOMBE DISTRICT, MALAWI – A QUALITATIVE STUDY USING THEORETICAL FRAMEWORK OF ACCEPTABILITY       

Author(s): Prince Nyumwa1,2* Agatha Kapatuka Bula3 and Alinane Linda Nyondo-Mipando1        

Affiliation(s):

1. Department of Health Systems and Policy, School of Global and Public Health. Kamuzu University of Health Sciences, P/Bag 360 Blantyre 3, Malawi.
2. Holy Family College of Nursing, P.O. Box 51224, Limbe, Malawi
3. University of North Carolina (UNC) Project, P/Bag A-104, Lilongwe, Malawi

Email: princenyumwa@gmail.com

Introduction:  The World Health Organization introduced a new model of care, ‘The 2016 WHO ANC Model’ to overcome challenges encountered during the implementation of Focused Antenatal Care Approach. For any new intervention to achieve its objective, it has to be widely accepted by both the deliverers and recipients of that intervention. Malawi rolled out the model in 2019 without carrying out acceptability studies.

Objectives: To explore the perceptions on the acceptability of the 2016 WHO ANC model among pregnant women in Phalombe District, Malawi.

Methods: We conducted a descriptive qualitative study between May and August 2021 at Phalombe Health Centre in Phalombe District. The study was guided byTheoretical Framework of Acceptability.We conducted 21 in-depth interviews (IDIs) among pregnant women, postnatal mothers, a safe motherhood coordinator, and Antenatal clinic midwives and two focus group discussions among Disease Control and Surveillance Assistants. All IDIs and FGDs were conducted in Chichewa, digitally recorded, and simultaneously transcribed and translated into English. Data were analysed manually using content analysis.

Results: The study found that the model is acceptable among most pregnant women and that some women were able to complete the new eight-contact schedule. The major enabling factors forthe acceptability of the model were the presence of support from husbands, peers, and health care providers. The major burdens were fatigue and increased transport costs that were associated with attending to the increased number of ANC contacts.

Conclusion: The study found that the model was acceptable among the pregnant women and that they were able to complete the new schedule. Therefore, reinforcing the enabling factors and increasing access to ANC services through conducting outreach clinics would help improve the acceptability of the model. There is also a need to increase knowledge among all the stakeholders involved.

O25.A001099. CHALLENGES AND OPPORTUNITIES IN THE INTRODUCTION OF MIDWIFE-LED ANTENATAL POINT-OF CARE ULTRASOUND SCAN IN BLANTYRE DISTRICT  

Author(s): Chipiliro Payesa1, Linly Seyama1, Sufia Dadabhai1, and Yankho Kanise1        

Affiliation(s):

1. John Hopkins Research Institute 

Email: cpayesa@jhp.mw

Introduction: Current WHO and Malawi antenatal care (ANC) guidelines recommend one ultrasound scan before 24 weeks of gestation. However, antenatal ultrasounds are not performed routinely in Malawi due to the lack of ultrasound devices and skilled providers. An ongoing study of the acceptability and feasibility of midwife-led ultrasound scans at health centres, using the Butterfly iQ point of care ultrasound (POCUS) has generated important knowledge for the future implementation of this service delivery model.

Objectives: To describe challenges and opportunities for implementation of midwife-led POCUS from the ARC-005 study

Methods: ARC-005 is a multi-phase, mixed-method, implementation research study in 10 rural, and urban health centres. Phase 1 trained 44 midwives on obstetric ultrasound using Butterfly iQ. Phase 2 involves an iterative approach to improving ANC service delivery, with an enrollment of 1500 ANC clients and Phase 3 will evaluate the program through stakeholders. For this analysis, we summarise the initial challenges and solutions from Phases 1 and 2.

Results:  Opportunities – 1500 obstetric scans have been conducted by midwives across the 10 health centres in the Blantyre district. Midwives are able to provide referrals to Queen Elizabeth Central hospital when they diagnose complicated pregnancies in their particular health centres Referral. Midwives are able to document in the health passports the findings of the ultrasound for continuity of care.

Challenges- Lack of skill with first-trimester scans due to the low patronage of first-trimester women at the ANC, midwives have not had a lot of experience in conducting the first-trimester scan. Waiting time for women: women spend extra time for the ultrasound service.

Conclusion: Robust implementation research can generate important data to inform service delivery and scale-up of ANC ultrasound at the national level. Ongoing mentorship and feedback to newly-trained midwives are needed to sustain ultrasound skills and achieve adequate quality scans.

A26.001369.   CHALLENGES EXPERIENCED BY NEWLY QUALIFIED NURSE-MIDWIVES TRANSITIONING TO PRACTICE IN SELECTED MIDWIFERY SETTINGS IN NORTHERN MALAWI    

Author(s): Mathews Brave Mtegha1*, Elizabeth Chodzaza2, Ellen Chirwa2, Fatch Welcome Kalembo3, and Maggie Zgambo4           

Affiliation(s):

1. Department of Nursing and Midwifery, St John’s Institute for Health, Mzuzu, Malawi
2. School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
3. School of Nursing, Curtin University, Perth, Australia
4. School of Nursing and Midwifery, Edith Cowan University, Perth, Australia

Email: mteghamathews3@gmail.com

Introduction: Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice.

Objectives: The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi.

Methods: A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview guides; one for the newly qualified nurse-midwives and another one for the key informants. The interview guides had questions related to newly qualified nurse-midwife’s experiences of transitioning to practise and the support they received. Participants were from three selected hospitals in the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis.

Results: Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practise in midwifery units emerged from the thematic analysis of the data. These included (1) Theory – practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict.

Conclusion: Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from education to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.

HEALTH SYSTEMS & POLICY ABSTRACTS

O28.A001477. EVALUATING THE USABILITY AND ACCEPTABILITY OF IMPLEMENTING THE NATIONAL MATERNAL AND NEONATAL SURVEILLANCE PLATFORM FOR ESTABLISHING THE DIRECT AND INDIRECT EFFECTS OF COVID-19 IN MALAWI

Author(s): Moses Kumwenda1, Chikondi Chapuma1, Luis Gadama2, Fanny Kachale3, William Peno3, Deborah A. Phiri1, Lumbani Makhaza1, Andrew Likaka3, Rosemary Bilesi3, Malangizo Mbewe3, Owen Musopole3, Kondwani Kawaza2, Bertha Maseko1, Chifundo Ndamala1, Clemens Misesa1, Marc Henrion 1,4. James Chirombo1, Mercedes Bonet5, David Lissauer1

Affiliation(s):

1. Malawi Liverpool Wellcome Programme, Malawi, Kamuzu University of Health Sciences, Malawi
2. Kamuzu University of Health Sciences, Malawi
3. Ministry of Health, Malawi
4. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
5. World Health Organisation
6. Malawi Liverpool Wellcome Programme, University of Liverpool, United Kingdom”  

Email: cchapuma@mlw.mw

Introduction and objective: To evaluate the usability and acceptability of implementing a novel maternal and neonatal COVID-19 surveillance system (MATSurvey) for capturing national-wide data on the direct and indirect effects of COVID-19 on Maternal and neonatal outcomes in Malawi.

Methods: A mixed methods process evaluation explored experiences during the implementation of the MATSurvey. A quantitative usability questionnaire was administered to 40 healthcare providers directly involved in the implementation of the system. Nine key informants and 14 healthcare workers were interviewed from four purposively selected health facilities (two high-performing and low-performing facilities). A deductive theme analysis using Proctor’s taxonomy of implementation outcomes was used.

Results: 85% of those who filled in the MATSurvey usability questionnaire thought it was easy to use. 87.5% were confident using it; 92.5% thought it was less cumbersome, and 80% thought it was less complex. 87.5% felt that various functions in the system were well integrated.  Qualitative data revealed that the surveillance platform was simple and acceptable to users. They expressed competency in using the platform and stated that utilisation of the information from the system to inform facility decision-making improved with time. The MATSurvey also addressed critical data management gaps linked to a paper-based system and allowed facilities to get feedback on their performance near real-time. Key barriers to the implementation included 1) technical challenges, such as poor internet connectivity and system downtime; 2) human resource problems, such as lack of training for new staff and increased human resource turnover; and data collection challenges, such as the difficulty to collect district-level data from peripheral health facilities.

Conclusion: The MATSurvey was acceptable, appropriate and usable among healthcare providers in Malawi. It also facilitated the delivery of care through timely, evidence-based decision making. However, the effective application requires overcoming technical and human resources challenges.

O29.A001415. NOVEL COMMUNITY-BASED RABIES SURVEILLANCE (CBRS) IN LILONGWE URBAN, MALAWI        

Author(s): Precious Innocent Mastala1,2*, Melaku Tefera1†, Edson Chiweta2, Madeline Nyamwanza2, Thoko Kapalamula1     

Affiliation(s):

1. Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
2. Lilongwe Society for the Protection and Care of Animals, Lilongwe, Malawi      

Email: preciousmastala@gmail.com

Introduction: Rabies is a neglected tropical disease that is endemic to Malawi, killing almost 500 people every year. Domestic dogs are implicated as the main reservoir for rabies. However, there is limited capacity to detect canine rabies in the country, particularly in urban areas where there are high dog densities. The Lilongwe Society for the Protection and Care of Animals designed and implemented a canine community-based rabies surveillance (CBRS) in Lilongwe city between January and June 2020.

Objectives: To assess the effectiveness of the CBRS program in canine rabies detection compared to the traditional passive routine surveillance data of the years between 2015 and 2019. Furthermore, the study determined rabies Post-Exposure Prophylaxis (PEP) issuance trends in emergent cases.

Methods: Suspected canine rabies cases were recorded and followed. The dogs that were found alive were quarantined for 10 days for observation. Brain samples were collected postmortem for antigen detection using a direct-fluorescent antibody test.

Results: There were 610 suspected cases, and only 217 (39.2%) were followable. Out of these, 150 (62.8%) were followed. A total of 9 dogs (6%) tested positive, and there were 11 (7.3%) probable cases. This represents a 4.97-fold increase in detected rabies cases compared to the pre-surveillance period, with a resultant of 3.33 cases/month from 0.67 cases/month. There were 141 bite victims and 136 (96.5%) reported for PEP. Out of these, 89 (65.4%) were from healthy bites and 33 (24.4%) from suspect cases indicating a 63.1-87.6% rate of irrelevant PEP issuance. Exposed individuals were advised to seek PEP treatment immediately.

Conclusion: The CBRS program established relevance in increasing canine rabies detection and subsequent prevention of related human infections. It also established a high rate of PEP issuance following healthy bites. Therefore, we recommend enhanced multi-sectoral collaborative efforts aimed at increasing rabies detection and optimising PEP usage.

O30.A001409. PRIMARY PALLIATIVE CARE FOR THE OLDER POPULATION AND PATERNALISTIC MEDICINE: LESSONS FROM MANGOCHI, MALAWI          

Author(s): D Kwaitana1, D van Breevoort1, M Mnenula1, J Bates1, C. Evans2 K Nkhoma2, and R Harding2           

Affiliation(s):

1. Kamuzu University of Health Sciences, Department Family Medicine, Blantyre, Malawi  
2. King’s College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.    

Email: dkwaitana@medcol.mw

Introduction: Ageing is a natural process, which presents a unique challenge to patients, families and health systems. WHO projects that by 2050, 80% of older people will be living in Low and Middle Income Countries (LMIC). Global successes in prevention and management of early childhood illness and safe motherhood pose a new health challenge to adequately meet healthcare needs of ageing patients and their families in light of increasing progressive multimorbidity. Keeping primary palliative care services available and accessible to the older patients is therefore vital to promote good quality of life.

Objectives: To assess whether healthcare needs and concerns of older people were discussed with service providers and considered in the management options.

Methods: In-depth qualitative interviews were conducted with n=15 older patients and family caregiver dyads with multimorbid illnesses attending primary care at Mangochi District Hospital and Lungwena Health Centre. Topic guides were developed and explored their experiences for primary palliative care services and how their needs were managed by healthcare professionals. Interviews were transcribed, translated, then analysed thematically using NVivo software.

Results: The majority of patients and caregivers were largely impressed with the care saying it improved the patients’ conditions. However, some participants indicated that their problems and concerns regarding care were not discussed with service providers because that opportunity was not made available for them.  Similarly, some caregivers stated that healthcare providers did not discuss with them about patients’ needs, but were quick to give advice on what they were supposed to do in caring for the patient at home. 

Conclusion: Practice of paternalistic medicine was reported as a common phenomenon among service providers in the primary care setting. Patients and caregiver problems and concerns were not always holistically assessed. Patient and family centred care is needed to achieve good palliative care.         

O31.A001157.  OVERCOMING OBSTACLES TO ACHIEVING GOOD ASTHMA CONTROL AMONG SCHOOL AGE CHILDREN IN BLANTYRE URBAN 

Author(s): Elizabeth Mkutumula1, Lovemore Nkhalamba1, Bernadetta Payesa1, Lusungu Sauli1, Annie Joabe1, Alberta Mukapita1, Beatrice Chinoko1, Jamie Rylance1,2, Gioia Mosler 4, Victoria Oluwatabi Oyenuga4, Jonathan Grigg4

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust, Malawi
2. Liverpool School of Tropical Medicine, UK 
3. Queen Elizabeth Central Hospital, Blantyre, Malawi
4. Queen Mary University of London, London UK

Email: emkutumula@mlw.mw

Introduction: Asthma prevalence has been shown to be increasing in urban areas. According to the ISAAC study, childhood asthma is the most common non-communicable childhood disease affecting 14% of children globally. A report by the Global Asthma Network sighted inadequacies in diagnosis, disease knowledge and management, as contributors to poor asthma control in African children. The knowledge gap in childhood asthma is a hindrance to implementation of population specific solutions in low-income countries. There is limited childhood asthma research in Malawi.

Objectives: To measure the burden of asthma among school age children, identify the barriers to achieving good asthma control, and explore ways to address identified barriers.

Methods: We screened students aged 12-14 years for wheeze and/or asthma symptoms. We obtained consent and collected core data from students who screened positive, using an electronic questionnaire, spirometry and exhaled nitric oxide (FeNO). Focus group discussions were completed with children, parents, and teachers, to further explore barriers to achieving good asthma control. We piloted a theatre intervention in schools and surrounding communities.  

Results: Preliminary data – 10,189 students from 35 Blantyre urban schools screened for wheeze in the last 12 months and/or asthma symptoms. 761 (7.5%) screened positive, with 52% reporting severe symptoms and 50% with no doctor confirmed asthma diagnosis. Core data collected from 213 students, objective airflow obstruction and/or airway inflammation noted in some who reported severe symptoms. Barriers to good asthma control included low asthma awareness/knowledge, undiagnosed symptoms, and limited access to care. 

Conclusions: Screening of school age children for asthma symptoms in combination with a school-based theatre intervention can be used to overcome some of the obstacles to achieving good asthma control through increasing asthma knowledge among children, teachers, and parents.

O32.A001358. HEALTH LEADERSHIP AND MANAGEMENT DEVELOPMENT IN MALAWI: TOWARDS A THEORY FOR HEALTH SYSTEMS STRENGTHENING    

Author(s): Thomasena O’Byrne1,2,6, Bongani Chikwapulo5, Kingsley Chikaphupha4, Linda Nyondo-Mipando7, Maryse Kok3, Marlen Chawani2, and Frédérique Vallières1           

Affiliation(s):

1. Centre for Global Health, Trinity College Dublin, Dublin, Ireland
2. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
3. KIT Royal Tropical Institute, Amsterdam, the Netherlands
4. Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
5. Quality Management Directorate, Ministry of Health and Population, Lilongwe, Malawi
6. Liverpool School of Tropical Medicine, UK
7. School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi  

Email: tobyrne@mlw.mw

Introduction: Strong leadership and management capacity of Human Resources for Health (HRH) is key to a health system’s performance. The current study sought to develop a framework for how health leadership and management is understood, can be further developed, and applied for HSS in Malawi, placing HRH at the centre of efforts.

Objectives: Offer an in-depth description of current leadership and management for health systems strengthening efforts in the context of Malawi.

1. To describe how key stakeholders conceptualise and understand health leadership and management in this context
2. To identify why health leadership and management approaches are being used to strengthen health systems within this context
3. To explore how the development of health leadership and management approaches are being implemented in practice

Methods: The study was informed by a qualitative case study methodology, drawing on the concepts and tools of grounded theory approaches, and using a soft-systems thinking lens. Four key methods were utilised, across a broad range of health-system stakeholders, including a documentary review of over 200 documents; in-depth interviews (n = 37); non-participant observation; and the development of rich pictures through systems mapping.

Results: Insights into values frontline stakeholders attach to effective leadership and management evidence a desire for approaches that are more relational and collectivistic, situated within a more psychologically safe and supportive working environment. Already overburdened district health teams faced unrealistic expectations as health leaders and managers. There was an identified desire for efforts to focus on developing health leadership and management at all levels of the health system, leveraging existing, yet often ignored, strengths and resilience at primary and community health care level.

Conclusion: For leadership and management development to contribute to HSS in Malawi, it must be aligned to the principles of systems thinking and applied faithfully system wide to enable people to better cope with their contexts.

O33.A001355. HARNESSING DATA SCIENCE RESOURCES TO ENHANCE CLINICAL STRATIFICATION OF INFECTIONS

Author(s): James Jafali1,2, Zahra Mungloo-Dilmohamud2,3 Dassen Sathan2,3, Sumir Panji 2,4, Christopher Fields2,5, Shakuntala Baichoo 2,3, Nicola Mulder2,3

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust, University of Liverpool
2. H3ABIONET
3. University of Mauritius
4. University of Cape Town, RSA
5. University of Ilinois, USA

Email: jjafali@mlw.mw

Introduction: Clinical stratification of bacterial and viral infections, which cause significant morbidity and mortality in low-and-middle-income-countries (LMICs), remains an outstanding public health challenge. Advances in Big-data science present powerful approaches such transcriptomic gene-signatures for enhanced diagnosis of diseases including cancer, infections, and autoimmunity. However, the existing gene-signatures are concentrated in high-income countries and lack robustness for wider applications in resource-limited settings.

Objective: To derive a robust gene-signature (using multiple data resources and rigorous approaches) for enhanced stratification of viral and bacterial infections.

Methods and results: Using a data-fusion approach involving multiple whole-blood transcriptome studies (n=1407) and a wide range of data science approaches; this analysis derived (n=1055, accuracy: 89%-93%) and validated (n=352, AUC: 93%-100%) a robust 18-gene transcriptomic signature for enhanced stratification of viral and bacterial infections. At the pathway level, this signature represents a cell-centred pro-inflammatory response involving an amplification of metabolic and myeloid immunity and a dysregulation of lymphoid (including NK-cells) and interferon pathways.

Conclusion: Together, these findings highlight an opportunity for robust diagnosis and optimal antibiotic treatment of bacterial infections in resource-limited and high-burden settings.           

SEXUAL & REPRODUCTIVE HEALTH ABSTRACTS

034.A001068.  BURDEN OF SEXUALLY TRANSMITTED INFECTIONS AMONG THE YOUTH IN RURAL MALAWI: A CROSS-SECTIONAL STUDY IN NENO DISTRICT  

Author(s): Justice Kachitsa1, 2, George C Talama2, Moses Banda Aron2, Fabien Munyaneza2, Chikondi Mchazime2, Rachel Mwanza2, Willy Chisindo3, Chiyembekezo Kachimanga2

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre, Malawi
2. Partners in Health Malawi, Neno, Malawi
3. District Health Office, Ministry of Health and Population, Neno, Malawi      

Email:  jkachitsa@kuhes.ac.mw

Introduction: In Malawi, youths aged 15-24 years’ account for the majority of clients with sexually transmitted infections. Yet, the burden of sexually transmitted infections among the youth in rural settings remain unclear.

Objectives: To investigate the proportion of sexually transmitted infections and factors associated with sexually transmitted infection recurrence among youths 15-24 years in Neno, rural Malawi.

Methods: A cross- sectional study was conducted utilizing routinely collected sexually transmitted infections data in five primary care and two secondary care facilities. Multivariate logistic regression analysis was used.

Results: Of the 4,993 sexually transmitted infection clinic attendees, 37. 96% were youth aged 15-24 years. The mean age was 20.94 years (SD± 2.33 years). In females, abnormal vaginal discharge (high-risk) was the most commonly reported sexually transmitted infection syndrome, (47.2%). The proportion of HIV and sexually transmitted infection co-infection was higher in females (81.4%). Significant factors associated with STI recurrence included female gender [OR =1.29; 95% CI: 1.04 – 1.60, p= 0.022], age between 20-24 years [AOR =1.87; 95% CI: 1.47 – 2.37, p= <0.001] and being HIV negative [AOR =0.28; 95% CI: 0.21 – 0.39, p= <0.001].

Conclusion: We found a higher prevalence of sexually transmitted infections among the youth 15-24 years in rural Malawi, suggesting of the need to strengthen youth targeted behavior change interventions aimed at reducing risky sexual behaviors. Strengthening screening and treatment of sexually transmitted infection among the youth is also greatly encouraged in health facilities in rural settings. Youth living with HIV had high rates of sexually transmitted infections. These findings support the advocacy to strengthen integration of sexually transmitted infection screening and treatment with HIV services.

O35.A001097. INFLUENTIAL SOURCES OF KNOWLEDGE ON EARLY SEX ONSET AMONGST YOUTH IN BLANTYRE RURAL

Author(s): Gladson Makowa1, and Mary Kamwaza1          

Affiliation(s):

1. The Malawi University of Business and Applied Sciences (MUBAS), Blantyre, Malawi

Email: gladsonmkw@gmail.com

Introduction: Sexuality issues are taught in schools, youth clubs, initiation ceremonies and other media to prevent early sexual onset. But youths still have early sexual onset resulting in early pregnancies and high prenatal deaths. The aim of this study was to analyse sources of knowledge that influence early sexual onset among youths of Blantyre rural.

Objectives:

1. To examine major sources of sexual knowledge
2. To determine the information/knowledge that these sources give out
3. To establish sources that influence early sexual onset

Methods: Mixed research methods were used on a total sample of 222 with which individual and informants’ interviews, and focus group discussions were conducted. The study area was Mapazi, Chilaweni, Namikasi and Nankumba Blantyre Rural Secondary Schools.

Results: The study found that 100% learnt from school, 79.3% from peers, 67.7% from parents, 60% from television films, 48.8% from youth clubs. Out of 164 interviewed individually, 48.2% had sex, 82.1% sexed before the age of 18 and at 18 years 94.9 had sex and 81.3% used condoms. Those that had not initiated sex acknowledged parents, Church counselling, youth clubs and school as their dependable sources of knowledge and those that initiated sex acknowledged peers, pornographic films on television and the internet, traditional initiation, and radio adverts. Messages that delayed sex are; abstain to be righteous, moral, holy and have a bright future, sex outside marriage is a sin and threats from parents. Parents and teachers fail to replace peers as the most accessible sources because they are difficult to approach, not friendly. The peers are available and dependable source but mostly lack moral values and lead friends astray sexually. The television, internet and new media are full of pornography.

Conclusion: The recommendation is to provide dependable and accessible sources as their peers and that youth clubs should share economically bankable skills, not chats only.

O36.A001449. ASSESSING BARRIERS OF CONTRACEPTIVE UPTAKE AMONG ADOLESCENT GIRLS IN A RURAL DISTRICT OF MALAWI

Author(s): Sitalire Kapira1,2, Hannah Gilbert, Emilia Connolly1, Joan Kuffman2, Isaac Mphande1, Beatrice Matanje1, Chiyembekezo Kachimanga1, Anatole Manzi2, and Emily Wroe2

Affiliation(s):

1. Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi, and Harvard Medical School, USA
2. Harvard Medical School, USA     

Email: sitalirekapira@yahoo.com     

Introduction: Malawi’s unmet need for family planning for unmarried adolescent girls remains high despite efforts to improve provision and uptake. High adolescent fertility has been shown to lead to school dropouts, unsafe abortions, and a lack of employment opportunities increasing those living in poverty. In the rural Malawian district of Neno, the unmet need for family planning in adolescents was 52% in 2021, with 32% of young women giving birth before 18.

Objectives:

1. Describing the current uptake of contraceptives among adolescents in Neno.
2. Exploring service delivery capacity in Neno District.
3. Identifying barriers to modern contraceptive use among adolescents in Neno.

Methods: We conducted a mixed-methods study to identify barriers to family planning provision and uptake for adolescent girls in Neno District. Quantitatively, we collected data from 3 sources: (a) FP reports from 11 health facilities, (b) mobile health data from Community Health Workers in two catchment areas, and (c) facility survey data from six randomly selected facilities. Qualitatively, we conducted three focus group discussions with teachers and parents (N=28) and 32 in-depth interviews with adolescents, local leaders, service providers, and facility managers (N=32).

Results: 2.9% of 10-14-years-old girls and 10% of 15-19-year-old girls accessed family planning services in Neno District in 2019, with increased uptake in the dry season compared to the rainy season. FP uptake decreased by 20% during the COVID-19 pandemic in 2020. Qualitatively, we identified barriers to contraceptive uptake, including poverty, lack of youth-friendly health services, lack of privacy, misuse of media, and the impact of the COVID-19 pandemic.

Conclusions: Barriers to adolescent contraceptive uptake are multifactorial and inadequately addressed by existing programs in Malawi. Despite national efforts to promote youth-friendly health services, additional efforts are needed to provide effective and culturally acceptable interventions with community engagement to increase adolescent contraceptive uptake.   

O37.A001245. GENDER-BASED VIOLENCE CASE IDENTIFICATION AND LINKAGE TO CARE AMONG ADOLESCENT GIRLS AND YOUNG WOMEN IN MALAWI          

Author(s): Tessah Musukwa1, Rachel Kanyenda1, Lester Kapanda1, Thulani Maphosa2, Cosima Lens2, Allan Ahimbisibwe2      

Affiliation(s):

1. Elizabeth Glaser Pediatric AIDS Foundation      

Email: tmusukwa@pedaids.org

Introduction: EGPAF-Malawi supported the implementation of gender-based violence (GBV) services at 10 facilities in Blantyre and Zomba districts to strengthen case identification and linkage to care among adolescent girls and young women (AGYW) aged 10-24years.

Objectives: To describe the number of GBV cases registered and linked to appropriate care in the targeted facilities.

Methods: In April 2019, EGPAF implemented a package of GBV services, including demand creation and awareness of early reporting (within 72 hours of violence), training, development, and deployment of GBV registers, GBV client flow changes, active screening using standardised tools, use of trained youth champions and documentation of cases prior to referrals. We analysed programmatic data for GBV among AGYW who were identified and offered related services between 2020 and 2021 following the implementation of the package.

Results: From April-December 2019, there were 1,221 registered GBV cases, an increase from 72 cases from July 2018 to March 2019. Between January 2020 to December 2021, 5,309 individuals received post-GBV care, of which, 46% (2,423) were young people and 33% (1,730) were AGYW. Physical violence was the most common form of GBV among AGYW at 46% (788), followed by sexual violence at 28% (480).  Through post-violence care, 29% (509) were linked to HIV testing. Due to delayed reporting (beyond 72 hours), only 53% (255) who experienced sexual violence received and completed Post-exposure Prophylaxis; 35% (167) received emergency contraception and 57% were screened and treated for sexually transmitted infections. AGYW were linked to psychosocial support, police and to community support for continuity of care.

Conclusion: The GBV package optimised the identification and linkage of AGYW who experienced GBV to care and support services.  Significant gaps in the follow up of GBV cases including delayed reporting require further strengthening of GBV services to increase their efficacy and improve outcomes among AGYW.

O38.A001460.  IMPACT OF COVID-19 ON ADOLESCENTS’ ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH SERVICES           

Author(s): Medrina Mtende-Mbotwa1, Patani Mhango1, Princess Kaira1, Razak Mussa1, Wanangwa Chimwaza-Manda1, Monica Patricia Malata1, Adamson S. Muula2, Anthony Idowu Ajayi3, Gavin George4, Effie Chipeta1        

Affiliation(s):

1. Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
2. Kamuzu University of Health Sciences, School of Global Public Health, P/Bag 360, Chichiri, Blantyre 3
3. Population Dynamics and Sexual and Reproductive Health Rights, African Population and Health Research Center, Nairobi Kenya
4. University of KwaZulu-Natal

Email: mmtende@kuhes.ac.mw

Introduction: COVID-19 is a global health crisis bringing numerous obstacles among adolescents related to access to sexual and reproductive health and rights (SRHR) services, especially in poor resource settings.  Adolescents in Malawi have been particularly vulnerable to challenges associated with the COVID-19 pandemic with sustained consequences with ceaseless difficulty to access and utilization of youth friendly sexual and reproductive health services.

Objectives:  To assess the impact of COVID-19 on adolescents’ access to SRHR services.

Methods: Mixed-methods approach involving qualitative data collection methods and desk-based document review were utilised. The desk-review assessed existing legal, policy, and adolescent sexual and reproductive health and rights (ASRHR) and services guidelines.  Qualitative data was collected through key informant interviews (KIIs) (42) to understand the socio-economic conditions affecting SRH delivery services to adolescents. Interviews were digitally recorded and transcribed verbatim. Data were coded using Nvivo software and thematic content analysis synthesised the key emerging codes, drawing meaning from the data to understand adolescents’ vulnerability and access to SRHR services.

Results: Increased numbers of child marriages, unplanned pregnancies and high school drop- out rates were attributed to the presence of COVID-19. Adolescents’ low utilisation of SRHR services was reported mostly due to fear of contracting COVID-19 at the facilities, restrictions which resulted into the suspension or slowing down of services and also school closures which negatively affected students’ ability to meet in their schools as Youth Clubs- hence low access to services. At service level, health workers fear of exposure to COVID-19, Health systems’ priority re-direction of resources and support to covid-19 response, over other services affected delivery of SRHR services to the adolescents.

Conclusions: Covid-19 impacts negatively on adolescents’ access to SRH services. Understanding the magnitude of this crisis would help inform the development of evidence-based strategies to improve service delivery targeting special populations such as adolescents.

NON COMMUNICABLE DISEASES ABSTRACTS

O39.A001309. PREVALENCE OF PROGNOSTIC FACTORS IN PATIENTS WITH CERVICAL CANCER OPERATED AT QUEEN ELIZABETH CENTRAL HOSPITAL

Author(s): William Wayne Peno1     

Affiliation(s):

1. Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital   

Email: penowapeno@gmail.com

Introduction: Cervical cancer is the 4th leading cancer in the world, with a global incidence of 6.6 percent and a mortality rate of 7.5percent. Prognostic factors in cervical cancer can predict the likelihood of recurrence and 5 year survival depending on whether they are present or not and help in further management of patients who have undergone cervical cancer surgery. In our local setting, data on the prevalence of these prognostic factors are scanty, this study aimed to fill that gap.

Objectives: To estimate the prevalence of prognostic factors of cervical cancer in patients operated at Queen Elizabeth Central Hospital, Blantyre, Malawi.

Methodology: We conducted a retrospective descriptive quantitative study. The study population were all women that had an operation at QECH for cervical cancer from November 2019 to April 2021. We collected data from 82 patients’ files and excluded 1 patient.

Results: The mean patient age was 49.1 years (range 30-70). 59% of patients were HIV positive with squamous cell carcinoma as the commonest histological subtype (87.7%),30.49% of the patients presented with FIGO stage IIB. The prevalence of lymph node metastasis, tumour status, parametrial involvement and lymphovascular space invasion was 14.6%, 20.7%, 2.4% and 24.4 % respectively. 

Conclusion: The study established the overall prevalence of pathologic prognostic factors of 14.5%.  These findings can be used in triaging and planning patient management from the moment a patient presents to the hospital for comprehensive cervical cancer care.    

O40.A001425. SURVIVAL AFTER DIAGNOSIS OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN LILONGWE MALAWI          

Author(s): Bongani Kaimila1, Gift Mulima2, Chifundo Kajombo2, Ande Salima1, Peter Nietschke3, Yingxi Chen 4. Satish Gopal 5, Christian C Abnet 4, and Kamija S Phiri 6

Affiliation(s):

1. UNC Project, Lilongwe Malawi
2. Kamuzu Central Hospital, Lilongwe Malawi
3. St. Gabriel Hospital, Lilongwe Malawi
4. National Cancer Institute, USA
5. University of North Carolina, Chapel Hill USA
6. School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre Malawi

Email: bkaimila@unclilongwe.org

Introduction: Esophageal cancer (EC) is the second commonest cancer in Malawi, with Esophageal Squamous Cell Carcinoma (ESCC) being the most common subtype. Despite significant morbidity and mortality, little is known about disease outcomes. We assess post-diagnosis survival of ESCC in Malawi.

Objectives: To describe survival after diagnosis of ESCC in Malawi.

Methods: We report on ESCC cases enrolled in a longitudinal study at Kamuzu Central Hospital in Lilongwe from August 2017 to April 2020. Suspected cases completed a questionnaire interview, provided blood, urine and saliva specimens, and underwent a tumour biopsy for histologic confirmation. Cases were followed up by phone every two weeks until study outcome (death), loss to follow-up or censoring date. Time from diagnosis to death was assessed using Kaplan Meier methods. Differences in mortality among patients treated with palliative pain control alone, those who received a palliative self-expanding metal stent and those receiving palliative chemotherapy were assessed using the log-rank test.

Results: There were 300 ESCC cases enrolled during the study period, of which 290 (97 %) had known vital status at censoring date and 10 (3%) were lost to follow-up. As of the censoring date, 286 (99%) of those not lost to follow-up had died. Median age at enrollment was 56 years (range: 19-92). Median follow-up time was 105 days (range: 0-1188). Overall 1-year survival was 15% (95% CI 11-19%). Palliative chemotherapy reduced the risk of death, adjusted hazard ratio 0.54 (95% CI 0.32-0.91).  Tobacco use, alcohol consumption and HIV status did not affect risk of death.

Conclusion: Survival following diagnosis of ESCC was poor. Palliative chemotherapy was associated with improved survival compared with other forms of palliative treatment. Greater emphasis should be placed on early detection of EC, as well as prevention once key modifiable risk factors in Malawi are identified through ongoing studies in Malawi.           

O41.001439    CLINICAL CHARACTERISTICS AND OUTCOMES OF ACUTE LYMPHOBLASTIC LEUKEMIA IN ADOLESCENTS AND YOUNG ADULTS IN MALAWI

Author(s): Edwards Kasonkanji 1, Stephen Kimani 1,2, Brent Skiver 3, Grace Ellis 4, Ryan Seguin 1, Bongani Kaimila 1, Tamiwe Tomoka 1,5, Maurice Mulenga 6, Nathan Montgomery 4, Yuri Fedoriw 4, Satish Gopal 7, Katherine D. Westmorland 1,4 and Matthew S. Painschab1,4 

Affiliation(s):

1. University of North Carolina Project-Malawi, Lilongwe, Malawi
2. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
3. Messino Cancer Center, Asheville, NC
4. Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
5. University of Malawi College of Medicine, Blantyre, Malawi
6. Malawi Ministry of Health, Lilongwe, Malawi
7. Center for Global Health, National Cancer Institute, Rockville, MD”          

Email: ekasonkanji@unclilongwe.org

Introduction: There’s limited data on treatment and outcomes for acute lymphoblastic leukaemia (ALL) among adolescents and young adults in sub-Saharan Africa.

Objectives: To describe clinical characteristics and outcomes of acute lymphoblastic leukaemia in adolescents and young adults in Malawi.

Methods: Patients aged 15-39 years with newly diagnosed ALL at Kamuzu Central Hospital, Malawi, were enrolled from 2013 to 2019; follow-up was censored in December 2020. ALL diagnosis was confirmed on-site using immunohistochemistry and telepathology consultation involving pathologists in Malawi and the United States. All but four patients were treated with a modified paediatric-inspired regimen (Cancer and Leukaemia Group B 10403 protocol). Key modifications included omission of asparaginase and no dose escalation for methotrexate.

Results: Of 19 participants, the median age was 22 (range 15-36) years. Of the 15 patients who initiated treatment, 11 (73%) achieved remission after induction, one (7%) died during induction, two (13%) had refractory disease, and one (7%) absconded. No patients were lost to follow-up. Eventually, 10 of 11 patients (91%) with confirmed remission relapsed. The median duration of first remission was 10 (range 3-22) months. Twelve of 15 treated patients (80%) had died at the time of censoring. Among treated patients, the 12- and 24-month overall survival was 50% (95% CI, 23 to 72) and 17% (95% CI, 3 to 42), respectively. CNS involvement was associated with worse survival.

Conclusion: It is possible to treat adolescents and young adults with ALL in low-resource settings using a low-cost, paediatric-inspired regimen; however, outcomes are poor. Both cost and limitations in supportive care infrastructure limit intensive cytotoxic approaches such as asparaginase. Patient-reported outcomes are needed to understand the quality of life and cost-effectiveness. Critically, innovative, leap-frog therapies, such as monoclonal or bispecific antibodies, and feasible economic models for resource-limited settings are urgently needed.

O42.A001438. SALIENT BELIEFS ABOUT MODIFIABLE RISK BEHAVIOURS AMONG PATIENTS LIVING WITH DIABETES, HYPERTENSION OR BOTH IN MANGOCHI, MALAWI: A QUALITATIVE FORMATIVE STUDY BASED ON THE THEORY OF PLANNED BEHAVIOUR PROSPER

Author(s):  Prosper Lutala1,2, Peter Nyasulu 3,4, Adamson Muula2           

Affiliation(s):

1. Department of Family Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KuHes) Blantyre Malawi
2. Department of Community & Environmental Health, School of Global Health and Public Health Blantyre, Kamuzu University of Health Sciences (KuHes) Malawi
3. Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
4. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Email: plutala@medcol.mw

Introduction: Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs.

Objectives:

1. To identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi
2. To identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi.

Methods: A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour’s elicitation interview guide. Thematic content analysis was used to identify emerging themes.

Results: A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change.

Conclusion: Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension. Contribution to the field: The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.

O43.A001106. IMPACT OF CARING FOR A MULTIMORBID OLDER ADULT ON THE FAMILY: A CROSS-SECTIONAL QUALITATIVE STUDY FROM MALAWI.      

Author(s): D.van Breevoort1, D. Kwaintana1, M. Mnenula1, J. Bates1, C. T. Nkhoma2, and R. Harding2

Affiliation(s):

1. Department Family Medicine, Kamuzu University of Health Science, Blantyre, Malawi
2. King’s College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.

Email: dorotheevb@hotmail.com      

Introduction: Aging, with associated multimorbidity, is accelerating most in low- and middle-income countries like Malawi. Although family members will play a fundamental role for provision of care, little is known about the impact on them. Appropriate palliative care requires inclusion of patients’ family needs.

Objectives: To understand how caring for older adults with multimorbid illness impacts on the life of the family.

Methods: We conducted in-depth qualitative interviews with patients (n=15) and caregivers (n=15) of older people with multimorbid illness attending primary care at Mangochi district hospital and Lungwena health centre. All patients were 50 years of age or above and living with two or more chronic conditions. A semi-structured topic guide explored patients and caregivers’ experiences of caring for their older patient with multimorbid illness. Verbatim transcripts were translated into English, and analysed thematically supported by NVivo software.

Results: Family members support older patients with multimorbidity financially, practically and emotionally. Caring for and to be cared for has a major impact on the family as a whole.  We identified the following themes around the impact of caring for older family members with multi-morbidities; 1) Decision making, hierarchy and co-dependence within the household 2) The “work” of caregiving; responsibilities for the patient and the household 3) The “hidden” impacts of caregiving on the household: 3Fs food, finances and future 4) Spiritual and social distress 5) Fears for the future: worried and questions. 

Conclusion: Living and taking care of older person with multimorbidities impacts the life of the family. Therefore, awareness and understanding of the impact of caring for an older patient on the life of a family is vital to improve health care for older adults with multimorbid conditions. Practice of family-oriented health care package for older patients with multi-morbid conditions and their families is needed to address family needs and concerns.

O44.A001285. AN ASSESSMENT ON THE MANAGEMENT OF OPEN FRACTURES IN HOSPITALS IN MALAWI BEFORE AND IMMEDIATELY AFTER IMPLEMENTING OPEN FRACTURE GUIDELINES 

Author(s): Sabawo MF1, Jaffry Z2, Chokotho L3, and Schade AT4,5

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Bart’s Health NHS Trust
3. Malawi University of Science and Technology
4. Malawi-Liverpool-Wellcome Trust
5. Liverpool School of Tropical Medicine

Email: febemchinguwo@gmail.com

Introduction: Open fractures are a common consequence of road traffic collision (RTC) and are associated with risk of complications. The introduction of standard guidelines, have improved patients care and reduce the risk of complications in other countries. In September 2021, the Malawi Orthopaedic Association/Arbeitsgemeinschaft Fur Osteosynthesefragen Alliance (MOA/AOA) guidelines and standards for open fracture management were introduced in Malawi. The study aimed to assess the management of open fractures in hospitals of Malawi before and after implementation training of the MOA/AOA guidelines.

Methods: This is a descriptive quantitative ambidirectional study, which reviewed patient’s medical files with open fractures of long bones presenting to Zomba central hospital, Mulanje, Salima, and Mangochi district hospitals for over 6 months. The study key variables were initial assessment, antibiotic prophylaxis, temporary fracture immobilization, place of debridement, type of anaesthesia, wound closure and definitive treatment of open fracture in casualty, theatre and wards.

Results: A total of 88 open fracture case files were reviewed with an overall median age of 36years (interquartile Range [IQR]: 27-45) and 90% (n=80) were male. Limb neurovascular status assessment improved from 25% (n=11) before the guidelines to 64% (n=28, P<0.05). The number of patients undergoing debridement in theatre significantly (P<0.05) increased from 21% (n=8) to 79% (n=31). Debridement done under general or spinal anaesthesia significantly increased (P<0.05) from 11% (n=2) to 89% (n=17) and from 28% (n=5) to 72% (n=13) respectively. However, missing data was 25% and did not include long-term patient outcomes.

Conclusion: This study demonstrates that training of MOA/AOA standard for open fracture management guidelines combined with its practice can lead to improvement in patient care. We recommend that the results of this study add further justification to the adoption and further training course for the implementation of MOA/AOA guidelines and standards for open fracture management to all other concerned cadres in all hospitals of Malawi.

O47.A001423. MOLECULAR TYPING OF MYCOBACTERIUM BOVIS ISOLATES FROM HUMANS REVEALS PUBLIC HEALTH IMPLICATIONS OF ZOONOTIC TUBERCULOSIS IN MALAWI    

Author(s): Thoko Kapalamula1,2 Yasuhiko Suzuki1, and Stephen V. Gordon3         

Affiliation(s):

1. Division of Bioresources, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido, Japan.
2. Malawi-Liverpool Wellcome Trust, Blantyre, Malawi.
3. School of Veterinary Medicine, University College Dublin, Dublin, Ireland

Email: tkapalamula@mwl.mw

Introduction: Mycobacterium bovis (M. bovis), the principal bovine pathogen, also causes tuberculosis (TB) in humans, termed zoonotic TB. Moreover, M. bovis is naturally resistant to pyrazinamide (PZA), a crucial first-line anti-TB drug. Understanding the molecular diversity and phylogenetic relationships of M. bovis is critical for strengthening and developing alternative control strategies. Previously, we discovered highly diverse and clonally expanding M. bovis strains circulating among cattle in Malawi. However, there is limited information about M. bovis in humans.

Objective: Thus, in the present investigation, we screened for M. bovis in clinical isolates previously identified as M. tuberculosis complex (MTBC) and preserved in biobanks at the National TB Reference Laboratory in Lilongwe, Malawi. M. bovis isolates were genotyped using spoligo-and a 26 loci MIRU VNTR-typing.

Results: We sequenced the pncA gene to determine the susceptibility of the isolates to PZA. Out of 94 screened isolates, 5 were confirmed as M. bovis, whilst one was classified as a mixed infection (M. bovis/M. tuberculosis). Spoligotyping revealed three patterns: SB0273, SB0131, and SB0425. The clinical isolates showed phylogenetic relationships to isolates previously reported circulating in cattle in the central parts of Malawi, suggesting possible transmission links. Sequencing of the pncA gene revealed that SB0425 strains were susceptible to PZA.

Conclusion: These findings highlight the public health implications associated with M. bovis in humans in Malawi and call for a holistic multidisciplinary approach to control TB.

O48.A001335. ADULTS LIVING WITH HIV ON ANTIRETROVIRAL THERAPY EXHIBIT PROLONGED HIGH DENSITY PNEUMOCOCCAL CARRIAGE AND SHED ANTIMICROBIAL RESISTANT PNEUMOCOCCI         

Author(s): Lusako Sibale1,2, Newton Kalata1, Tinashe Nyazika2, Alice Kalirani1, Mercy Khwiya1, Gift Sagawa1, Todd D Swarthout3, Neil French4, Ken Malisita5, Arox Kamng’ona6, Robert S Heyderman3, Brenda Kwambana-Adams3, Kondwani Jambo1,2.  

Affiliation(s):

1. Malawi-Liverpool-Wellcome Programme, University of Malawi College of Medicine, Blantyre, Malawi
2. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
3. NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, WC1E 6JF, London, UK
4. Institute of Global Health, University of Liverpool, L69 3GE, Liverpool, UK
5. Lighthouse, QECH, P.O. Box 95, Blantyre, Malawi
6. Kamuzu University of Health Sciences, Blantyre, Malawi

Email: lsibale@mlw.mw

Introduction: Despite successful roll out of the pneumococcal conjugate vaccines, vaccine serotype (VT) carriage remains high among People Living with HIV (PLHIV) on antiretroviral therapy (ART). We investigated the impact of HIV infection on pneumococcal carriage duration, density, shedding and antimicrobial resistance (AMR).

Objective: To investigate the impact of HIV infection on pneumococcal carriage duration, density, shedding and AMR

Methods:  In a prospective cohort study, we recruited 90 asymptomatic PLHIV on ART and 54 HIV-uninfected adults aged 18-45 years and followed them up at regular intervals for 12 months. Standard microbiological techniques were used to test for pneumococcal presence and density on nasopharyngeal swab and shedding specimens (cough, nose poke and facemask). Disk diffusion using oxacillin, tetracycline, erythromycin and co-trimoxazole was performed to screen AMR.

Results: PLHIV on ART had a longer duration of pneumococcal carriage (133 [95% CI 112-140] vs. 49 [95% CI 26-66] days; p=0.0012) and higher pneumococcal carriage density (51088 [95% CI 27542-95499] vs. 7630 [95% CI 3467-16218] CFU/ml; p=0.0394) than HIV-uninfected adults. PLHIV on ART were more likely to shed pneumococcus than HIV-uninfected adults (46% vs 25%; p=0.002). Shed isolates were more often multidrug resistant (MDR) than the nasopharyngeal carriage isolates (57% vs. 36%; p=0.0015). A generalised linear mixed model demonstrated that being HIV-infected on ART (p=0.017) or having a higher carriage density (p=0.0002) were independently associated with increased pneumococcal shedding.

Conclusion: We have demonstrated profoundly greater risks of pneumococcal carriage and shedding among PLHIV on ART compared to HIV-uninfected adults. These findings suggest that PLHIV on ART could be an important reservoir of pneumococcal transmission, including of AMR pneumococci.

O49.001178. bootComb- an R PACKAGE TO COMBINE INDEPENDENTLY ESTIMATED PARAMETER

Author(s): Marc Y.R. Henrion1

Affiliation(s):

1. Malawi Liverpool Wellcome Programme, Blantyre Malawi

Email: mhenrion@mlw.mw

Introduction: In epidemiological applications, it is often necessary to derive confidence intervals for a parameter estimate derived from two or more independently estimated parameters. Important epidemiological examples include adjusting a prevalence estimate for the estimated sensitivity and specificity of a novel diagnostic assay or combining conditional and unconditional prevalences. The derivation of the point estimate is straightforward, but deriving confidence intervals with correct coverage is difficult.

Objectives: The aim of this work was to develop an algorithm for deriving confidence intervals with correct coverage for combinations of independently estimated parameters. Importantly, while estimated independently, the parameters themselves might be dependent and therefore a key requirement is the ability to handle dependent parameters.

Methods: Using quantile matching, parametric distributions are fitted to the confidence interval for each input parameter. Parametric bootstrap sampling is used to derive an empirical distribution for the combined parameter, summarised as a confidence interval using either the percentile or the highest density interval methods. Dependent parameters are handled by using Gaussian copula functions which allow specifying the dependency structure as a simple correlation matrix. The algorithm is available as an R package, bootComb (https://cran.r-project.org/package=bootComb).

Results: The bootComb package provides a simple-to-use solution to a common but non-trivial epidemiological problem. Simulations show that the bootComb estimated confidence intervals have correct coverage. Results for two specific applications will be discussed: i) combining the conditional prevalence of Hepatitis D infection among Hepatitis B infected patients and the unconditional Hepatitis B prevalence in the general population to obtain a population-level Hepatitis D prevalence estimate and ii) accounting for sensitivity and specificity of a novel SARS-CoV-2 diagnostic assay to estimate the SARS-Cov-2 infection prevalence in Malawi during the Covid-19 pandemic.

Conclusion: bootComb is an open-source toolkit for the applied epidemiologist. Its usefulness has been demonstrated in recent, relevant epidemiological applications in Malawi.

MATERNAL & CHILD HEALTH 2 ABSTRACTS

O50.A001329. THE CHILDHOOD ACUTE ILLNESS AND NUTRITION (CHAIN) NETWORK; A MALAWIAN PERSPECTIVE ON CHILD MORTALITY ASSOCIATED WITH ACUTE ILLNESS 

Author(s): Emmie Mbale1, Wieger Voskuijl1, Robert Bandsma2, Dennis Chasweka3, Isabel Potani3, and Chisomo Eneya3 

Affiliation(s):

1. Paediatric and Child Health Department, Kamuzu University of Health Sciences
   1. Sickkids Hospital, University of Toronto
   1. CHAIN project, Paediatric and Child Health Department, Kamuzu University of Health Sciences     

Email: dchasweka@medcol.mw

Introduction: Mortality among children with acute illness in low-income and middle-income settings like Malawi remains unacceptably high and the importance of post-discharge mortality is increasingly recognised. We aimed to explore the epidemiology of deaths among young children with acute illness across sub-Saharan Africa (Burkina Faso, Uganda, Kenya, Malawi) and south Asia (Pakistan, Bangladesh) to inform the development of interventions and improved guidelines.

Methods: In this prospective cohort study, we enrolled children aged 2–23 months with acute illness, stratified by nutritional status defined by anthropometry (ie, no wasting, moderate wasting, or severe wasting or kwashiorkor), who were admitted to Queen Elizabeth Central Hospital, Malawi and eight other hospitals in six countries across sub-Saharan Africa and south Asia between Nov 20, 2016, and Jan 31, 2019. Each site provided care and complied with national guidelines. Co-primary outcomes were mortality within 30 days of hospital admission and post-discharge mortality within 180 days of hospital discharge. A priori exposure domains, including demographic, clinical, and anthropometric characteristics at hospital admission and discharge, as well as child, caregiver, and household-level characteristics, were examined in regression and survival structural equation models.

Results:  333 of 3101 children were recruited in Malawi (median age 11 months [IQR 7−16]). Of the total cohort, 1120 (36·1%) had no wasting, 763 (24·6%) had moderate wasting, and 1218 (39·3%) had severe wasting or kwashiorkor. Of 350 (11·3%) deaths overall, 234 (66·9%) occurred within 30 days of hospital admission and 168 (48·0%) within 180 days of hospital discharge. 90 (53·6%) post-discharge deaths occurred at home. The proportion of children who died following discharge was relatively similar across nutritional strata. Numerically large high-risk and low-risk groups could be disaggregated for early mortality and postdischarge mortality. Structural equation models identified direct pathways to mortality and multiple socioeconomic, clinical, and nutritional domains acting indirectly through anthropometric status.

Conclusion: Among diverse sites in Africa (including Malawi) and south Asia, almost half of mortality occurs following hospital discharge. Despite being highly predictable, these deaths are not addressed in current guidelines. A fundamental shift to a childcentred, risk-based approach to inpatient and post-discharge management is needed to further reduce childhood mortality, and clinical trials of these approaches with outcomes of mortality, readmission, and cost are warranted. Partnering with the Malawian Ministry of Health on disseminating this important information is crucial and might improve the care for acutely ill children on a country wide level both during hospital admission as well as post-discharge.          

O52.A001380. DOSE-RESPONSE RELATIONSHIP BETWEEN ESSENTIAL HEALTH INTERVENTIONS AND COMORBIDITY AMONG UNDER-FIVE CHILDREN IN MALAWI

Author(s): Peter A. M. Ntenda1*, Christopher C. Stanley1, Noel Patson1, 2, Harrison Msuku1, Vincent Samuel2, Jobiba Chinkhumba1,2, Don P. Mathanga1,2, Atupele T. Kapito1,2           

Affiliation(s):

1. MAC-Communicable Diseases Action (MAC-CDAC), Kamuzu University of Health Sciences (KUHeS), Privative Bag 360, Chichiri, Blantyre 3, Malawi.
2. School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Privative Bag 360, Chichiri, Blantyre 3, Malawi.

Email: peterantenda@yahoo.com     

Introduction: Globally, it is reported that most childhood morbidities can be prevented with access to simple, and affordable interventions. This study assessed the coverage, factors associated with adequate essential child health interventions, and whether these interventions have effects on comorbidity among children under 5 years old in Malawi.

Methods: Data on 5,622 children aged 12–48 months who participated in the Midline Household Survey which was conducted as part of the Evaluation of Malaria Vaccine Implementation Programme was analysed. Children were considered to have access to adequate essential health interventions if they received vitamin A supplementation, deworming medication, completed basic immunisation, and owned a mosquito net. Comorbidity was defined as the co-occurrence of fever, diarrhoea, and cough in the same children. Generalised estimating equations (GEE) were fitted to estimate independent predictors of adequate child essential health interventions and whether adequate essential health interventions were associated with childhood comorbidity.

Results:  The coverage of adequate essential health interventions was 37.2% while comorbidity was estimated at 5.0%. The GEE showed that low education levels of caregivers (aOR: 0.78; 95% CI: 0.67–0.91), low household socio-economic status, (aOR: 0.58; 95% CI: 0.49–0.70), and absence of the child’s health passport (aOR: 0.71; 95% CI: 0.59–0.86) reduced the odds of achieving adequate essential health interventions. Children who had access to three interventions (aOR: 0.41; 95% CI: 0.20–0.84) and all four interventions (aOR: 0.32, 95% CI: 0.15–0.64) exhibited a low risk of comorbidity from fever, cough, and diarrhoea.

Conclusions:  The study revealed that the coverage of adequate essential health interventions was low and that there was a dose-response relationship between adequate essential health interventions and low risk of comorbidity. These results underscore the need to scale up the coverage of essential health interventions in order to curb comorbidities among under-five children in Malawi.

O53.A001262. ASSOCIATION BETWEEN MATERNAL BREAST MILK MICROBIOTA COMPOSITION AND ROTAVIRUS VACCINE RESPONSE IN AFRICAN, ASIAN AND EUROPEAN INFANTS: A PROSPECTIVE COHORT STUDY  

Author(s): Jonathan Mandolo1,7, Arox W. Kamng’ona1,7, Edward P.K. Parker3, Nigel A. Cunliffe4,5, Miren Iturriza-Gómara6, Khuzwayo C. Jere1,2,4

Affiliation(s):

1. Virology Research Group, Malawi–Liverpool–Wellcome Trust Clinical Research Programme, Blantyre, 312225, Malawi
2. Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, 312225, Malawi.
3. The Vaccine Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
4. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK
5. NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
6. Centre for Vaccine Innovation and Access, Program for Appropriate Technology in Health (PATH), Geneva, 1218, Switzerland
7. Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, 312225, Malawi.

Email: jmandolo@mlw.mw

Introduction: Maternal breast milk is a source of pre- and probiotics that impact neonatal gut microbiota colonisation. Since oral rotavirus vaccines (ORVs) are administered at a time when infants are often breastfed, breast milk microbiota may have a direct or indirect influence on ORVs response.

Objectives: We conducted this study to understand the geographical differences in maternal breast milk microbiota composition and the impact of maternal breast milk microbiota composition on ORVs response.

Methods: Using standardised methods across sites, we compared breastmilk microbiota composition in relation to geographic location and ORV response across prospective cohorts in India (n = 307), Malawi (n = 119), and the UK (n = 60).

Results:  Across three longitudinal samples per participant (spanning weeks 1 to 13 of life), breast milk microbiota diversity was higher in India and Malawi than in the UK. Though dominant taxa such as Streptococcus and Staphylococcus were consistent across cohorts, we observed significant geographic differences in the prevalence and abundance of common and rare genera throughout follow-up. By contrast, breast milk microbiota diversity and composition did not differ consistently with respect to ORV outcomes including seroconversion, dose 1 vaccine shedding, and post-vaccination rotavirus-specific IgA level.

Conclusions: Our findings suggest that breast milk microbiota composition may not be a key factor in shaping trends in ORV response within or between countries. Other key components of human milk were not considered in the present study and would be a valuable focus of future investigation. Human milk oligosaccharides such as lacto-N-tetraose and 2’-fucosyllactose have previously been linked with symptomatic rotavirus infection in Indian neonates, possibly via an effect on neonatal G10P[11] rotavirus infectivity. Future studies of the breast milk metabolome may help discern whether similar factors influence the immunogenicity and efficacy of ORVs.

O54.A001063. THREE-YEAR EFFICACY RESULTS OF A TYPHOID CONJUGATE VACCINE FROM MALAWI   

Author(s): Priyanka Patel1, Yuanyuan Liang2, James E. Meiring1,3, Tsion Girmay2, Shrimati Datta2, Theresa Misiri1, Felistas Mwakiseghile1, J. Kathleen Tracy2, Clemens Masesa1, Nginache Nampota-Nkomba4, Marc Henrion1,5, Matthew B. Laurens2, Robert S. Heyderman6, Kathleen M. Neuzil2, and Melita A. Gordon1,7,8 on behalf of the TyVAC Malawi team

Affiliation(s):

1. Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
2. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
3. Oxford Vaccine Group, Department of Paediatrics, Oxford University, United Kingdom
4. Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
5. Liverpool School of Tropical Medicine, Liverpool, UK
6. Division of Infection and Immunity, University College London
7. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
8. College of Medicine, University of Malawi, Malawi.

Email: ppatel@mlw.mw

Introduction: Typhoid fever is a high-burden, vaccine-preventable, multidrug-resistant systemic disease which remains a major health threat in sub-Saharan Africa (sSA), including Malawi. The World Health Organization recommended the use of Typhoid Conjugate Vaccines (TCV) in countries with a high burden of disease, and/or high rates of antimicrobial resistance. We present the longest-term efficacy data available globally to date, from the randomized, blinded, controlled clinical trial in Malawi. 

Methods: 28, 130 healthy children aged 9 months through 12 years were randomised 1:1 and received TCV (Typbar, Bharat Biotech) or meningococcal A conjugate vaccine (MenA). Enhanced passive surveillance at secondary and tertiary health facilities identified febrile presentations and serious adverse events (SAEs). Children presenting with an axillary temperature of ≥38°C, or subjective fever for ≥72 hours, or hospitalisation with a history of fever of any duration had blood culture collected (5-10ml) to confirm S. Typhi-positive typhoid fever.

Results: As of 30 September 2021 (minimum 36-month follow-up), intention-to-treat (ITT) analysis showed that 92,862 person-years of surveillance yielded 100 culture-confirmed typhoid cases; 18 cases in the TCV group (38.69 per 100,000 person-years) and 82 cases in the MenA group (176.97 per 100,000). Vaccine efficacy was 78.2% (95% confidence interval (CI): 63.7%- 86.9%) in an ITT analysis, and 80.4% (95% CI: 66.4%- 88.5%) in a per protocol analysis. Subgroup analysis showed consistent efficacy across all age-groups. We detected 499 serious adverse events, mostly hospitalizations for common childhood illnesses, and 20 deaths. No SAEs or deaths were related to the vaccine and no excess of either in the vaccine group.

Conclusion: Long-term efficacy data are crucial to informing decision-making and accelerating the introduction of TCVs globally, especially in sSA. The results of the trial have demonstrated durable protection in African children up to 36 months, which is consistent across a range of age-groups, and an excellent safety profile.

O55.A001070. INTERRUPTING THE TRANSMISSION OF SOIL-TRANSMITTED HELMINTHS THROUGH WHOLE-COMMUNITY MASS DRUG ADMINISTRATION: METHODS, BASELINE RESULTS AND PROGRESS UPDATE FOR THE DEWORM3 MALAWI TRIAL.       

Author(s): Stefan Witek-McManus1, James Simwanza2, Rejoice Msiska2, Hastings Mangawa2, Lyson Samikwa3, William Oswald1, Elliott Rogers1, Alvin Chisambi2, Stella Kepha4,  Zachariah Kamwendo2,  Alfred Mbwinja3,  Joseph Timothy1,  Hugo Legge1,  Sean Galagan5, Kristjana Ásbjörnsdóttir5,  Katherine Halliday1,  Judd Walson5, Lazarus Juziwelo 6, Rachel Pullan1,  Robin Bailey1,  and Khumbo Kalua2,3      

Affiliation(s):

1. London School of Hygiene & Tropical Medicine, UK;
2. Blantyre Institute for Community Outreach, Malawi
3. Kamuzu University of Health Sciences, Malawi
4. Kenya Medical Research Institute, Kenya
5. University of Washington, USA
6. Ministry of Health, Malawi.          

Email: stefan.witek-mcmanus@lshtm.ac.uk

Mass drug administration (MDA) for soil transmitted helminths (STH) has successfully reduced morbidity amongst school-age children and other high-risk groups, but is unlikely to result in interruption of transmission without routine treatment of the broader population. Established in 2017 as part of a multicentre trial in Malawi, India and Benin; the Deworm3 trial in Namwera zone, Mangochi district aims to assess the feasibility of eliminating STH through a novel strategy of biannual MDA to all eligible members of a community. A baseline census conducted in 2017 enumerated 131,074 individuals across 124 villages, who were subsequently allocated into 40 geographically contiguous study clusters. A baseline parasitological survey conducted in 2018 showed an age-cluster weighted prevalence of any STH infection by Kato-katz of 7.8% (95% CI: 7.0-8.6%), comprised predominantly of low-intensity infections of hookworm species. Community clusters were randomised 1:1 to annual school-based MDA (sMDA) (standard of care) or sMDA plus biannual whole-community MDA (cMDA). An annual census update recorded vital events and migration within the study site and served as a population frame for cMDA and survey sampling. Between 2018 and 2020, six separate rounds of cMDA were conducted biannually by Health Surveillance Assistants, with electronic registers used to record treatments administered and provide real-time performance monitoring. Per-protocol coverage of cMDA ranged by round between 79.1%-92.3%, with adults and males consistently less likely to receive treatment. The primary outcome of the trial (cluster-level STH prevalence ≤2% at 24 months after the last round of cMDA) will be determined by quantitative polymerase chain reaction (qPCR) of stool samples from 1,000 randomly selected individuals per cluster (total 40,000). We report the final enrolment profile of this endline survey conducted between May-November 2022 and discuss methodological considerations of qPCR for STH. Trial registration: NCT03014167.

O56.A001347. IMPLEMENTATION OF A SCALABLE TABLET-BASED ASSESSMENT TOOL TO DETECT CHILDREN AT RISK OF DEVELOPMENTAL DELAY IN MALAWI    

Author(s): Maria M. Crespo-Llado1, Vukiwe Ngoma2, Emmie Mbale2, and Melissa Gladstone1

Affiliation(s):             

1. University of Liverpool, Liverpool United Kingdom
2. Kamuzu University of Health Sciences, Blantyre Malawi

Email: m.crespo-llado@liverpool.ac.uk

Background: A key obstacle in detecting mental health problems in young children in low-to-middle income countries is the lack of scalable and standardised tools. Commonly used tools are proprietary, time-intensive, expensive, and require highly skilled professionals to administer. This ‘detection gap’ poses the biggest challenge to developing and implementing effective interventions in early childhood. In order to overcome this gap, we have developed a scalable mobile platform (known as Scalable Trans diagnostic Early Assessment of Mental health -STREAM- tool) to detect children at risk of developmental delays.

Objectives: To test the acceptability, feasibility, reliability, validity, and sensitivity of STREAM in preschool children in Malawi.

Methods: We are conducting a cross-sectional study which will randomly recruit 2000 infants aged 0 to 6 years, of which 1850 will be sampled from the population (normative sample) and 150 children from centres for children with disabilities (Neurodevelopmental Disorders-risk sample). We will collect data on child development using the STREAM tool, general demographics, anthropometry, and risk factors known to impact neurodevelopment on all children. A randomly sub-selected sample of children (N = 500) from the normative sample will undergo additional assessments including the administration of the Griffith’s, the collection of hair samples and EEG assessment. A further 150 children form the NDD-risk sample will be assessed to test the predictive value of the tool on diagnoses. Since March 2022, we have recruited 411 participants (206 boys) aged 0 to 6 years old.

Results: We anticipate that by 2024 this study will provide normative data on key neurodevelopmental domains in Malawi as well as evidence of its clinical utility in the assessment of neurodevelopmental domains at a population level in community settings.

Conclusion: Harnessing the potential of mobile technology to assess early neurodevelopment could allow for such assessments to be administered at scale on multiple devices across multiple locations by non-specialist workers.

SOCIAL SCIENCE IN HEALTH ABSTRACTS

O57.A001443. SEXUAL AND GENDER BASED VIOLENCE COORDINATION IN HUMANITARIAN CONTEXTS: THE CASE OF DZALEKA REFUGEE CAMP OF MALAWI 

Author(s): Pilira Chirambo Miseleni1, Blessings N. Kaunda-Khangamwa2 and Effie Chipeta3

Affiliation(s):             

1. Kamuzu University of Health Sciences, School of Public and Global Health, Blantyre, Malawi
2. Kamuzu University of Health Sciences, Malaria Alert Centre, Communicable Diseases Action Centre, Blantyre, Malawi
3. Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi  

Email: p.chirambo@yahoo.com

Introduction: Understanding risk factors that contribute to adolescent girls and young women (AGYW) sexual and gender based violence (SGBV) in humanitarian contexts is critical to implementing proactive response mechanism aimed at protecting the rights of refugees and asylum seekers. It is a global health, human rights and protection issue that worsens in a humanitarian context. Coordination is a special component of every humanitarian response that allows people-centred mechanisms to reduce SGBV. Therefore, we explored SGBV coordination strategies, identifying facilitators and barriers influencing effectiveness at the Dzaleka refugee camp.

Objectives:

1. To explore SGBV coordination strategies put in place to reduce/end SGBV among AGYW in Dzaleka refugee settlements in Malawi
2. To identify facilitators and barriers influencing effectiveness at the Dzaleka refugee camp

Methods: We conducted three focus group discussions (n=30) with AGYW, fourteen Key informant interviews with youth groups representatives, in-depth interviews with eight humanitarian staff using structured interview guides. Thematic content analysis synthesised responses, mitigating strategies and (non) effective SGBV coordination measures. The socio-ecological framework showed the interplay between the individual, societal and policy related SGBV factors and the corresponding (non) protective mechanisms at each level.

Results: AGYW in the camp were exposed to sexual, physical and socio-economic violence, due to gender inequality, poor social norms, lack of awareness of the available SGBV mechanisms, re-victimization and restricted livelihood opportunities. Lack of SGBV coordination mechanisms enforcement, by humanitarian actors and the government, affected service provision and the availability of specialised care for AGYW. Mitigation strategies were compromised by weak coordination across sectors and refugees, poor accountability and funding systems.

Conclusion: SGBV remains consistently under-prioritised and under-resourced despite set global commitments to date. There is a need for a holistic approach to strengthen SGBV coordination in humanitarian contexts like Dzaleka refugee camp.

O58.A001434. THE IMPACT OF NATURAL DISASTERS ON THE MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT GIRLS AND WOMEN IN MULANJE DISTRICT      

Author(s): Hilda Chizule1, Vincent Samuel Phiri1 and Blessings N. Kaunda-Khangamwa2,3        

Affiliation(s):

1. Kamuzu University of Health Sciences, School of Global and Public Health, Department of Public Health
2. Kamuzu University of Health Sciences, Malaria Alert Centre, Communicable Diseases Action Centre, Blantyre, Malawi
3. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa        

Email: hildahchizule@gmail.com

Introduction:  Malawi faces natural disasters periodically such as floods -Cyclone Idai and Ana which affect the well-being of people and sometimes cause death. People face challenges in accessing the bathrooms, toilets and drying areas when dislocated to camps. Lack of Menstrual Hygiene Management (MHM) and inclusive shelters hinder girls’ and women’s privacy and safety.

Objectives: To understand how people manage menstruation, we explored the differential impact of disasters on MHM for both genders.

Methods: This study used an explorative qualitative approach with multi-stage and purposive sampling to select 111 participants in four humanitarian camps in Mulanje district. Fifteen focus group discussions and fifteen key informant interviews with community members and programmes coordinators solicited individual and group experiences of MHM, shelter needs and cultural beliefs during flooding. A structural vulnerability framework and thematic analysis extrapolated disparities of gender, class, culture and the impact on communities in the context of disasters.

Results: The women and girls used rags, pieces of cloth, blankets when menstruating showing lack of underwear, re-usable and non-reusable pads. Period poverty forced girls out of school. Most camps had no areas to wash, dry and dispose of used materials. Other camps had no user-friendly bath-rooms nor separate sleeping rooms for women and girls, including those with disabilities which limited privacy and safety issues. There were mixed reactions on the perceptions of males on menstruation and MHM with a few being indifferent, others showing disgust while some provided monetary support. Cultural beliefs and taboos are still rife across communities increasing shame, stigma and discrimination.

Conclusion: Women and girls lack MHM contributing to the rise in the school absenteeism and dropouts. Lack of inclusive shelters and gendered support exacerbates the inferiority complex among young people. There is a need to pay closer attention to gender dynamics in camps and addressing other vulnerabilities through alternative services and support.

O59.A001238. EXPLORING THE RELATIONSHIP BETWEEN NEGATIVE HOUSEHOLD ECONOMIC SHOCKS AND MENTAL HEALTH IN RURAL MALAWI: A FIXED EFFECT ESTIMATION TECHNIQUE 

Author(s): Tafwirapo Chihana1        

Affiliation(s):

1. Stellenbosch University

Email: tschihana@gmail.com           

Introduction: Prevalence of mental health problems and their common consequences like suicides and violence is rising in Malawi. Though several studies in developed countries show a consistent association between adverse household economic events and individual psychological problems, comparative literature is rare in the local context.

Objectives: To estimate the association between mental health of adult rural Malawians and negative economic shocks.

Methods: The fixed effects technique is employed on three rounds of longitudinal data from the Malawi Longitudinal Study on Families and Health (MSLFH) conducted from 2006 to 2010 in Balaka, Mchinji and Rumphi districts.

Results: A longitudinal sample of 1662 (61% females) was analysed with 30% coming from Central region, 35% from Southern and 35% from Northern region. By 2010, 90% of the respondents were married; their age averaged 42; over 20% had no formal schooling and agriculture was the main economic activity for more than 70%. Descriptive analysis showed a high and rising prevalence of adverse economic shocks with 58% reporting at least a single shock in 2006 compared to 96% in 2010. Crop loss (45%) was the most common shock, followed by price shocks (42%) and then death or illness of adult household members (25%).

SF12 mental health scores averaged 54.32 over the pooled sample and revealed a deteriorating trend over the years with a mean score of 55.80 in 2006, 54.49 in 2008, and 52.67 in 2010. Fixed effects regression results suggested that death or serious illness of a family member who used to provide financial support to the household reduces family members’ mental health by 0.87 points on average, holding all other factors constant. 

Conclusion: Policymakers should therefore fund mental health and family support programs and promote shock-sensitive social protection that is responsive to the mental health needs of members affected by different shocks.

O60.A001281. MOBILITY IS ASSOCIATED WITH ART INTERRUPTIONS AMONG MEN IN MALAWI: A MIXED-METHODS STUDY          

Author(s): Marguerite Thorp1, McDaphton Bellos2, Tijana Temelkovska3, Misheck Mphande2, Isabella Robson2 Augustine Choko3, Risa Hoffman1 and Kathryn Dovel1,2

Affiliation(s):             

1. University of California, Los Angeles, USA
2. Partners in Hope, Lilongwe Malawi
3. Malawi Liverpool Wellcome Trust, Blantyre Malawi

Email: mthorp@mednet.ucla.edu

Introduction: Mobility is common across sub-Saharan Africa. Mobile men in antiretroviral treatment (ART) programs may face unique challenges to accessing care.

Objectives: We sought to understand how mobility impacts HIV care for men living with HIV in Malawi.

Methods: This mixed methods study was embedded within two trials conducted at 20 health facilities in Malawi. Eligibility criteria were: >15 years; HIV+; and not currently on ART (never initiated or stopped treatment). Survey questions on mobility were conducted with all men at trial enrollment. In-depth interviews (n=32) were performed with a subset of ‘mobile’ men (spent >14 nights away from home last year) to discuss reasons for travel and the relationship between travel and ART interruption. Interviews were translated, transcribed, coded, and analysed using grounded theory in Atlas.ti.

Results: Between August-December 2021, 651 men with treatment interruptions were enrolled in the trials, of whom 34% were mobile (median 60 nights away from home in the past year [IQR 30-90]). Among them, 77% took long trips (>14 consecutive nights), of which 68% were for income generation. In-depth interviews revealed that men had limited control over travel dates and durations. Most experienced unplanned, “urgent” trips due to employer demands or funerals. While the majority brought ART, most ran out of medication while away. Men understood the importance of ART and made extensive efforts to adhere during travel, including caregiver refills, accessing refills at alternate facilities, and returning home solely to collect ART, though efforts were often unsuccessful to prevent treatment interruption. Participants desired multi-month dispensing, rapid/flexible access to refills pre-travel, and the ability to refill at any facility in Malawi.

Conclusion: Mobile men were highly vulnerable to ART interruptions despite efforts to prioritise treatment. Mobile men may require multi-month dispensing and flexible ART refill locations and days to achieve sustained retention.

061.A001127. COMMUNITY PERSPECTIVES ON BARRIERS AND FACILITATORS TO HOUSEHOLD-AND-AMBIENT AIR POLLUTION (HAAP) REDUCTION; SITUATING PRACTICES IN CONTEXT: THE CASE OF NSUNGWI VILLAGE IN CHIRADZURU, MALAWI        

Author(s): Marisen Mwale1, Vincent Jumbe2, Eunice Phillips3, Ronan Conary4, and Debbi Stanistreet5

Affiliation(s):             

1. School of Public Health and Family Medicine – Kamuzu University of Health Sciences
2. School of Public Health and Family Medicine
3. Royal College of Surgeons University of Medicine and Health Sciences, Dublin Ireland
4. Royal College of Surgeons University of Medicine and Health Sciences, Dublin Ireland
5. Royal College of Surgeons University of Medicine and Health Sciences, Dublin Ireland

Email: marisen.mwale@yahoo.co.uk

Introduction: Globally, over 7 million premature deaths are ascribed to HAAP annually. With a mortality rate of 187.1 per 100,000 general populations, sub-Saharan Africa bears the greatest burden. HAAP by-products in particulate matter -P.M 2.5, black carbon and carbon monoxide have been associated with adverse health outcomes in women such as lung cancer, cataract, heart disease, and pregnancy related complications including stillbirths. Previous HAAP studies have focused on top-down supply-based improved cookstoves (ICS) but dearth of demand-led bottom-up perspectives driven by targeted communities exists.

Objectives: To appraise community perspectives on barriers and enablers to HAAP reduction in a village in southern Malawi. 

Methods: We used community led qualitative participatory approaches; focus group discussions (FGDs), transect-walk, photo-voice and community mapping in data collection. FGDs were held at different intervals to determine community perspectives on barriers and facilitators to HAAP reduction.  Data were analysed thematically first in excel and through the dedoose 9.0.62 QDA software.

Results:  Findings reflect high HAAP risk awareness and willingness to change risk related practices such as cooking outdoors, use of mafuwa, cookstove stacking, cooking in windowless kitchens and open rubbish burning. There is also willingness to adapt risk reduction interventions including compost processing, improved cookstoves, ventilation and use of solar lamps. The study identifies limited access to ICS and seasonal fuel poverty as major factors derailing HAAP risk reduction efforts.

Conclusion: Interventions aimed to mitigate HAAP health risk in poor communities are integral for gains in global health and for informing development policy direction. Efforts are however compounded by structural barriers of poverty, sustainability bottlenecks and empowerment pitfalls. The current study furnishes hope that given the opportunity to map out their development options, positive outcomes are achievable in grassroots communities. Also that development behaviour change is incremental with efforts building upon efforts.

MENTAL HEALTH ABSTRACTS

O62.A001313. SYSTEMATIC MAPPING ON AVAILABILITY, EXTENT AND DISTRIBUTION OF MENTAL HEALTH RESEARCH CONDUCTED IN MALAWI   

Author(s): Genesis Chorwe1, Felix Chisoni1, Ditress Nyirongo1, Japhet Myaba1, Anthony Sefasi1, Jonas Sagawa1, Grace Sibande1, Costantine Chaima1, Eluby Napwanga Katola1, Febbie Tambala-Jamieson1, Lucy Kululanga1, and Diana Jere1        

Affiliation(s):

1. Kamuzu University of Health Sciences

Email: fchisoni@kuhes.ac.mw

Introduction: Mental health research is essential in the implementation of evidence-based interventions. This can be impeded by unavailability or limited access to local evidence in low- and middle-income countries such as Malawi.

Objectives. To describe the availability, extent and distribution of mental health research conducted in Malawi. The study was conducted at Kamuzu University of Health Sciences in Malawi.

Methods: A systematic search of ten electronic databases for literature published from inception to September 2021. All published and unpublished mental health studies in all languages were eligible for inclusion in this systematic mapping. Studies were screened against inclusion and exclusion criteria and data was extracted, analysed and presented in tables and as a narrative synthesis.

Results: This systematic mapping included 226 articles of which 225 were published in English between 1988 and 2021. Cross-sectional studies (33.6%, n=76) were found to be the most common study design for mental health research in Malawi. More studies were conducted on women (21.2%, n=48) compared to men (1.3%, n=3). Mental health research was concentrated in the southern region of the country (44.8%, n=120) and in the three cities of Lilongwe (17.9%, n=48), Blantyre (16.4%, n=44), and Zomba (9%, n=24). Violence (24.3%, n=55) was the most studied mental health issue while depression (16.4%, n=37) was the most studied mental disorder.

Conclusion: This systematic mapping suggests that there are few studies on mental health in Malawi and they are not equally distributed across the country. There is a pressing need to conduct more mental health research using robust designs across disciplines.

O63.A001174. THE FEASIBILITY AND ACCEPTABILITY OF NON-INVASIVE BIO-SAMPLING FOR BIOMARKERS OF STRESS IN MOTHERS, FATHERS, AND INFANTS IN URBAN AND RURAL MALAWI: A QUALITATIVE STUDY

Author(s): Myness Kasanda Ndambo1*, Robert C Stewart1, 2, Christopher Bunn1, 4, Lucinda Manda-Taylor5, Martyn Pickersgill3, Eric Umar5 and Rebecca Reynolds6

Affiliation(s):

1. Malawi Epidemiology Intervention Research Unit
2. Division of Psychiatry, College of Medicine and Veterinary Medicine, University of Edinburgh
3. Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh
4. School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow
5. School of Global and Public Health, Kamuzu University of Health Sciences
6. Centre for Cardiovascular Science, Edinburgh University

Email: mynessndambo@yahoo.com

Introduction: Exposures shape the health and long-life development of babies in the womb. For instance, when women are exposed to psychological or environmental stressors, fetal growth can be negatively influenced, and the longer-term risk of neurodevelopmental and cardiometabolic disorders can increase. Glucocorticoids are commonly used as biomarkers of stress. Saliva and breast milk samples provide a cross-sectional cortisol concentration measurement, while hair samples help examine longitudinal cortisol measurement retrospectively.

Objective: To determine the feasibility and acceptability of collecting non-invasive biological samples such as saliva, breast milk, and hair to measure glucocorticoids from mothers, fathers, and infants.

Methods: A qualitative formative study utilising eight FGDs from November to December 2021 in rural Karonga and urban Lilongwe. Breastfeeding women, couples, field workers, and Health Care Workers were purposively sampled. Interviews were conducted in local languages, recorded, transcribed verbatim, translated into English, and analysed thematically.

Results: Participants described the samples intended for collection as sensitive in nature. Study findings indicate cultural, religious, gender dynamics, and therapeutic misconceptions on continued sample collection. All samples are attached to particular beliefs hence the exacerbated fear among participants. Sample collection methods framed commonly as ‘non-invasive’ within biomedicine can still be regarded as ‘invasive’ by sample donors. Participants further suggested that these concerns could potentially be addressed by deep and dialogical community engagement activities.

Conclusion: The feasibility of biosample collection connects to broader understandings and experiences of bodies, human biomaterials, and prior and ongoing encounters with research and researchers. Biomedical and community framings of ‘invasiveness’ might diverge, and the former must respond to and be informed by the perspectives of the latter. Clarity concerning how samples will be safely stored and used is critical to the success of collection procedures. As part of these, ongoing demonstrations of trustworthiness by individual researchers, research organisations, and communities are vital.

O64.A001075. COVID-19-RELATED DEPRESSION, ANXIETY AND PTSD AMONG HEALTH WORKERS IN MALAWI: A MIXED-METHODS STUDY   

Author(s): Limbika Maliwichi1*, Yamikani Ndasauka2, Martina Mchenga3, Fiskani Kondowe4, Chilungamo Mmanga5, Jimmy Kainja 6, Simunye Nyamali7

Affiliation(s):

1. Department of Psychology, University of Malawi
2. Department of Philosophy, University of Malawi
3. University of Cape Town
4. Department of Mathematics, University of Malawi
5. Department of Health Systems and Policy, Kamuzu University of Health Sciences
6. Department of Language and Communication Skills, University of Malawi
7. University of East Anglia, United Kingdom         

Email: lmaliwichi@unima.ac.mw

Introduction: The coronavirus disease 2019 (COVID-19) has affected the mental health of the general population and healthcare workers worldwide. COVID-19-related depression, anxiety and posttraumatic stress in healthcare workers could negatively impact health care provision.

Objective: To assess the effects of COVID-19 on the mental health of healthcare workers in Malawi.

Methods: This cross-sectional study was conducted in Malawi using a mixed methods approach. Interview guides were used to collect qualitative data from 16 participants, while questionnaires were used to collect quantitative data on 109 healthcare workers. The study utilised the Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and the Primary Care Post Traumatic Symptom Disorder Screen for DSM-5 (PC-PTSD-5).

Results: The results of this study indicate an overall high prevalence of COVID-19-related depression (31%; CI [23, 41]), anxiety (30%; CI [22, 40]) and PTSD (24%; CI [17, 34]) among healthcare workers. Regression analysis indicates that there are significantly more healthcare workers with depression (36% vs. 16%, P=0.06), anxiety (38% vs. 1%, P<0.01), and PTSD (30% vs. 8%, P=0.03) in city referral hospitals compared to the district hospitals. Further, the results showed that COVID-19 negatively affected health workers’ work, family, and social life leading to adverse effects on their mental health.

Conclusion: Healthcare workers have a high prevalence of depression, anxiety and posttraumatic stress related to COVID-19. Policymakers should consider prioritising the assessment and treatment of mental health problems in health workers.

O65.A001264. AN ASSESSMENT OF BURNOUT AND DEPRESSION AMONG HEALTH CARE WORKERS PROVIDING HIV CARE DURING THE COVID-19 EPIDEMIC IN MALAWI        

Author(s): John Songo1, Khumbo Phiri1 Hannah Whitehead2, Elija Chikuse1, Corrina Moucheraud 3, Agnes Moses1, Kathryn Dovel 2, Sam Phiri 1, Risa Hoffman2, Joep J. van Oosterhout 1,2

Affiliation(s):             

1. Partners in Hope, Lilongwe, Malawi
2. Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
3. Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, USA      

Email: Pemphosongo@gmail.com

Introduction: Burnout and depression levels among health care workers (HCWs) may have risen during the COVID-19 pandemic due to anxiety and increased work pressure.

Objectives: To assess the prevalence of burnout, depression, and associated factors among Malawian HCWs providing HIV care.

Methods: In April-May 2021, between the second and third COVID-19 waves, we randomly selected up to 14 HCWs at 30 PEPFAR/USAID-supported health facilities for an anonymous survey. We screened respondents for depression, using the WHO Self Report Questionnaire for depression screening (score ≥8 indicating positive screen) and burnout using the Maslach Burnout Inventory tool (positive screen defined as moderate or high burnout on Emotional Exhaustion and/or Depersonalization and/or low-moderate Personal Accomplishment). Logistic regression models were used to evaluate factors associated with depression and burnout.

Results: We surveyed 435 HCWs, median age 32 years (IQR 28-38), 54% female, 34% clinical cadres and 66% lay cadres. 28% HCWs screened positive for depression, 29% for burnout, and 13% for both. Being a clinician (vs. lay cadre) was associated with positive burnout screen (aOR 2.0 95%CI:1.1-3.5). Screening positive for burnout was associated with positive depression screen (aOR 3.2, 95%CI:1.9-5.4). Controlling for age, sex, marital status and years of work, positive depression screen was associated with working in the southern region (aOR 2.3, 95%CI:1.4-3.6), previous COVID-19 infection (aOR:2.2, 95%CI: 1.2-4.2) and expecting to probably or definitely get COVID-19 in the next year (aOR 2.8, 95%CI:1.3-5.9).

Conclusion: HCWs commonly screened positive for burnout or depression, but prevalence was not higher than reported before the COVID-19 pandemic. Regular screening for both conditions should be encouraged given consequences of these conditions for mental health and work performance and availability of feasible interventions to support HCWs.

O66.A001169. CLINICIANS’ AND NURSES; MENTAL HEALTH DURING THE COVID-19 PANDEMIC AT QUEEN ELIZABETH CENTRAL HOSPITAL, BLANTYRE, MALAWI       

Author(s): M. Chaika 1, P. Kajombo1, T. Mwaungulu 1, N. Namale1, C. Bandawe1, and A.S Muula1

Affiliation(s):

1. Kamuzu University of Health Sciences

Email: m201750043864@stud.medcol.mw  

Introduction. The COVID-19 pandemic had a psychological toll on people, especially health workers who were the frontline response against the disease. This study assessed the prevalence of anxiety and functional impairments during the COVID-19 pandemic waves 1 to 4 among health workers at Queen Elizabeth Central Hospital.

Objectives: To establish the impact of mental health problems on professional performance and to determine whether socio-demographic characteristics affect the impact COVID 19 had on health workers mental health.

Methods. This was a quantitative cross sectional study that used snowball sampling to identify health workers who had worked with COVID-19 patients. The WHO 5 wellbeing index, Coronavirus anxiety scale and Work and Social Adjustment Scale were used to evaluate the study participants. Data analysis tools utilised were Stata 12, SPSS and Microsoft Excel.

Results. Out of 96 study participants, 2.1 % (n=2) of the health workers had COVID-19 related anxiety, 16.7 % (n=16) had poor psychological wellbeing and 27.1 % (n=26) had self-reported functional impairment. There were significant differences in levels of poor psychological wellbeing in relation to age (x2=8.18, p=0.02) with higher prevalence among younger age groups of ≤30 years (81.2%, n= 13). Statistical differences were also noted in relation to vaccination status (x2=7.29, p=0.026); with participants who received the COVID-19 vaccine 76.0 %( n=73), having a higher prevalence of poor psychological well being (15.0%, n=11).

Conclusion. The findings in the study indicate that at least 1 in 6 health workers at Queen Elizabeth Central Hospital suffer from poor psychological wellbeing and 1 in 4 health workers suffer from functional impairment. Health workers’ mental health should be prioritised with evidence based interventions such as support groups.

O67.A001084. PREVALENCE OF EARLY POSTPARTUM DEPRESSION AND ASSOCIATED RISK FACTORS AMONG WOMEN IN SOUTHERN MALAWI: A NESTED COHORT STUDY           

Author(s): Moya E1,2 Mzembe G1,2, Mwambinga M2, Truwah Z2, Harding R3, Ataide R3, Larson R4, Fisher J5, Pasricha S3, Mwangi MN2, Phiri KS1,2       

Affiliation(s):

1. Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi
2. Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, BT3, Blantyre, Malawi
3. Walter and Eliza Hall Institute of Medical Research, The University of Melbourne, 1G Royal Parade, Parkville, Melbourne 3052, Australia
4. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
5. Global and Women’s Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Email: moyaernest@gmail.com

Introduction: The birth of a child should be a time of celebration. However, for many women, childbirth represents a time of great vulnerability to become mentally unwell, a neglected maternal morbidity.

Objectives: To determine the prevalence of early postpartum depression (PPD) and its associated risk factors among women giving birth at health facilities in southern Malawi.

Methods: We conducted a nested cohort study. Women were screened for early PPD using a locally validated Edinburgh Postpartum Depression Scale (EPDS) as they were discharged from the maternity ward. The prevalence of moderate/severe (EPDS≥6) and severe (EPDS≥9) PPD was determined, including 95% confidence interval (CI). Socio-demographic variables during the second trimester, obstetric and infant characteristics at delivery were examined as potential risk factors for early PPD using univariable and multivariable logistic regression analyses.

Results: A total of 636 women were enrolled, of which 9.6% and 3.3% had early PPD at EPDS cut-off ≥6 and ≥9 respectively. Multivariable analysis showed that maternal anaemia at delivery (aOR; 2.65, CI; 1.49 – 4.71, p-value; 0.001) was associated with moderate/severe early PPD. Good pregnancy outcome (aOR; 0.15, 95% CI; 0.02 – 0.55, p-value; 0.004), being single compared to divorced/widowed (aOR; 0.09, 95% CI; 0.02 – 0.55, p-value; 0.009), and attending <9 years of formal school (aOR; 0.36, 95% CI; 0.20 – 0.65, p-value; 0.001) decreased the risk for early PPD. Being HIV positive (aOR; 3.18, 95% CI; 1.19 – 8.50, p-value; 0.021) increased the risk of  severe PPD.

Conclusion: Early PPD was more prevalent in moderate/severe than severe form in our sample. We believe that early detection and appropriate treatment will prevent progression to severe depression thereby improving overall maternal quality of life and child growth and development. Hospitalisation following childbirth provides clinicians an opportunity for screening and treatment of PPD.

O68.A001327. FEASIBILITY AND ACCEPTABILITY OF GRIFFITHS SCALES OF CHILD DEVELOPMENT III IN MEASURING DEVELOPMENT IN CHILDREN IN AN URBAN SETTING IN MALAWI

Author(s): Chisomo Namathanga2,3, Maria M. Crespo-Llado1,2, Alan Beni 2,3, Vukiwe Nkhoma2,3, Richard Nkhata2, 3, Emmie Mbale2, 3, and Melissa Gladstone1

Affiliation(s):             

1. University of Liverpool,
2. Blantyre Malaria Project, 3
3. Kamuzu University of Health Sciences   

Email: embale@kuhes.ac.mw

Introduction: Early detection of neurodevelopmental problems in Low to Middle Income Countries is challenging due to the lack of standardised and culturally appropriate tools. To address this gap we developed a mobile platform, the Scalable TRans-diagnostic Early Assessment of Mental health (STREAM) tool. The construct validity of the STREAM app will be verified by comparing scores with the Griffiths Mental Development Scales (GMDS) scores. GMDS is an established gold-standard measure of development but has never been used in Malawi.

Objectives: We aim at adapting the GMDS tool for use in Malawi and test its feasibility, acceptability, and sensitivity to capture changing abilities as children mature.

Methods: All items were translated and back translated. The sample is 2000 children aged 0 to 6 years, (1850 normal children and 150 at-risk). The GMDS was piloted on 13 children to test the acceptability of the tool in Malawi. Mainly from the language domain, were adapted to be culturally appropriate. Adaptation was supervised by the developers of GMDS III.

Results: 50 children have been assessed using the GMDS;20 were 0 to 24 months, 16 were 25 to 48 months, and 14 were 49 to 72 months.

All children provided meaningful data for all subscales (cognitive, language, eye hand coordination, social and gross motor). Raw scores by age group revealed significant differences in cognitive (F(2,49)=117.7, p <0.001, n2=.83), language (F(2,48)=122.17, p<0.001, n2=.84), eye hand coordination (F(2,49)=146.9, p<0.001, n2=.86), social (F(2,49) = 153.02, p<0.001, n2=.86), and gross motor domains (F(2,48)= 123.41, p<0.001, n2= .84). For all domains, 0-12m group had significantly lower scores than both 25-48m and 49-72m groups, 25-48m group had lower scores than the 49-72m group.

Conclusion: The adapted version of the GMDS is appropriate for Malawian children, is well received by caregivers and their children, and can capture changes by age.

NUTRITION ABSTRACTS

O69.001180. DEMYSTIFYING “NAMADYABWINO”: PERCEPTIONS OF RURAL RESIDENTS IN LILONGWE, MALAWI           

Author(s): Patience Tsoka1, Khumbo Kapalamula1, Rodwell Nkhoma1, Kenam Chitatanga1, Lucy Mbale1, Alexander A. Kalimbira1

Affiliation(s):             

1. Department of Human Nutrition and Health, Bunda College, Lilongwe University of Agriculture and Natural Resources, Malawi     

Email: mildredtsoka7@gmail.com

Introduction: “Namadyabwino”, a vernacular term which literally means “the one who eats well”, is a perceived benchmark of what some in the Malawi would consider as a representation of healthy eating and healthy body weight. Consequently, the term is mostly used to describe persons who are overweight or obese and are perceived as wealthy and healthy.

Objectives: To populate perceptions and generate consensus among rural residents on the meaning of Namadyabwino and how the perceptions influence their dietary habits.

Methods: A descriptive cross-sectional study of 15 to 50-year-old men and women (n=159) was conducted in a rural setting on the outskirts of Lilongwe, Malawi’s capital. Participants responded to a semi-structured questionnaire which assessed their perceptions of Namadyabwino and how those perceptions influence their desired weight status and dietary habits. In focus group discussions (FGDs), consensus definitions and perceptions of Namadyabwino were sought, and participants were presented with Stunkard’s visual figures scale to determine weight preferences. Means and percentages were used to summarise the quantitative responses while content analysis was used to analyse the FGD data.

Results: The Namadyabwino status was perceived as being wealthy, healthy and fat, such that the majority of participants (59.1%) described Namadyabwino as an individual who is wealthy. The most frequently chosen figures on the Stunkard’s figures scale were 9 (52.8%) and 8 (17.6%), which represent obesity. More than nine in ten respondents (94.4%) expressed desire to attain the Namadyabwino status by consuming more animal foods and fats/oils, but less staples and fruits.

Conclusion: Namadyabwino is a positively perceived and desirable status among rural residents of Lilongwe, which may influence their dietary habits and attainment of overweight status. Therefore, rural residents should be targeted with healthy eating and healthy body weight messaging to minimise the risk of unhealthy eating and unhealthy body weight.

O70.A001283. ASSOCIATION BETWEEN INTIMATE PARTNER VIOLENCE AND NUTRITION STATUS OF UNDER-FIVE CHILDREN IN MALAWI: A CROSS-SECTIONAL ANALYSIS OF MALAWI DEMOGRAPHIC AND HEALTH SURVEY 2015-2016 DATA        

Author(s): Lydia Amin Kaisi1, Tzu-I Tsai2, Madalitso Khwepeya3, Francis Njala4, Wallace Hastings Goffat4, Atupele Kapito -Tembo5

Affiliation(s):

1. National Yang-Ming Chiao Tung University, College of Nursing, Taiwan.
2. National Yang-Ming Chiao Tung University, College of Nursing, Taiwan.
3. Chang Gung University, Chang Gung Medical Education Research Centre, Taoyuan City, Taiwan
4. Kamuzu University of Health Sciences, Department of Public Health, School of Global and Public Health
5. Kamuzu University of Health Sciences (KUHES) Department of Public Health and Family Medicine

Email: Kaisilydia07@gmail.com       

Introduction: Intimate partner violence (IPV) against women is a universal problem affecting an individual’s psychological and physical well-being. Studies have found that IPV against women negatively impacts their physical and mental health causing depression. Depression may affect women’s ability to take care of their children including ensuring good nutrition and feeding or seeking healthcare services. In Malawi, 37% of under-five children are stunted, 12% are underweight and 3% are wasted. Although the association between mothers’ exposure to IPV and under-five children’s nutritional status has been explored in developed and few African countries, there are no data for Malawi.

Objectives: To examine whether there is an association between women’s exposure to IPV and malnutrition among under-five children in Malawi.  

Methods: Secondary data analysis of the Malawi Demographic Health Survey 2015–2016 was used. The analysis was restricted to women with under-five children aged 15-49 years with complete information on IPV and child nutrition status. The child’s nutritional status was categorised as; Normal, stunted, underweight, or wasted.  A child was categorised as malnourished if stunted, underweight, or wasted.  Bivariate and multivariate logistic regression analyses were used to examine the association between women’s exposure to IPV and under-five children’s malnutrition status.

Results: A total of 4,548 mother-pairs were included in the analysis and the mean age for the mothers was 20.4years. Thirty-six percent (36%) of the mothers had experienced IPV and 39% (1774) of the children were malnourished. In bivariate analysis, compared to women not exposed to IPV, women who experienced IPV had higher odds of having malnourished children (cOR=1.16, 95%CI: 1.02–1.31). In multivariate analysis, compared to women not exposed to IPV, women exposed to IPV had higher odds of having a malnutrition child (aOR=1.18, 95%CI: 1.04–1.34) adjusting for the following child factors; weight at birth, size of the child at birth, sex, twin delivery, and maternal factors; education status, economic status, and antenatal care.

Conclusion:  The study has found that there is an association between women’s exposure to IPV and under-five malnutrition in Malawi. There is a need to consider developing effective and integrated interventions targeting IPV in women and child nutrition t in order to reduce both IPV and malnutrition in Malawi.

O71.A001258. CHILD AFLATOXIN EXPOSURE IS ASSOCIATED WITH POOR CHILD GROWTH OUTCOMES: A PROSPECTIVE COHORT STUDY IN RURAL MALAWI.      

Author(s): Andrew Matchado1,5, Joshua W. Smith2, Kerry J. Schulze3, John D. Groopman2, Emma Kortekangas4, David Chaima1, Charles D. Arnold5, Kenneth Maleta1, Ulla Ashorn4, Per Ashorn 4,6, Kathryn G. Dewey5, Christine P. Stewart5

Affiliation(s):             

1. School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
3. Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
4. Center for Child, Adolescent, and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
5. Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
6. Department of Paediatrics, Tampere University Hospital, Tampere, Finland

Email: amatchado@kuhes.ac.mw    

Introduction: Aflatoxin exposure has been associated with child growth faltering in cross sectional studies, but there is limited evidence from longitudinal studies.

Objectives: To evaluate the relationship between maternal aflatoxin B1-lysine adduct concentration (in utero and at 6 months postpartum), child aflatoxin B1-lysine adduct concentration (at 6 and 18 months of age) and child growth in the first 30 months of life.

Methods: Aflatoxin B1-lysine adduct was measured in mother-child dyad plasma samples using isotope dilution mass spectrometry. Linear regression models were used to assess the relationship between aflatoxin B1-lysine adduct concentration and child anthropometric outcomes assessed at 1 week and at 6, 12, 18, 24 and 30 months of age.

Results: The percentage of mothers and children with detectable plasma aflatoxin B1-lysine adduct was at least 95% except in children at 6 months when the percentage was 60%. In adjusted models, maternal aflatoxin B1-lysine adduct concentration during pregnancy was positively associated with newborn anthropometric outcomes: beta coefficients for associations between standardized values (standard deviation units) for both aflatoxin and outcomes (newborn weight-for-age z score, weight, length and head circumference) ranged from β = 0.10; 95% CI: 0.00, 0.21 to β = 0.13; 95% CI: 0.02, 0.24; P < 0.05). Child aflatoxin B1-lysine adduct concentration was negatively associated with weight-for-age z-score; length-for-age z-score; weight-for-length z-score; MUAC-for-age z-score and head circumference-for-age z-score assessed at 6, 12, 18, 24 or 30 months, with beta coefficients ranging from β = -0.11; 95% CI: -0.24, 0.03 to β = -0.21; 95% CI: -0.35, -0.07; P < 0.01, P < 0.05).

Conclusion: There is high exposure to aflatoxin in pregnant women, infants and young children in this study site in Malawi. In utero exposure was positively associated with birth size, contrary to expectations, while child exposure was negatively associated with child growth outcomes.

O72.A001384. PREVALENCE OF RISK FACTORS AND DETERMINANTS OF METABOLIC SYNDROME AMONG PATIENTS LIVING WITH HIV AND ON ANTIRETROVIRAL TREATMENT AT BWAILA LIGHTHOUSE, MARTIN PREUSS CENTRE, LILONGWE          

Author(s): Rebecca J. Chindenga1*, Lloyd Chauwa1, Alfred Ngwira2, Alexander A. Kalimbira1

Affiliation(s):

1. Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
2. Basic Sciences Department, Faculty of Agriculture, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.

Email: chindengar@yahoo.com

Introduction: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, which include central obesity, elevated blood pressure, hyperglycaemia, elevated triglycerides and low levels of high density lipoprotein cholesterol. Together, these risk factors increase the risk of heart disease, stroke and Type 2 diabetes.

Objectives: To assess the prevalence of risk factors of MetS among patients living with HIV and on antiretroviral treatment at Bwaila Lighthouse in Lilongwe.

Methods: From 101 study participants aged 18 years, data were collected on demographic, health and lifestyle factors; record of systolic and diastolic blood pressure; anthropometry (weight, height and waist circumference) and biochemical variables (triglycerides, total cholesterol, high density lipoprotein cholesterol, haemoglobin A1c and fasting blood glucose). The International Diabetes Federation criterion was used to classify MetS. In Stata v17, descriptive statistics were used to estimate prevalence of MetS. Chi-square was used to determine the association between explanatory variables and the response variable, while multivariable logistic regression was used to identify determinants of MetS.

Results: Nearly one in five (n=19, 18.8%) of the study participants had MetS. The most prevalent components of MetS were elevated waist circumference (56.4%), triglycerides (47.5%) and fasting blood glucose (42.6%). In multivariable logistic regression, gender (odd ratio (OR) =0.0013, 95% confidence interval (CI): 0.0004–0.0426, p<0.001) and elevated haemoglobin A1c (OR=14.9, CI: 2.609–85.05, p=0.002) were associated with MetS.

Conclusion: Nearly one in five patients living with HIV and on antiretroviral treatment may have MetS, largely contributed by large waist circumference, elevated triglycerides and fasting blood glucose. Given the risk of heart disease, stroke and diabetes that is associated with MetS, routine screening of such patients is warranted.

O73.A001218. VITAMIN A SUPPLEMENTATION AND IMMUNIZATION STATUS BASED ON VACCINATION CARDS IN UNDER-FIVE CHILDREN: A PILOT ON INTEGRATION OF VITAMIN A SUPPLEMENTATION IN IMMUNIZATION PROGRAM IN MALAWI

Author(s): Tapiwa Ntwere1, Francis Njala1, Janet Guta2, Mike Chisema3, Temwa Mzengeza3, Dennis Mwagomba3, Frank Msiska3, Lusungu Chitete4, Chikondi Makawa4, Jeanne Ejigui4, Mamadou Ndiaye, Atupele Kapito-Tembo1,5     

Affiliation(s):

1. Kamuzu University of Health Sciences-MAC Communicable Diseases Action Center
2. Malawi Ministry of Health Nutrition Unit
3. Malawi Ministry of Health Expanded Program on Immunisation EPI unit
4. UNICEF Malawi
5. Kamuzu University of Health Sciences, Public Health Department, School of Global and Public Health

Email: ttntwere@mac.kuhes.ac.mw

Introduction: The Malawi Ministry of Health piloted the transitioning of delivery of Vitamin A supplementation (VAS) in under-five children from bi-annual child health days’ campaign approach to integrating into routine immunisation services in 10 selected districts in Malawi from 2018 to 2020.

Objectives: To determine VAS and immunisation up to date status based on vaccination cards in under five children during integration of VAS in immunisation services in Malawi.

Methods: A cross-sectional community-based household survey was conducted in 5 pilot districts in 2021. A two-stage cluster design sampling was used to select 38 enumeration areas (EAs) in each district based on probability proportional to population size. In each EA, 8 households with at least one child aged 6-59 months were randomly selected. Child caregivers were interviewed using standardised questionnaires and information on socio-demographics, VAS and immunisation was collected. Descriptive analysis of data was done using Stata software.

Results: A total of 1,510 caregivers and 1,671 children were enrolled. Child vaccination card availability was 77%. The up to date status according to age of child using the vaccination card records was lower for VAS (36%) compared to immunisation (80%,). VAS status in districts ranged from 31% to 53% for children aged 6-11 months compared to 33% to 41% in those aged 12-59 months. The common reasons for VAS status not up to date were: health workers did not document in health passport (60%), previous vaccination card lost or damaged (27%), vitamin A capsules not available (10%), caregivers were away (3%), COVID-19 restrictions (2%) and child is grown (1%). Reasons for immunisation status not up to date were similar to those of VAS.

Conclusion: The coverage of VAS in children based on vaccination cards during pilot integration in immunisation services was low compared to immunisation coverage mostly due to lack of documentation in vaccination cards by health workers. There is a need to implement strategies to improve documentation in vaccination cards by health workers.      

O74.A001136. DIETARY INTAKE, NUTRITIONAL STATUS AND BIOMARKERS AMONG ADULTS DIAGNOSED WITH CKD ON HAEMODIALYSIS AT KAMUZU AND QUEEN ELIZABETH CENTRAL HOSPITALS IN MALAWI

Author(s): Felistace Mtande1, Getrude Mphwanthe 1, and Aaron Chikakuda1

Affiliation(s):

1. Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe Malawi

Email: mtandefelistace@gmail.com

Introduction: Chronic kidney disease (CKD) is a public health problem, with 70% of patients already on hemodialysis globally. However, CKD and hemodialysis may lead to worse health outcomes and reduced quality of life if the individuals have suboptimal nutrition.

Objectives: To assess dietary intake, nutritional status, and biomarkers among adults with CKD on hemodialysis.

Methods:  We conducted a hospital-based cross-sectional study at Kamuzu and Queen Elizabeth Central Hospitals’ dialysis units. Using convenient sampling, we recruited 40 clinically stable participants, 19 years above, who had been on hemodialysis for at least three months. We assessed nutritional status using a seven-point Subjective Global Assessment tool and dietary intake using three-day food records. Pre-dialysis blood samples were collected for creatinine and urea analysis.  Data were analysed using SPSS (26). Chi-square and t-tests were used for categorical and continuous variables, respectively. We elucidated determinants of nutritional status and dietary intake using logistic regression. 

Results: About 52.5% were females and the mean age for the participants was 37.42±12.13 years. Moderate to severe malnutrition was more prevalent in about 70% of the participants. Dietary intake was generally not adequate to meet the estimated intake per day. The average energy intake was 1509.3±439.4 kcal per day, equivalent to 26.53 kcal/kg body weight/day below Kidney Disease Outcomes Quality Initiative guidelines. Mean urea 128.97±36.83 mg/dl and creatinine 11.21±4.08 mg/dl were higher than the reference value of 5-20 and 0.6-1.2 mg/dl respectively. The odds of inadequate dietary intake increased with gastrointestinal symptoms, longer duration of hemodialysis use, and being underweight. Furthermore, the risk of being malnourished increased with inadequate dietary intake and older than 50 years.

Conclusion: Moderate to severe malnutrition was prevalent, and dietary intake was poor to meet the recommended intakes. Therefore, a multidisciplinary approach that includes dietetic services is a prerequisite for managing CKD.

COVID-19 & HEPATITIS EPIDEMIOLOGY ABSTRACTS

O75.A001146. HISTOPATHOLOGICAL CHANGES IN VITAL ORGANS IN PATIENTS WITH COVID-19 IN MALAWI      

Author(s): Takondwa Rex Namalima1,2,6, Steve Kameza3, Weiger Voskuijl3,5   Charalompus Attipa1,7, Dennis Chasweka5, Memory Siwombo 3,6, Peter Banda 3, 6, Ben Morton1, Chisomo Eneya5, Flora Dickson5, Stanley Khoswe5, Abel Tembo5, Frank Ziwoya5, Kingsley Makwakwa3, Chikondi Makwinja5, Deborah Nyirenda5, Isabel Potani5, Leticia Suwedi5, Sarah Lawrence8, Donna Demo8, and Christopher A. Moxon1,2,4    

Affiliation(s):

1. Malawi Liverpool- Wellcome Trust Clinical Research program, Kamuzu University of Health sciences, Blantyre Malawi
2. Blantyre malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
3. Kamuzu University of Health Sciences, Blantyre Malawi
4. Wellcome Centre for Integrative Parasitology, Institute of Infectious, Immunity and Inflammation, University of Glasgow
5. The childhood Acute illness & nutrition (CHAIN) network, Kamuzu University of Health Sciences, Blantyre, Malawi
6. Medicine department, Queen Elizabeth Central Hospital, Blantyre Malawi
7. Department of clinical science, Liverpool school of tropical medicine, Liverpool, UK
8. University of Washington, Seattle, Washington, USA

Email: trnamalima@gmaill.com

Introduction:  Autopsy studies have been useful in understanding histopathological changes to the lung and other vital organs in Covid-19 cases. This information has been helpful in making therapeutic interventions directed at the pathological process in other settings. There is little information on pathological processes in Covid-19 among the African population. However, this is key to understanding whether similar or different therapeutic interventions are indicated.

Objective:  To understand the histopathological changes to vital organs in fatal Covid-19 cases and to determine the cause of death.

Methods: We recruited sixteen deceased adult subjects from Queen Elizabeth central hospital, Blantyre, Malawi within 12 hours of death; Eight Covid-19 cases, five lower respiratory tract infection (Covid-19 negative) and three with no lower respiratory tract illness cases. We collected and analysed demographic and ante-mortem clinical information, blood for a detailed laboratory panel, CSF and core biopsy from vital organs. All cases were also tested for Covid-19. 

Findings:   Among Covid-19 cases, we saw marked alveolar changes (diffuse alveolar damage, type 2 cell hyperplasia, alveolar emphysema and oedema) consistent with findings in western and eastern world. In contrast, while thrombosis was observed among our cases, it was less compared with other countries. Fibrosis was only identified in one case. There were no Covid-19 specific changes in any extra pulmonary organs. All cases that had classical Covid-19 associated changes post-mortem and positive post-mortem SARS-CoV2 PCR results were identified and treated as Covid-19 pneumonia ante-mortem.

Conclusion: Alveolar damage dominating lung pathology in Covid-19 patients indicate similarities in disease process with other populations. Lack of fibrotic changes and extra-pulmonary disease may be related to rapid death. There is concordance between ante-mortem and post-mortem Covid-19 diagnosis.  Ongoing immunological investigations within the study may provide further therapeutic interventions.

O76.A001229. ASTRAZENECA COVID-19 VACCINE INDUCES ROBUST BROADLY CROSS-REACTIVE ANTIBODY RESPONSES IN MALAWIAN ADULTS PREVIOUSLY INFECTED WITH SARS-COV-2

Author(s): Marah G Chibwana1, Thandeka Moyo-Gwete2, Guarav Kwatra3, Jonathan Mandolo1, Tandile Hermanus2, Ndaona Mitole1, Chisomo Jassi1, Raphael Kamng’ona1, Henry Mwandumba1,4, Stephen B. Gordon1,4, Khuzwayo Jere1,5, Shabir Madhi3, Penny L. Moore2, Robert S. Heyderman6, Kondwani C. Jambo1,4    

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2. National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
3. Respiratory and Meningococcal Pathogens Research Unit, Johannesburg, South Africa
4. Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
5. Centre for Global Vaccine Research, Institute of Infection, Veterinary Ecological Sciences, University of Liverpool, Liverpool, UK
6. NIHR Global Health Research Unit on Mucosal Pathogen, Research Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom

Email: mchibwana@mlw.mw

Introduction: Binding and neutralising anti-Spike antibodies play a critical role in the control of SARS-CoV-2 infection. The emergence of new highly immune evasive variants has raised concerns about the longevity of antibodies induced by natural infection and vaccination. We aimed to assess the dynamics of antibodies induced by natural infection and subsequently augmented by COVID-19 vaccination.

Methods: We recruited 52 individuals who had recovered from prior laboratory-confirmed mild/moderate COVID-19 in Blantyre, Malawi, and followed them up for 270 days. 12 of these participants received a single dose of the AstraZeneca COVID-19 vaccine (ChAdOx nCov-19). Serum samples were collected from all participants and a Luminex-based assay was used to measure anti-Spike and receptor-binding domain (RBD) IgG antibodies. A pseudovirus neutralisation assay was used to measure neutralising antibody titres against multiple variants of concern (VOCs).

Results: Neutralising antibody titres declined within the first 6 months following PCR confirmed mild/moderate SARS-CoV-2 infection (30-60 days vs 210-270 days; Log ID50 6.8 vs 5.3, p=0.0093). A subset of the participants (n=12) was vaccinated at a median of 60 days post confirmed mild/moderate COVID-19.  In these participants, a single dose of the AstraZeneca COVID-19 vaccine led to a 2 to 3-fold increase in anti-Spike and RBD IgG antibodies. The anti-Spike and RBD IgG antibodies in the vaccinated individuals were broadly cross-reactive against multiple VOCs and had potent neutralisation against the D614G, beta, and delta variants.

Conclusion: SARS-CoV-2 neutralising antibodies wane within 6 months post laboratory-confirmed mild/moderate COVID-19. A single dose of the AstraZeneca vaccination in individuals with prior SARS-CoV-2 infection induces hybrid immunity evidenced by cross-reactive antibodies against multiple VOCs. This data has implications for vaccination policies in sub-Saharan Africa where there is limited access to COVID-19 vaccines.          

O77.A001080. LONGITUDINAL SARS-COV-2 SEROSURVEILLANCE STUDY IN URBAN AND RURAL COHORTS IN MALAWI: CHARACTERISING NEUTRALISING ANTIBODY RESPONSES USING PSEUDOTYPED VIRUS NEUTRALISATION ASSAYS        

Author(s): Mhairi McCormack *1,2. Antonia Ho*1, Ellen Hughes1, Louis Banda 2, Stephen Kasenda 2, Estelle McLean 1, Alison Price 2, Amelia Crampin 2, David Chaima 3, Abena S Amoah†2. Brian Willett†2 and Tonney Nyirenda†2

Affiliation(s):

1. University of Glasgow, Centre for Virus Research: Mhairi McCormack, Antonia Ho, Ellen Hughes, Brian Willett
2. Malawi Epidemiology and Intervention Research Unit: Louis Banda, Stephen Kasenda, Estelle McLean, Alison Price, Amelia Crampin, Abena S Amoah
3. Kamuzu University of Health Sciences: David Chaima, Tonney Nyirenda

Email: m.mccormack.1@research.gla.ac.uk

Introduction: The extent of SARS-CoV-2 exposure and transmission in Malawi is unclear due to limited testing and a high proportion of mild/asymptomatic infections. Existing SARS-CoV-2 seroprevalence studies have been cross-sectional, focused on ELISAs and convenience samples (e.g. blood donors and healthcare workers).  

Objectives: To determine burden and factors affecting SARS-CoV-2 neutralising antibody seroprevalence and strength in urban and rural Malawi, using data from a community-based, longitudinal serosurveillance study.

Methods: Sera were obtained from 2,005 participants in rural (Karonga; n=1,005) and urban (Lilongwe; n=1,000) Malawi, at 3-monthly intervals between February 2021 and April 2022 (Surveys 1-4). HIV-based pseudotyped virus neutralisation assays targeting SARS-CoV-2 spike protein assessed neutralising antibody responses against the ancestral (D614G), Beta (B.1.351), Delta (B.1.617.2), and Omicron (BA.1) variants, with 90% reduction as the positive result threshold. Data from Surveys 1 to 3 and HIV-negative participants were included (sera from HIV-positive individuals interfered with the HIV-based assay).

Results: Seroprevalence of neutralising antibodies increased with time and differed between locations (Survey 1: 6.5% Karonga, 11.7% Lilongwe; p<0.001) (Survey 3: 15.9% Karonga, 34.5% Lilongwe; p<0.001). The viral variants participants were exposed to differed with site and time: new variants appearing first in Lilongwe. Unvaccinated participants ≥60 years with positive neutralisation assay tests had lower percentage neutralisation compared participants <60 years (Survey 1, B.1.351: 88.0% vs. >90%; p=0.0013). Individuals reporting >1 COVID-19 vaccines had higher neutralising antibody responses compared with unvaccinated participants (Survey 1, D614G: 31.5% vs. 89.4%; p<0.001). Vaccination rates increased from 5.0% in Survey 1 to 17.5% in Survey 3 (p<0.001).

Conclusions: Neutralisation seroprevalence was high and increased over time; especially in Lilongwe, which is a travel hub with higher population density. Vaccination effectively induced neutralising antibodies. With limited vaccine supply, participants ≥60 years should be prioritised to boost their low neutralising antibodies post exposure relative to participants <60 years.     

O78.A001232. COVID-19 SELF-TESTING USING ANTIGEN RAPID DIAGNOSTIC TESTS: FEASIBILITY EVALUATION AMONG HEALTH-CARE WORKERS AND GENERAL POPULATION IN MALAWI        

Author(s): Madalo Mukoka1, Euphemia Sibanda1, Constancia Watadzaushe1, Moses Kumwenda1, Florence Abok1, Elizabeth L. Corbett2, Elena Ivanova1, Augustine Talumba Choko1

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Malawi Liverpool Wellcome Trust, Blantyre Malawi

Email: mmukoka@kuhes.ac.mw       

Introduction: COVID-19 testing is critical for identifying cases to prevent transmission. SARS-CoV-2 self-testing has the potential to increase diagnostic testing capacity and to expand access to hard-to-reach areas in low-and-middle-income countries. We investigated the feasibility and acceptability of COVID-19 self-sampling and self-testing using SARS-CoV-2 Ag-RDTs.

Methods: July 2021 to February 2022, we conducted a mixed-methods cross-sectional study examining self-sampling and self-testing using Standard Q and Panbio COVID-19 Ag Rapid Test Device in Urban and rural Blantyre, Malawi. Health care workers and adults (18y+) in the general population were systematically sampled.

Results: Overall, 1,330 participants were enrolled of whom 674 (56.0%) were female with 664 for self-sampling and 666 for self-testing. Overall mean age was 30.7y (standard deviation [SD] 9.6). Self-sampling usability threshold for Standard Q was 273/333 (82.0%: 95% CI 77.4% to 86.0%) and 261/331 (78.8%: 95% CI 74.1% to 83.1%) for Panbio. Self-testing threshold was 276/335 (82.4%: 95% CI 77.9% to 86.3%) and 300/332 (90.4%: 95% CI 86.7% to 93.3%) for Standard Q and Panbio, respectively. Agreement between self-sample results and professional test results was 325/325 (100%) and 322/322 (100%) for Standard Q and Panbio, respectively. For self-testing, agreement was 332/333 (99.7%: 95% CI 98.3 to 100%) for Standard Q and 330/330 (100%: 95% CI 99.8 to 100%) for Panbio. Odds of achieving self-sampling threshold increased if the participant was recruited from an urban site (odds ratio [OR] 2.15 95% CI 1.44 to 3.23, P < .01. Compared to participants with primary school education those with secondary and those with tertiary achieved higher self-testing threshold OR 1.88 (95% CI 1.17 to 3.01), P = .01 and 4.05 (95% CI 1.20 to 13.63), P = .02, respectively.

Conclusions:  One of the first studies to demonstrate high feasibility of self-testing using SARS-CoV-2 Ag-RDTs in low- and middle-income countries potentially supporting large scale-up.

O79.A001284. COMPARISON OF MATERNAL AND NEONATAL OUTCOMES OF COVID-19 BEFORE AND AFTER SARS-COV-2 OMICRON EMERGENCE IN MATERNITY FACILITIES IN MALAWI (MATSURVEY): DATA FROM NATIONAL SURVEILLANCE PLATFORM   

Author(s): Leonard Mndala1*, Edward J M Monk1*, Deborah Phiri1, Jennifer Riches1, Regina Makuluni1, Luis Gadama2, Fannie Kachale3, Rosemary Bilesi3, Malangizo Mbewe3, Andrew Likaka4,5, Chikondi Chapuma1, Moses Kumwenda1,2, Bertha Maseko1, Chifundo Ndamala1, Annie Kuyeri1, Laura Munthali1, Marc Y R Henrion1,6, Clemens Masesa1,6, David Lissauer1,7           

Affiliation(s):

1. Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
2. Kamuzu University of Health Sciences, Blantyre, Malawi
3. Ministry of Health, Lilongwe, Malawi
4. Malawi Blood Transfusion Services, Blantyre, Malawi
5. Universidade Federal de Pernambuco, Recife, Brazil
6. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
7. University of Liverpool, Liverpool, United Kingdom        

Email: lmndala@mlw.mw

Introduction: Outcomes of omicron-associated COVID-19 in pregnancy have not been reported from low-resource settings, and data before the emergence of omicron are scarce.

Objectives: To compare maternal and neonatal outcomes of COVID-19 in Malawi during the omicron wave to the preceding waves of beta and delta, utilising MATSurvey online platform.

Methods: Pregnant and recently pregnant patients, up to 42 days following delivery, admitted to 33 health-care facilities with symptomatic, test-proven COVID-19 during the second (beta: January to April 2021), third (delta: June to October 2021), and fourth (omicron: December 2021 to March 2022) waves were included. Demographic and clinical features, maternal outcomes of interest, and neonatal outcomes of interest were compared between the fourth wave and the preceding waves using Fisher’s exact test. Adjusted ORs for maternal outcomes were estimated using mixed-effects logistic regression.

Results:  Between Jan 1, 2021, and March 31, 2022, 437 patients in 28 health care facilities had symptoms of COVID 19. SARS-CoV-2 was confirmed in 261 patients; of whom 76 (29%) had a severe maternal outcome and 45 (17%) died. These outcomes were less common during the fourth wave (omicron) than the second (aOR of severe maternal outcome: 3·96 [95% CI 1·22–12·83], p=0·022; aOR of maternal death: 5·65 [1·54–20·69], p=0·0090) and third waves (aOR: 3·18 [1·03–9·80], p=0·044; aOR: 3·52 [0·98–12·60], p=0·053). Shortness of breath was the only symptom associated with poor maternal outcomes of interest (p< 0·0001) and was less frequently reported in the fourth wave (23%) than in the second wave (51%; p=0·0007) or third wave (50%; p=0·0004). During the second and third waves, 12 (13%) of 92 singleton neonates were stillborn.

Conclusion:  Maternal and neonatal outcomes of COVID 19 were less severe during the fourth wave. Electronic surveillance platforms aid in establishing direct impact of a pandemic in pregnancy while it is on-going.

O80.A001170. THE CHIWINDI STUDY: PRELIMINARY RESULTS FROM A COMMUNITY-BASED HEPATITIS B SEROSURVEY IN KARONGA, MALAWI           

Author(s): Riches N1, Njawal T1, Thom N1, Mkandawire C1, Phiri F1, Banda L1, Mzumara, W2, Nkoka O2, MacPherson, P3, Stockdale A3, and Crampin A1         

1. Malawi Epidemiology and Intervention Research Unit
2. Department of HIV/AIDS and viral hepatitis, Ministry of Health
3. Public Health Group, Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
4. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.

Email: nicholas.riches@lstmed.ac.uk

Introduction: Hepatitis B virus (HBV) is the leading cause of liver cirrhosis and hepatocellular carcinoma in Africa, despite the existence of a highly-effective vaccine and drug therapies to improve individual outcomes. The Chiwindi study aims to describe risk factors for HBV infection and for the development of liver disease in people living with chronic HBV, in order to improve the early diagnosis and treatment of HBV in Malawi.

Methods: The Chiwindi serosurvey is testing 5,000 adults (18+) resident within rural (Southern Karonga District) and urban (Area 25, Lilongwe) health and demographic surveillance sites run by the Malawi Epidemiology and Intervention Research Unit (MEIRU). Testing is nested within the MEIRU Healthy Lives Malawi (HLM) study of long-term conditions, whose participants are consented for hepatitis B surface antigen testing (Monolisa HBsAG ULTRA). Positive cases are invited to clinic to be assessed for treatment eligibility, including by transient elastography (TE) and HBV DNA measurement using Xpert HBV.

Results: Interim results show 91 HBsAg-positive people from the first 1847 tests in Karonga (4.9%; 95% CI 4.0-6.0), all newly-diagnosed. The prevalence in men (5.7%; 95% CI 4.4-7.4%) was significantly higher than in women (3.4%; 95% CI 2.4-4.7%; p=0.03). HBV prevalence among people living with HIV was 7.4% (95% CI 4.0-12.2%) compared to 4.6% (95% CI 3.6-5.8%) among HIV-negative residents (p=0.2). Directly age-standardised adult seroprevalence was 4.5% (95% CI 3.6-5.6%). Clinic reviews of 69 participants were completed: 7.9% (95% CI 3.0-16.7%) had significant fibrosis (TE >7.9kPa), and 26.4% (95% CI 15.9-39.4%) had HBV DNA greater than 2,000 copies/ml. 4/53 (7.5%) met treatment thresholds based on European Liver Association (EASL) criteria.

Conclusions:   There is a substantial burden of undiagnosed hepatitis B infection in Karonga, including individuals who require HBV treatment. Future findings will expand the serosurvey to Lilongwe and evaluate the performance of different blood biomarkers in predicting liver fibrosis and cirrhosis.

ANTIMICROBIAL RESISTANCE ABSTRACTS – POSTER

P82.A001469. INVESTIGATING THE IMPACT OF PHARMACEUTICAL RESIDUES ON ANTIMICROBIAL RESISTANCE FROM WASTEWATER TREATMENT PLANTS IN BLANTYRE, MALAWI          

Author(s): Edna Ibrahim1, Charity Mkwanda1, Edward Masoambeta1, Chisomo Msefula 1, Save Kumwenda 2, and Janelissa Musaya1

Affiliation(s):

1. Pathology Department, Kamuzu University of Health Sciences
2. Malawi University of Business and Applied Sciences    

Email: ednabrhm@gmail.com

Introduction:  Wastewater treatment plants (WWTPs) are important point sources of antibiotics and antibiotic-resistant bacteria in the environment. The fate of antibiotics and other pharmaceuticals in WWTPs is greatly influenced by the design and operation of treatment systems. In an attempt to address the knowledge-gap on the presence of pharmaceuticals residues in wastewater treatment plants in Malawi, this paper discusses a cross-sectional study that will investigate pharmaceuticals residues from wastewater treatment plants in Blantyre, Malawi and associated resistant bacteria. This is due to concerns related to residual antibiotics in aquatic ecosystem from wastewater discharged to the environment. The study aims to investigate the impact of pharmaceutical residues on antimicrobial resistance in effluent from wastewater treatment plants (WWTPs) in Blantyre Malawi.

Objectives:

1. To determine the present antibiotic residues in effluent of WWTPs
2. To quantify the present antibiotic residues in the effluents
3. To isolate bacteria from WWTPs
4. To determine antibiotic sensitivity of the identified bacteria

Methods: Samples will be collected from Soche, Limbe and Blantyre wastewater treatment plants. Gas Chromatography-Mass spectrometry will be used to identify pharmaceutical residues and quantify them using Liquid Chromatography with tandem mass spectrometry. Biological analysis will also be conducted by culturing the samples on selected media and testing for antimicrobial susceptibility using standard Kirby-Bauer disk diffusion. All recorded results will be transferred to a statistical package for social science (IBM SPSS) Version 20 and statistical test will be done using Analysis of Variance.

Expected Results: The study expects to detect pharmaceutical residues in both low and high concentration levels and some bacteria being resistant to the detected residues in wastewater effluents.

P83.A001073. PREVALENCE OF MRSA COLINISATION AMONG PATIENTS ADMITTED WITH INJURIESAT MACHINGA DISTRICT HOSPITAL    

Author(s):      Dorothy Donata Moyo1,2, Daniel Lawadi Banda3, Janelisa Musaya4

Affiliation(s):

1. Pathology Department, Kamuzu University of Health Sciences Blantyre, Malawi
2. Machinga District Hospital Laboratory Department
3. Medical Laboratory Sciences Department, Kamuzu University of Health Sciences Blantyre, Malawi
4. Malawi Liverpool Wellcome Trust Clinical Research Program Blantyre, Malawi  

Email: mdorothydonata@yahoo.co.uk

Introduction: MRSA is a major challenge to the treatment of S. aureus infections. People colonized with MRSA are at risk of developing a subsequent infection and present an important MRSA reservoir for further transmission.

Objectives: The main objective of this study was to determine prevalence of MRSA colonization among patients admitted with injuries at Machinga District Hospital.

Methods: A longitudinal research design was used. Participants between 5 to 65 years old consented to take part in the study. Samples from both anterior nares and site of the wound were collected. Samples were cultured to identify individuals with MRSA colonisation at admission and within their hospital stay. Antimicrobial susceptibility testing was performed for S.A positive samples by disc diffusion method. An interview guide was used to acquire demographic data and ascertain the exposure to risk factors for MRSA carriage. Data analysis was done using statistical package STATA 15. The prevalence of MRSA among patients admitted with injuries was estimated with 95% CI.

Results: A total of 232 individuals participated in the study. 116 had a wound and 116 had no wound. Nasal colonisation with S. aureus was seen in 42/232 (18.1%) individuals but only 7/232 (3%) were confirmed to be MRSA by Oxacillin disk diffusion method. 2/7 (28.6%) of MRSA isolates were from the community. Prevalence of MRSA colonisation among patients admitted with injuries was 6/116 (5.17%) in our study. Antibiotic resistant to Penicillin was 85.71%, Erythromycin 42.86%, and Ciprofloxacin 30.95%. All isolates were 100% sensitive to Vancomycin and Rifampicin regardless of their Methicillin status.

Conclusion: We found prevalence of MRSA colonisation among patients admitted with injuries to be at 5.17% in this study and 28.6% of MRSA isolates from the community suggesting a considerable reservoir for possible transmission. We recommend screening of MRSA colonisation to patients admitted with injuries to combat transmission and avoid subsequent infection.

P84.A001328. “I DON’T HESITATE TO USE THE LEFT- OVER ANTIBIOTICS FOR MY CHILD” PRACTICE, EXPERIENCES WITH ANTIBIOTIC USE AMONG CAREGIVERS OF PAEDIATRIC PATIENTS AT ZOMBA CENTRAL HOSPITAL, MALAWI 

Author(s): Redson B. Machongo1 and Alinane Linda Nyondo-Mipando2       

Affiliation(s):

1. Adult Health Nursing Department, School of Nursing, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Blantyre 3, Malawi.
2. Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Blantyre 3, Malawi

Email: rmachongo@kuhes.ac.mw

Introduction: Inappropriate use of antibiotics is among the major causes of the global emergency of antibiotic resistance. The spread of antibiotic resistance is causing not only increased morbidity and mortality among children but also a high economic burden. The inappropriate use of antibiotics among children is of special concern because they are still developing immunological systems, hence they are susceptible to many infectious diseases. As such, they receive a considerable disproportional amount of antibiotics which exposes them to antibiotics resistance. Parents’ experiences and practices on how to use antibiotics have important effects on the management of childhood illness. The aim of the study was to explore the lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital.

Objectives:

1. To describe perceptions of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital.
2. To explore practices of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital.
3. To determine factors that influence caregivers of children under the age of five years at Zomba Central Hospital.

Methods: This was a descriptive phenomenological qualitative study that was conducted from May 2019 to July 2020. Participants were selected following a purposive sampling approach in the Paediatric ward. Key informant interviews among 7 health care workers and 16 in-depth interviews among caregivers were conducted.  Data were analysed manually using thematic content approach.

Results: Caregivers had little knowledge about antibiotic use and their resistance. Most caregivers used the antibiotics inappropriately through self-medication, use of left-over antibiotics, buying of antibiotics without prescription, and sharing of antibiotics.

Conclusion: There is a need for investment in public awareness and initiating community-led interventions to curb the misuse of antibiotics.

P85.A001400. THE PREVALENCE OF MULTI-DRUG RESISTANT TUBERCULOSIS DISEASE IN CLINICAL ISOLATES IN BLANTYRE AND LILONGWE, MALAWI

Author(s): Tionge Sikwese1

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre Malawi

Email: tdsikwese@kuhes.ac.mw

Introduction: Drug-Resistant Tuberculosis disease is an emerging issue in Malawi. Drug-resistant TB continues to be a public health threat. Worldwide in 2019, close to half a million people developed rifampicin-resistant TB, of which 78% had multidrug-resistant TB.  Early diagnosis of TB and drug-resistant disease is of particular importance in human immunodeficiency virus (HIV)-infected individuals, as delay of therapy and drug-resistant TB can be devastating in those with compromised immune systems.

Objectives:

1. To investigate the prevalence of drug-resistant tuberculosis in clinical isolates in Blantyre and Lilongwe.
2. To investigate the agreement between molecular and conventional methods of detecting MDR TB.
3. To describe the association between MDR-TB and Age and Sex.

Methods: We conducted a cross-sectional evaluation study using pre-existing MTB-positive clinical isolates at KUHeS in Blantyre and National TB Reference Laboratory in Lilongwe. We conducted molecular characterization on 129 MTB positive clinical Isolates using the Line Probe Assay. The results were compared to phenotypic DST assessment.

Results: National TB Reference Laboratory, the prevalence of MDR TB by LPA was 18.18% (95% CI:10.5% –  25.8%).  The prevalence of mono-resistance by LPA was 6.06% (95% CI: 1.36% – 10.76%).  The prevalence of MDR TB by phenotypic DST was 29.29% (95 CI:20.32% – 38.26). The prevalence of mono-resistance TB by phenotypic DST was 70.70% (95% CI:2.02% –  12.12%). Combining the results of these two tests; LPA and phenotypic DST at 95% CI, there was a substantial agreement on the prevalence of MDR TB with the point estimate of 67.08%. Blantyre site at 95% confidence interval, the point estimate for MDR TB was 0% while for mono-resistance TB was 3.3%.

Conclusion: There is a high prevalence of MDR-TB among patients whose samples are sent to the Lilongwe National TB Reference Laboratory.

P86.A001164. CHARACTERIZATION OF MULTI-DRUG RESISTANT SALMONELLA USING LONG READ GENOME SEQUENCING          

Author(s): P. Nyambi1, S. Owen2, J. Hinton2, M. Gordon2, P. M. Ashton2

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre Malawi
2. Malawi Liverpool Wellcome Trust, Blantyre Malawi

Email: m201970135444@stud.medcol.mw

Introduction: Salmonella enterica subspecies enterica serovar Typhimurium sequence type 313 (S. Typhimurium ST313) is a major cause of invasive non-typhoidal Salmonella in many sub-Saharan African countries. Studying Salmonella Typhimurium ST313 genomes has enhanced our understanding of the pathogen, including the mechanism by which it is resistant to antibiotics. While most ST313 are resistant to ampicillin, chloramphenicol and co-trimoxazole there have been reports of ST313 resistant to third generation cephalosporins such as ceftriaxone.

Objectives: To identify the location (plasmid or chromosome) of the blaCTX-M-15 gene responsible for production of a resistant extended spectrum beta lactamase enzyme, which helps resist third generation cephalosporin antibiotics.

Methods: We used long-read sequencing (PacBio) to generate a complete genome for an isolate of ST313 which was resistant to ceftriaxone. The isolate came from an iNTS patient who had travelled from Kenya to the UK, and was isolated by Public Health England. After sequencing of the genome was done, the assembly of reads of the sample was first in series of processing with polishing following, and then annotation of the genes was done.

Results: We found that the gene blaCTX-M-15 was incorporated into the chromosome of the pathogen. Furthermore, 90% of the 300kb pST313 that had previously been described in Kenya as encoding the blaCTX-M-15, was also integrated into the chromosome.

Conclusion: Having the gene incorporated in the chromosome could mean that the ESBL gene will be more persistent within the ST313 lineage, further reducing the treatment options for this serious invasive disease. The implications of 90% of the plasmid being integrated need to be further investigated.

P87.A001088.  GENOMIC EPIDEMIOLOGY OF A CLUSTER OF EXTENSIVELY DRUG RESISTANT SALMONELLA ENTERICA SUBSPECIES ENTERICA SEROTYPE ISANGI AT A TERTIARY HOSPITAL IN BLANTYRE, MALAWI USING THE MINION SEQUENCE  

Author(s): Belson Kutambe1, Happy Banda1, Priyanka Patel1, Heather Galloway1, Samantha Lissauer1, Catherine Anscombe1, Melita Gordon1, and Philip Ashton1

Affiliation(s):

1. Malawi Liverpool Wellcome Trust, Blantyre Malawi        

Email: bkutambe@mlw.mw

Introduction: At Queen Elizabeth Central Hospital (QECH), a large tertiary referral centre in Blantyre, Malawi, there was a prolonged outbreak of extensively drug-resistant (XDR) Salmonella spp. which caused 21 cases between April 2018 and February 2021. We identified it as belonging to serogroup 6,7, but no further identification was possible. The responsible isolates were resistant to ampicillin, cefpodoxime, chloramphenicol, ciprofloxacin and co-trimoxazole, leaving few treatment options in our setting.

Objectives: To investigate the genomic epidemiology of the cluster of cases using the MinION sequencer.

Methods: We sequenced 24 XDR Salmonella spp. on the ONT MinION at MLW. Raw data was base-called with Guppy v5, de novo assembly was carried out with Flye, followed by polishing with Racon and Medaka. In silico serotyping was carried out using the Salmonella In Silico Typing Resource (SISTR). An alignment of the variable positions was generated using Split K-mer Analysis (SKA), and a phylogenetic tree derived using IQTREE v1.3.

Results: We sequenced 24 Salmonella spp, of which 16 had sufficient depth for further analysis. Fourteen of 16 sequences were identified by SISTR as Salmonella enterica subspecies enterica serotype Isangi, while the remaining two were S. Typhimurium ST313. The AMR phenotype of the ST313 isolates was predicted to be MDR, not XDR, suggesting either misidentification in the laboratory or mixed infections.

Phylogenetic analysis showed considerable diversity between the isolates, with the maximum pairwise SNP distance being 903 SNPs, and the median pairwise distance being 52 SNPs. There were four isolates from a malnutrition ward which formed a paraphyletic clade with one isolate from a different ward nested within it. The isolates from the malnutrition ward spanned a range of more than 1 year. In addition, two patients on different wards had infections within 9 days of each other which were only 8 SNPs apart. We report a prolonged outbreak of cases of XDR Salmonella enterica subspecies enterica serotype Isangi at a large tertiary referral hospital in Blantyre, Malawi. At least 6 of the 14 confirmed cases are either definite or probable hospital acquired infections, with at least 1 case being a probable community acquired case.

Conclusion: S. Isangi is not a widely studied serotype, but has been associated with nosocomial outbreaks in South Africa and the USA. The prolonged nature of the outbreak, and the hospital acquired epidemiology of at least some of the infections, combined with the previous reports of nosocomial infections leads us to hypothesise that S. Isangi is a hospital adapted Salmonella enterica.

Phylogenetic results indicated that some wards may be persistently contaminated with the same clades of S. Isangi leading to infections over the span of more than a year. We also observed very closely genetically related S. Isangi within a short range of time on two different wards, indicating potential transmissions between wards.”

P88.A001267. INVESTIGATING THE EFFECT OF gyrA, gyrB, parC and parE MUTATIONS ON TOPOISOMERASE-CIPROFLOXACIN INTERACTION IN S. TYPHI ISOLATED IN BLANTYRE

Author(s): Ernest Matambo1, Phillip Ashton2, Benjamin Kumwenda 1

Affiliation(s):

1. Kamuzu University of Health Sciences
2. University of Liverpool

Email: ematambo@kuhes.ac.mw     

Introduction: Decreased susceptibility of S. Typhi to ciprofloxacin, the recommended antibiotic for treatment of typhoid fever in Malawi, has been detected in Blantyre.

Objectives: To investigate the effect of gyrA, gyrB, parC and parE mutations on topoisomerase-ciprofloxacin interaction in S. Typhi isolated in Blantyre using in silico methods

Methods: GyrA, gyrB, parC and parE gene sequences were extracted from assembled S. Typhi genomes using a ncbi-blast+ ver 2.9.0-2. A Python script was developed to identify mutations and their positions in the extracted gene sequences. A protein structure prediction of the mutants and reference sequences was done and the resulting structures were superimposed in PyMol ver 2.3.0. Effect of mutations on protein free energy was investigated using FoldX plug-in tool in YASARA. Comparison of binding energy of the mutant and reference topoisomerases to ciprofloxacin was done through docking using AutoDockTools-1.5.6.

Results: Two hundred and ten gyrA, gyrB, parC and parE gene sequences were extracted from the assembled genomes. GyrA_D538N (n=206), gyrA_S83F(n=7), gyrA_D87G (n=1), gyrA_M334I (n=1) and gyrA_A384V (n=1) were the identified mutations in gyrA, gyrB_S464F (n=7) and gyrB_I471S (n=1) were the identified mutations in gyrB while parC_L560I was identified in one parC sequence. Four distinct sequences were identified in gyrA, two in gyrB and one in parC sequences, excluding the wild types.

Except gyrA_M334I and gyrA_A384V, all mutations occurred on the surface of the topoisomerases. GyrB_S464F was the most stabilising mutation (-1.42199 kcl/mol) whilst gyrB_I471S was the most destabilising (3.28201 kcl/mol). All mutants had higher binding energy to ciprofloxacin than the reference (gyrA: -9.53 kcl/mol, gyrB: -9.61 kcl/mol and parC: -10.83 kcl/mol)

Conclusion: GyrA_S83F, gyrA_D87G and gyrB_S464F mutations were identified in the S. Typhi samples analysed and, in other studies, were associated with decreased susceptibility and resistance to ciprofloxacin. The study findings suggest that mutations reduced topoisomerase-ciprofloxacin interaction.

P89.A001446.             A PROPOSED STUDY TO ESTIMATE THE ECONOMIC COSTS OF ANTIMICROBIAL RESISTANCE IN ONE HEALTH SETTING IN MALAWI       

Author(s):  Edward Masoambeta1, Charity Mkwanda1, Edna Ibrahim1, Watipatso Kasambala2, Rajab Mkakosya1, Janelisa Musaya1, Chisomo Msefula1, and Jobiba Chinkhumba3,

Affiliation(s):

1. Pathology Department, Kamuzu University of Health Sciences, Blantyre Malawi
2. Public Health Institute of Malawi, AMR, NCC, Lilongwe Malawi
3. Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre Malawi

Email: masoambeta.edward@gmail.com

Introduction: Malawi and other nations in Africa are experiencing an increase in infections that are difficult to treat. The National Antimicrobial Resistance (AMR) strategy to help combat AMR requires evidence on access and use of medication and economic cost benchmark figures. Nation-wide economic cost estimation is needed to derive interventions and guide allocation of resources to help reduce AMR in Malawi.  Aim of the study was to estimate the economic burden of AMR across one health setting in Malawi.

Objectives:

1. To estimate economic costs burden of AMR in humans,
2. To estimate effect of AMR on productivity of chickens,
3. To conceptualise AMR costs in the environment,
4. To model the social-economic burden of AMR in Malawi.

Methods: Data from eight AMR surveillance sites for humans and three for animals on costs of illness related to AMR and productivity of animals will be collected. Objective 1 is a facility based prospective cohort-study following patients with AMR infection tested using blood culture and urine, analysed using 2-stage least squares regression technique. Objective 2 is a retrospective research using secondary data from Mikolongwe veterinary. The data will be analysed descriptively in order to quantify the productivity costs among layers with and without AMR infection. For objective 3 and 4, systematic literature review will be used together with results from objectives 1 and 2 to conceptualise and also model a country specific estimation of AMR in the environment with regards to limited resources.

Expected Results: The study will provide context specific and accurate estimation of AMR economic costs in Malawi which can be used to guide policy and come up with guidelines for improving the current national action plan on antimicrobial resistance and appreciate the extent of the problem in monetary terms which will provoke ways to channel resources in fighting AMR.

P90.A001417. MAPPING THE TAXONOMY AND ANTIMICROBIAL RESISTANCE PROFILES FOR MATERNAL INFECTIONS IN SUB-SAHARAN AFRICA

Author(s) Chikondi Chapuma1, Charlotte Van der Veer1, Edward Monk2, Hussein Twabi3, Emily Beales2, David Kulapani3, Samantha Lissauer1, Nicholas Feasey4, and David Lissauer1 

Affiliation(s):

1. Malawi Liverpool Wellcome Program, University of Liverpool
2. Malawi Liverpool Wellcome Program
3. Kamuzu University of Health Sciences
4. Malawi Liverpool Wellcome Program
5. Malawi Liverpool Wellcome Program, Liverpool School of Tropical Medicine

Email: chikondi.chapuma@liverpool.ac.uk

Introduction: Maternal antimicrobial resistance (AMR) is a global pandemic. In Sub-Saharan Africa (SSA), where over two-thirds of global maternal deaths occur (>200,000 deaths per year), sepsis causes 10% of these deaths. In SSA, empirical treatment guidelines based on histological microbiological data are used due to limited access to diagnostic microbiology. In addition, these guidelines have not changed over seven years despite rapidly evolving AMR. Objectives: To summarize data on the main bacterial agents causing maternal infections and their antibiotic susceptibility in SSA over the past ten years.

Methods: We searched MEDLINE, Embase and African Journals online databases using a search strategy that combined terms relating to laboratory-confirmed bacterial infection, pregnancy, postnatal period, observational studies, and SSA. We summarised the proportion (and 95% confidence intervals) of samples testing positive for the most common bacteria and narratively described the antimicrobial resistance profiles (if available). We also performed subgroup analyses based on the source of the infection for the most common bacteria.

Results: Thirteen papers reported aetiology data, and nine reported AMR data. The majority of the papers were from East Africa and Ethiopia. The most reported bacteria were E-coli at 29% (22,39), S-aureus at 22% (15,31) and K-pneumoniae at 12% (8, 17). E-coli was most reported in endometritis, whilst S-aureus and K-pneumoniae were most reported in blood. Regarding antibiotic susceptibility, all nine papers reporting AMR reported some AMR to the WHO Access (First line) and Watch (Second-line drugs), including all classes of drugs.

Conclusion: E-coli, K-pneumoniae and S-aureus are SSA’s top three causes of maternal infection. AMR has been reported for first and second-line drugs. Therefore, the findings of this study need to be correlated with local surveillance data to assess the need to change the current empirical treatment guidelines.

ANTIMICROBIAL RESISTANCE ABSTRACTS – POSTER

BIOMEDICAL DIAGNOSTICS ABSTRACTS – POSTER

P92.A001155.             PROCESS EVALUATION OF EARLY INFANT DIAGNOSIS OF HIV SERVICES, AMONG POSTPARTUM WOMEN IN PRIMARY HEALTH FACILITIES IN BLANTYRE, MALAWI, 2020

Author(s):  Leticia Chimwemwe Suwedi-Kapesa1,2, Alinane Linda Nyondo Mipando3, Peter Macpherson1,2, Angela Obasi1, and Nicola Desmond1

Affiliation(s):

1. Liverpool School of Tropical Medicine, Liverpool United Kingdom
2. Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre Malawi
3. Kamuzu University of Health Sciences, Blantyre Malawi

Email: 355758@lstmed.ac.uk

Introduction: Low utilisation of post-natal health services contributes to significant gaps in HIV testing for HIV-exposed infants(HEIs), contributing to a lag in achieving UNAIDS targets for children. There is no guarantee that implementing evidence-based initiatives to improve early infant diagnosis of HIV(EID) will be successful in all contexts.

Objectives: To evaluate implementation of EID services to identify strategies to improve EID services uptake in Blantyre, Malawi.

Methods: We retrospectively extracted data for HEIs in two primary health facilities from January to December 2018, conducted process mapping of eight mother-infant pairs(MIP) and interviews with 16 health care workers(HCWs) from December 2019 to March 2020. We analysed data descriptively and used Fisher’s exact and Pearson Chi-square tests for the association test. We conducted thematic content analysis for qualitative data.

Results: Of 163 HEIs data, 54% had documentation of having enrolled in HIV care clinic (HCC), while only 23% had enrolled before post-natal discharge and 47% had HIV testing by six weeks. Proportion of HEIs enrolled in HCC was higher among HEIs whose mothers received antiretroviral therapy (ART) at same clinic as delivery (35%) than 23% of HEIs whose mothers did not. There was no significant association between HEI enrolment in HCC and mothers receiving ART at delivery facilities (p=0.220). The MIP received care from one hour and 35 minutes to eight hours, with some HEIs returning without an HIV test due to limited capacity of point of care testing machine (POC). The HCWs attributed gaps in EID services to problems with care organisation, identification and tracking of HEIs, motivation, and data management.

Conclusion: The enrolment of HEIs in HCC before post-natal discharge and HIV testing at six weeks was inadequate. The HCWs should organise post-natal care to improve identification, enrollment, tracking of HEIs, usage of POC and provision of comprehensive individualised care.

P93.A001272. STAKEHOLDER ENGAGEMENT IN ENHANCING THE UPTAKE OF EARLY INFANT DIAGNOSIS OF HIV SERVICES AMONG POST-PARTUM WOMEN IN PRIMARY HEALTH CARE IN BLANTYRE MALAWI

Author(s): Leticia Chimwemwe Suwedi-Kapesa1, Peter Macpherson1, Nicola Desmond1, Alinane Linda Nyondo Mipando2, Marlen Stacey Chawani3, Melody Sakala3, Chikondi Chapuma3, and Angela Obasi4

Affiliation(s):

1. Liverpool School of Tropical Medicine, Malawi Liverpool Wellcome Trust Clinical Research Programme
2. Kamuzu University of Health Sciences
3. Malawi Liverpool Wellcome Trust Clinical Research Programme
4. Liverpool School of Tropical Medicine

Email: lsuwedi@mlw.mw

Introduction: Low utilisation of health services after birth contributes to significant gaps in HIV testing for HIV-exposed infants(HEIs). We evaluated the implementation of early infant diagnosis of HIV services(EID) in Blantyre in 2020 to understand implementation gaps that contributed to the low uptake of EID services among post-partum women. Problems with organisation of postnatal care emerged.

Objectives: To develop an enhanced health system (EEHS) intervention among postnatal women in primary health facilities in Blantyre to improve the uptake of EID services.

Methods: We used stakeholder consultation to co-design the EEHs Intervention. We had seven meetings with policy experts and the Prevention of Mother to Child Transmission Program Manager. We conducted a two-day consultation workshop guided by the Behaviour Change Wheel model. We included eight health care workers(HCWs), four women with HEIs, five management team members, two representatives from implementing partners, and a policy expert.

Results: Preparations for the workshop included stakeholder mapping, networking, workshop logistics, managing power dynamics, authorisation and invitations for attendees. Discussions of the findings of the EID implementation formative study and stakeholders’ experiences with EID services confirmed implementation gaps in enrollment and HIV testing of HEIs. Problems with organisation of postpartum care, identification and tracking of HEIs, returning HEIs without HIV tests due to limited capacity of point of care equipment, insufficient motivation and teamwork were underlying factors. Stakeholders proposed using unique labels to identify HEIs, active screening, a booking system for point-of-care HIV testing and an equipped focal person as the main components of the EEHs intervention.

Conclusion: Stakeholder consultation is required when developing a context-appropriate intervention. It provides a platform for learning from stakeholders’ experiences and understanding the system and aspects of the context critical for developing appropriate interventions. We will evaluate the effectiveness and acceptability of EEHs intervention.

P94.A001118.  BARRIERS IN THE TIMELY RECEIPT OF 6-WEEK DNA-PCR RESULTS AMONG HIV EXPOSED INFANTS AT A MULANJE DISTRICT HOSPITAL, MALAWI – A MODIFIED DELPHI METHOD

Author(s): Chikondi Chapuma1,5,6, Titus Chiwindo2, Steve Gondwe3, Leticia Suwedi1,5, Maggie Nyirenda Ny’angwa4, Mitch Matoga2, Mina Hosseinpour2, and Victor Mwapasa5

Affiliation(s):

1. Malawi Liverpool Wellcome Clinical Research Program
2. University North Carolina Project
3. Mzimba District Hospital
4. University College London
5. Kamuzu University of Health Sciences
6. University of Liverpool

Email: chikondichapuma@gmail.com

Introduction: Loss to follow-up of HIV-exposed infants (HEI) due to long turnaround time (TAT) between testing and receipt of results is associated with a low ART coverage (<95% global target). Clinical trials have shown that using GeneXpert DNA-PCR Point-of-care (POC) testing may reduce the TAT to 1-10 days. However, despite installing DNA-PCR POC in some Malawian health facilities, TAT remains long (up 24 days), risking a high Loss to follow-up among HEI. Factors associated with the long TAT have not been fully elucidated.

Objectives: To identify influences associated with long TAT in a Malawian district-level hospital using GeneXpert- DNA PCR POC-testing.

Methods: From 24th-25th August 2022, we conducted a qualitative phenomenological study using a modified Delphi technique at Mulanje District Hospital (MDH), a secondary referral health facility in Southern Malawi. A “”Plan-Do-Study-Cycle”” semi-structured questionnaire was administered to purposively-selected health workers and support staff from MDH, including nurses, lab technicians, implementation partners, Health Surveillance Assistants (HSAs), HIV Diagnostics Assistants (HDAs), patient supporters(PS), sample transporters and data clerks. Key themes were identified after consensus was reached among participants.

Results: We interviewed eighteen health workers, and staff comprising of four HAS/HDAs, three clinicians, three nurses, three data personnel, two laboratory technicians (including an implementation partner), one sample transporter and one PS. Major perceived barriers associated with long TAT included poor quality samples by HDAs; nurses and HDAs not recording results in the sample log; HDAs not packing samples on time for the courier; the laboratory not printing the results despite processing the sample; and stockouts of cartilages for DNA-PCR.

Conclusion: Our findings suggest that investments in training and supervision of health workers in standard operating procedures for HEI sample management, procurement and supply management system for GeneXpert cartridges may improve the TAT.      

P95.A001208.  EVALUATION OF THE HIV-3 TEST HIV ALGORITHM AND THE SCAN FORM TECHNOLOGY: JOINT PILOT QUALITATIVE ASSESSMENT STUDY       

Author(s): Confidence Banda1, Agatha Bula1, Godwin Nyirenda2, Mercy Tsidya1, Andreas Jahn3, and Mina C. Hosseinipour1,4        

Affiliation(s):

1. University of North Carolina Project, Malawi-Tidziwe Research Centre, Lilongwe, Malawi
2. Clinton Health Access Initiative
3. Department of HIV AIDS, Ministry of Health
4. Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA”   

Email:cbanda@unclilongwe.org

Introduction: To improve HIV testing services and the accuracy of results, Malawi plans to adopt the WHO recommended 3-test algorithm, including an ultra-rapid first test to reduce the time to results delivery. The proposed algorithm is INSTI HIV1/2, Uni-Gold HIV1/2 and SD Bioline HIV1/2.

Objectives: To evaluate the proposed algorithm and the ScanForm technology in nine pilot facilities to assess performance in the hands of routine task-shifted providers (HIV Diagnostic Assistants).

Methods: A field evaluation was conducted in nine health facilities across seven districts. We used focus group discussions (FGDS) to assess the acceptability and experiences of the HTS service providers with the new HIV testing algorithm and the Scan Form Technology. A total of 56 participants were recruited through purposive sampling and we conducted 1 FGD at each site. Transcripts were coded and analyzed using NVivo software (Version 12.1). Coding summary reports were then generated from NVivo and analyzed using content analysis.

Results: Overall, the extremely fast performance of the INSTI test was consistently mentioned as a major advantage by all nine pilot sites. Participants said many more clients could be tested per provider per day without compromising the test results’ accuracy. However, the large packing volume of the INSTI test kits was identified as a challenge since storage space would need to be increased in most facilities. Participants appreciated using ScanForm technology as an efficient way of reporting data in real time and the immediate feedback after data upload improved data quality.

Conclusion: All HTS providers accepted the three-test algorithm and ScanForm Technology. Using the three-test HIV algorithm in Malawi, which includes an ultra-rapid first screening test, HIV testing services will be improved. ScanForm Technology enhances data accuracy and confidentiality.

P96.A001212.  IMPACT OF COVID19 ON HIV VIRAL LOAD MONITORING SERVICES AT BLANTYRE DREAM PROJECT LABORATORY

Author(s): Often A. Banda1, Richard Luhanga1 and Fatsani Ngwalangwa1

Affiliation(s):

1. Kamuzu University of Health Sciences

Email: oftenbanda14@gmail.com

Introduction:  Response to Covid19 pandemic has led to management of other infectious diseases being relegated to a minimal priority. The intense focus on Covid19 prevention might hinder the efforts and undo progress made in controlling other infectious diseases including HIV/AIDS. Both HIV viral load (HIV-VL) and Covid19 testing are done on the same PCR machines prioritizing Covid19 testing and puts HIV-VL testing at a halt hence impacting routine HIV-VL test turnaround times and tests throughput.

Objectives: To evaluate the impact of Covid19 on HIV-VL monitoring services at Blantyre Dream Project molecular laboratory. Secondary objective was to compare HIV-VL test mean turn-around time.

Methods: A cross sectional study focused on all HIV positive individuals (N=544) on ART presenting for routine HIV-VL monitoring services data from November 2018-August 2021 was conducted. Data from Laboratory Information Management Systems (LIMS) was utilized for analysis. A Two-sample Wilcoxon rank-sum (Mann-Whitney) Test, two-sample t-test and a Time-trend Graph were used exploring variables of age, gender, sample type, and reason for testing, viral load test result, sample reception and results dispatch dates.

Results: Descriptive analysis shows that 29.96% of total sample were males and 70.04% were females. 45.24% were adults (>40years) seconded by 44.44% young adults (19-40years), 9.13% were children (5-18years) and 1.19% were under five children. Comparing the period before Covid19 pandemic with the same period during Covid19, both HIV-VL testing turnaround time and HIV-VL laboratory tests throughput have significantly increased 3.8 fold (p<0.001) and 1.5 fold (p=0.0138) respectively.

Conclusion: This study provides evidence of prolonged HIV-VL monitoring turnaround times and increase in volume of HIV-VL tests result throughput during Covid19 compared with the same period before the pandemic.

P97.001173.    AN EXPLORATION OF ORGANIZATIONAL READINESS FOR SCALING UP THE USE OF URINE LAM TESTS IN HIGH TB BURDEN DISTRICTS AND PERIPHERAL HEALTH FACILITIES IN MALAWI. A NARRATIVE (IN-DEPTH) QUALITATIVE STUDY.        

Author(s): John Maseko Zondetsa1, Prof Mina Hosseinipour2, Dr Juliana Kagura1,

Affiliation(s):

1. University of Witwatersrand, SA
2. University of North Carolina, Malawi Project, Lilongwe.

Email: masekojohn17@gmail.com

Introduction: The use of the Urine LAM test was endorsed by the WHO in 2015 and it has been recommended for use in PLWH. Malawi is in the process of scaling up the use of LAM urine tests in low TB burden districts and peripheral health facilities. The scaling up of health interventions has received greater attention; however, there remains a lack of systematic exploration of organizational readiness that is deemed necessary for the scaling-up process. 

Objectives: To explore factors associated with organizational readiness for scaling up the LAM tests in high TB burden districts in Malawi

Methods: An in-depth qualitative study was conducted at the HIV and TB departments, and in seven high TB burden districts. The study used a purposive sampling technique to enrol participants and enrolled twenty-eight participants who were overseeing TB and HIVAIDS programs as aimed to concentrate on participants with the precise information and a wide range of expertise in TB and HIV programs, and readiness scale-up LAM urine tests. Thematic data analysis for qualitative data was conducted using MAXQDA software

Results: KII were conducted from twenty-eight participants with a wide range of expertise on HIV and TB. There is various extent of organizational readiness ranging from facility to facility as some facilities have all the necessities for scaling up the LAM urine tests while some facilities are still lagging. The study demonstrated that the MoH has done quite a remarkable work of preparing for the scaling up of the LAM urine tests, especially in policy and guidelines formulation and capacity building. 

Conclusion: There are varying levels of organizational readiness for scaling up the use of LAM urine tests due to several factors including lack of or inadequate capacity-building activities, lack of support from implementing partners, as well as dissemination of policies and guidelines. The results recommend the MoH to consider addressing factors related to the graded differences in readiness for scaling up the LAM tests, and that further studies are essential to evaluate the coverage and effectiveness of strategies to scale up and sustain the use of LAM tests for TB diagnosis.

P98.A001129. DETECTION OF VIABLE SARS-COV-2 FROM WASTEWATER USING MAGNETIC DYNABEADS

Author(s): Shannon McSweeney1, Patricia Blundell1, Shaun Pennington1, Rose Lopeman1, Claire Caygill1, Catherine Anscombe2, Richard Pleass2, Nicholas Feasey1,2, Kayla Barnes2

Affiliation(s)

1. Liverpool School of Tropical Medicine, Liverpool United Kingdom
2. Malawi Liverpool Wellcome Trust, Blantyre Malawi        

Email: shannon.mcsweeney@lstmed.ac.uk

Introduction: Viable SARS-CoV-2 has been recovered and cultured from stool. In addition, multiple studies have detected SARS-CoV-2 RNA in wastewater, highlighting the potential for faecal to oral transmission. Despite this, there are a limited number of infectivity studies from wastewater, of which all were unable to detect viable SARS-CoV-2. This is due in part to the complexity of   isolating and culturing SARS-CoV-2 from complex matrices such as wastewater.  

Methods: Untreated influent samples were collected from Sandon Dock sewage plant, Liverpool between January and March 2022. Magnetic dynabeads designed to target intact SARS-CoV-2 were used to isolate viable virus from 500 ml filtered wastewater. The isolated virus was cultured in VERO E6 cells for 6 days, with a passage at day 2.

Results: RT-qPCR was performed on extracted RNA from isolated virus prior to culture, on culture supernatant on day 2 and 6, with mean Ct values of 35.8 (SD ±0.24), 37.2 (SD ±0.33) and 28.8 (SD ±0.17), respectively. Cell culture plates were immunofluorescently stained and using confocal microscopy, SARS-CoV2 infected VERO E6 cells were observed and imaged. Conclusion: Preliminary data shows whole live SARS-CoV-2 is detected after two passages on VERO E6 cells via confocal fluorescence microscopy and by RT-PCR of the supernatant.  Further work includes sequencing the cultured SARS-CoV-2.         

P99.001210. IMPROVING LUMBAR PUNCTURE RATES IN PAEDIATRIC WARDS AT FOUR SECONDARY HEALTH FACILITIES IN MALAWI      

Author(s): Madalitso D. Zulu1, Harrison Msuku2, Christopher C. Stanley2, Vincent S. Phiri3, Hillary M. Topazian4, Jobiba Chinkhumba2,3, Irving Hoffman1,5, Jonathan J. Juliano1,5, Don P. Mathanga2,3, and Tisungane Mvalo1,5

Affiliation(s)

1. University of North Carolina Project Malawi (UNCPM), Lilongwe, Malawi
2. Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
3. Kamuzu University of Health Sciences, Blantyre, Malawi
4. Imperial College London, London, UK
5.  University of North Carolina at Chapel Hill, North Carolina, USA

Email: mdzulu2014@gmail.com       

Introduction:  Although a lumbar puncture (LP) is often the only available procedure to aid in meningitis diagnosis in sub-Saharan African countries like Malawi, this procedure is not always done when needed. Our objectives were to measure the proportion of LPs done among eligible children (LP rate), and to assess the impact of pilot interventions to improve this, at four secondary health facilities in Malawi. 

Methods: This was a secondary analysis using data collected through the hospital surveillance component of the Malaria Vaccine Implementation Program (MVIP). Data was collected using an electronic data capture (EDC) system; the Open Data Kit (ODK). We identified children LP eligible children using an LP indications algorithm adapted from Malawi and World Health Organization (WHO) guidelines. To improve LP rates, we piloted 3 interventions: refresher training for facility staff, automated LP reminders built into questionnaires, and hired evaluation-specific clinical officers. We tabulated LP rates, and compared these before and after interventions to determine impact.

Results: Of the 13,375 admitted children under 5 years of age, LP data were available for 2,102 LP-eligible children. Overall, 1,142 (54.3%) had an LP performed. The LP rate improved by 13% following refresher training for facility staff, 10% following automated LP reminders, and 48% following the introduction of evaluation-specific clinical officers. The cumulative increase in the LP rate was 19.9% after all interventions were implemented.

Conclusions: We recommend regular training for secondary health facility staff on the LP indications algorithm, using existing training platforms, and adoption of EDC systems with built-in reminders similar to those used in this surveillance. For researchers who plan to conduct similar meningitis surveillance activities in the future, we recommend hiring of additional evaluation-specific staff to support already existing facility staff.

P100.A001289. CORD BLOOD BIOMARKERS FOR PREDICTION OF EARLY ONSET NEONATAL INFECTION IN MALAWI

Author(s): Maryke J Nielsen 1;2, Bridget Freyne 1;2, Baleke Ndamala 2, Siphwe Jere 2, Vita Nyasulu 2, Emily Life2, Violet Khonje 3, Clotilda Makweya 5, Lumbani Makhaza 2, Josephine Langton 3;4, Kondwani Kawaza 3;4, Queen Dube 3;4, Luis Gadama 3;4, Enitan Carrol 1, Neil French 1

Affiliation(s): 

1. University of Liverpool
2. Malawi Liverpool Wellcome Clinical Research Facility
3. Queen Elizabeth Central Hospital
4. Kamuzu College of Health Sciences
5. Mlambe Mission Hospital

Email: m.nielsen@liverpool.ac.uk

Introduction: 2.3 million new-born deaths occur annually with infection the third leading cause.  Rising levels of anti-biotic resistance (AMR) may increase this further.  WHO recommends new-borns at risk of early onset neonatal infection (EO-NI) receive prophylactic treatment with five days of empirical antimicrobial therapy (AMT).  Improved risk stratification of early onset neonatal infection (EO-NI) is needed to reduce unnecessary AMT.  Cord blood biomarkers have been shown in high resource setting to be accurate for prediction of EO-NI. 

Objectives: To determine the accuracy of cord blood biomarkers for prediction of EO-NI. 

Methods: Mothers > 18 years of age were recruited in early labour from Queen Elizabeth Central Hospital and Mlambe Mission Hospital from June 2019 – July 2021.  New-borns were evaluated for signs and symptoms of EO-NI on day 1, day 3 and day 7 of life with blood and CSF samples for culture, biomarkers and molecular pathogen diagnostics taken if EO-NI was suspected.  Cord blood biomarkers and intra-partum maternal recto-vaginal swab were analysed in cases of EO-NI and controls (next born healthy new-born following a case). 

Results: 3934 mothers were screened for participation with 1411 mothers consented for recruitment.  Mean maternal age was 25.5 years, mean gestation 39 weeks and mean birth weight 2.83kg.  8.7% of all new-borns met study criteria for EO-NI.  The most frequently isolated pathogen in cases was Acinetobacter baumanni.  Cord blood AUC for interleukin 6 was 75.1% (95% CI 65.4 – 84.7%), procalcitonin 56.9 (46%-67.5%) and C-Reactive Protein 33.8% (27.7% – 39.8%). 

Conclusion: Performance of IL-6 was superior to procalcitonin and C-reactive protein however overall biomarker performance was below that reported in studies in high income settings.  Further analysis of the cohort is ongoing to develop a risk prediction model incorporating clinical variables and investigate the predictive accuracy of a wider spectrum of cord blood biomarkers.

P101.A001112.  THE PREVALENCE OF PLASMODIUM FALCIPARUM HISTIDINE RICH PROTEIN 2 AND HISTIDINE RICH PROTEIN 3 GENETIC DELETIONS AND ITS ASSOCIATION WITH MALARIA SEVERITY AMONG CHILDREN IN SOUTHERN MALAWI

Author(s): Godfrey Mvula1, Fatsani Ngwalangwa2 and Karl Seydel1           

Affiliation(s):

1. BMP ICEMR Lab
2. Kamuzu University of Health Sciences

Email: gzmvula@gmail.com

Introduction: Rapid Diagnostic Tests (RDTs) are widely used to detect malaria. The most common RDTs for malaria detect Histidine Rich Protein 2 (PfHRP2) which is abundant in Plasmodium falciparum (Pf) malaria. Some antibodies to HRP2 cross react with Plasmodium Histidine Rich Protein 3 which share similar antigenic epitopes. Recent reports of the emerging spread of mutant parasites that fail to express HRP genes. The burden of the HRP deletions in Malawi is not known and may be associated with malaria disease severity.

Objectives: To determine the prevalence of Plasmodium falciparum HRP genetic deletions and their association with malaria severity among Malawian children with malaria.

Methods: This study was a cross-sectional design among children aged 1 to 12 years diagnosed with malaria at Queen Elizabeth Central Hospital and Ntaja Health center between February 2019 and March 2021. The study participants were grouped into asymptomatic, uncomplicated (UM) and cerebral malaria (CM). Demographic data were linked to qPCR results. The prevalence of PfHRP deletions were presented in percentages. Chi2 and multiple logistic regression used to determine the association between PfHRP gene deletion and malaria severity.

Results: The overall proportion of HRP deletions was 8%. The proportion was higher (44%) in the asymptomatic malaria arm than in either the UM (3.3%) or CM arms (6.8%) with a p value of 0.002. Children with CM and UM had a lower risk of having gene deletion when compared to those with asymptomatic malaria, UOR 0.09 (P value 0.003), AOR 0.08 (P value 0.080), UOR 0.04 (P value <0.0001) and AOR 0.05 (P value 0.066) respectively.

Conclusion: Deletions of HRP genes in Pf were observed among Malawian children diagnosed with malaria which might affect the performance of PfHRP2 based RDTs. There is need for routine surveillance to monitor HRP deletion parasites.       

P102.A001419. FACTORS THAT AFFECT TURNAROUND TIME FOR FULL BLOOD COUNT TESTS IN THE ADULT EMERGENCY DEPARTMENT AT QUEEN ELIZABETH CENTRAL HOSPITAL  

Author(s): Yilinase Gondwe1 and Mulinda Nyirenda1,2     

Affiliation(s):

1. Kamuzu University of Health sciences, Blantyre, Malawi 
2. Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Blantyre, Malawi

Email: yilinasegondwe@gmail.com

Introduction: Quality emergency care delivery is anchored with effective and efficient diagnostic services. Turn Around times for diagnostic tests are key quality indicators for measuring laboratory efficiency; particular when anchored to commonly ordered emergency care tests like the Full Blood Count (FBC). 

Objectives: To explore factors that affect the turnaround times (TAT) of the full blood count in the adult emergency department (AETC) at Queen Elizabeth Central Hospital in Blantyre, Malawi.

Methods: This was an observational study conducted for 2 weeks in October 2021. FBC specimens were accompanied with a study form that recorded specific time point from clinician order to communication of results to patient. The form also captured factors that affected defined QECH laboratory TAT during the FBC test processing journey. The collected information was analyzed in Microsoft excel to produce frequencies. College of Medicine Research Ethics Committee (COMREC – U.05/21/3325) provide ethical clearance for this student research project.

Results: We successfully followed up 196 FBC specimens. Eighty-two percent (n=162) study specimens were delayed from the standard 60 min TAT for the QECH lab. Factors reported as contributing to prolonged FBC TAT were delayed transportation (41%), delayed reporting (27%), missing specimens (17%), insufficient specimens (6%), machine malfunction (4%), difficulties in phlebotomy 2% and clotted specimens arriving at the Laboratory (0.5%).

Conclusion: The commonest factors that affected the TAT for FBC tests highlighted the need for better custodian chain of FBC specimens and communication modalities between emergency department and laboratory staff. Emergency Department and Laboratory staff should be encouraged to regularly review and implement pertinent measures that shorten FBC test TAT.

CONTROLLED HUMAN PNEUMOCOCCAL CHALLENGE ABSTRACTS – POSTER

P103.A001296. COMPARISON OF CLASSICAL MICROBIOLOGY CULTURE AND MULTIPLEX LYTA/CPSA IN DETECTING EXPERIMENTAL SEROTYPE 6B (SPN6B) IN MALAWIAN HEALTH ADULTS        

Author(s): Christopher Mkandawire1, Tarsizio Chikaonda1, Faith Thole1, Simon Sichone1, Bridgette Galafa1, Edna Nsomba1,3, Dingase Dula1,3, John Ndaferankhande1, Joel Gondwe1, Marc. Henrion1,2, Ben Morton1,2, Kondwani Jambo1,2, and Stephen Gordon1,2,3 on behalf of MARVELS Consortium     

Affiliation(s):

1. Malawi-Liverpool Wellcome Programme
2. Liverpool School of Tropical Medicine,
3. Queen Elizabeth Central Hospital, Blantyre, Malawi

Email: cmkandawire@mlw.mw

Introduction: Controlled Human Infection Model (CHIM) is a safe, cost-effective, and efficient method to determine the protective efficacy of new vaccines. We have successfully established the CHIM using pneumococcal serotype 6B (SPN6B) in Malawi. Identification of experimental SPN6B is an essential endpoint in the success of all CHIM studies. Here we have compared the detection of experimental SPN6B using both Classical Microbiology Culture and multiplex LytA/cpsA.

Objectives: To compare the detection of experimental SPN6B using Classical Microbiology Culture and multiplex LytA/cpsA

Methods: Healthy volunteer’s adults aged 18-40 were challenged with SPN6B with 20,000 (n=42) 80,000 (n=83) or 160,000 (n=100) cfu/100ul naris dose. Detection of the carriage was done by classical microbiology cultures and LytA / cpsA multiplex PCR using Nasal Wash (NW) sample pellet suspended in skim milk, tryptone, glucose, and glycerin (STGG). Classical culture involved plating NW pellets suspended in STGG. Morphologically, SPN6B presented with Alpha hemolytic colonies on a blood agar plate and was Optochin sensitive. Serotype confirmation was performed using the Immulex Pneumotest kit. The LytA/cpsA multiplex PCR’s starting material was the extracted stored NW pellet suspended in STGG. Results were then compared between the two methods.

Results: Experimental SPN6B was detected in 15.1% (34/225) using classical culture while LytA/cpsA PCR detected 19.6% (44/225). For other serotypes, 15.6% (35/225) and 36.0% (81/225) were detected by culture and PCR respectively. 34 samples were 6B in concordance for both methods whilst and 46 were concordance non SPN6B.

Conclusion: PCR has shown to be more efficient compared to culture in detecting other serotypes. Both assays allowed the rapid and consistent identification of true S. pneumoniae strains. PCR demonstrated additional positivity as it could detect DNA from low concentrated samples. Sequencing will be performed to confirm the experimental strain.

P104.A001298. PNEUMOCOCCAL CARRIAGE IN YOUNG HEALTHY ADULTS IN BLANTYRE, MALAWI SHOWS HIGH VACCINE TYPE CARRIAGE

Author(s): Bridgette Galafa1, Simon Sichone1, Faith Thole1, Tarsizio Chikaonda1, Christopher Mkandawire 1, Dingase Dula 1, Edna Nsomba 1, John Ndaferankhande 1, Joel Gondwe 1, Marc Y R Henrion 1, Mphatso Chaponda 1, Godwin Tembo 1, Raphael Kamng’ona 1, Kondwani Jambo 1,2, Ben Morton 1,2, and Stephen B Gordon 1,2

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Clinical Research Programme
2. Liverpool School of Tropical Medicine

Email: bgalafa@mlw.mw

Introduction: Despite the introduction of PCV13 in Africa, Streptococcus pneumoniae (SPN) remains a burden with carriage of both vaccine type (VT) and non-vaccine (NVT) streptococcal serotypes still being persistent. Nasopharyngeal colonization is a prerequisite for transmission and pathogenesis of pneumococcal diseases. We studied natural nasopharyngeal carriage rates of pneumococci in participants recruited in an adult experimental human challenge PCV13 trial.

Objectives:

1. To estimate the prevalence and diversity of natural carriage pneumococcal serotypes in Blantyre, Malawi.
2. To estimate the distribution of vaccine type and non¬-vaccine type serotypes in Blantyre, Malawi

Methods: Healthy adult participants aged 18 to 40 were randomized to receive PCV13 and a placebo. The participants underwent intranasal administration of SPN6B. Assessment for pneumococcal carriage by culture of nasal wash samples (NWS) collected on 2 screening visits and 2, 7 and 14 days after challenge was done. Samples underwent bacterial culture and all SPN isolates were serotyped using ImmuLex Pneumotest kit. Natural carriage of either VT or NVT was determined at all visits whilst experimental carriage of SPN6B was determined at days 2,7 and 14 post challenge.

Results: Our study found 21 different serotypes with overall carriage rate for natural and experimental carriage at 84.5% (n=169/200) of the study population. Among the naturally carried serotypes, 50.8% (n= 63) were VT whilst 49.2% (n=61) were NVTs. VT dominated over other serotypes by contributing 37.3% (n=63/169) of total pneumococcal carriage for all five visits/participant. None of the participants naturally carried SPN6B at baseline which is being used in the PCV13 trial for human challenge.

Conclusion: These findings give insight in the dynamic nature of SPN nasal colonization (VT and NVT) in Malawian young adults. Our results suggest that natural carriage of SPN serotypes covered by the conjugate vaccine (PCV13) is common among young adults.

P105.A001354. CHALLENGE AGENT PREPARATION IN A PNEUMOCOCCAL EXPERIMENTAL HUMAN CHALLENGE MODEL IN MALAWI

Author(s): Bridgette Galafa1, Faith Thole 1, Simon Sichone 1, Christopher Mkandawire 1, Tarsizio Chikaond1, Dingase Dula 1, Edna Nsomba1, Marc Henrion1, John Ndaferankhande 1, Joel Gondwe1, Kondwani Jambo1,2, Ben Morton1,2, and Stephen B Gordon1,2

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Clinical Research Programme
2. Liverpool School of Tropical Medicine

Email: bridgetgalafa@gmail.com

Introduction: Experimental Human Pneumococcal Challenge (EHPC) studies involve intentional administration of Streptococcus pneumoniae (SPN) to volunteers. The selection, isolation, development and production of the challenge agent is one of the first steps in developing a challenge study and critical for minimizing the risk to volunteers.

Objectives: To assess the stability and reproducibility of SPN6B inoculum preparation

Methods: Penicillin sensitive SPN6B used in EHPC in Liverpool was prepared to determine dose, and inoculated in 200 healthy volunteers (aged 18 – 40 years) between April 2021 and August 2022. We recruited participants into a low (n=40), optimal (n=75) and high (n=90) inoculation dose and inoculated them with 20,000, 80,000 and 160,000 CFU/100ul respectively to assess the stability and reproducibility of laboratory and transportation methods of SPN6B for participant inoculation. We measured the inoculum before and after administration to the participant to determine the actual dose administered.

Results: We found the geometric mean of the inoculum before and after administration at low dose was 19,250 CFU/100ul, at optimal dose was 74,500 CFU/100ul and high dose was 154,138 CFU/100ul. These results fell within the acceptable ranges for each dose which were 10,000 to 40,000 (low), 40,000 to 160,000 (optimal) and 80,000 to 320,000 (high).

Conclusion: These findings show that the preparation and transportation methods did not have any negative impact on the viability of S. pneumoniae. Production and preparation of challenge agents to be used in human challenge models is paramount to accelerate the development, testing and authorization of vaccines for use against different diseases and outbreaks. There is room for production of the challenge agent in Malawi using a GMP-like model (currently under progress).

P106.A001297. FREQUENCY, DENSITY AND DURATION OF STREPTOCOCCUS PNUEMONAE SEROTYPE 6B COLONISATION IN A CONTROLLED HUMAN PNEUMOCOCCAL CARRIAGE MODEL – A FEASIBILITY STUDY

Author(s): Faith Thole1, Bridgette Galafa1, Christopher Mkanawire1, Tarsizio Chikaonda1, Simon Sichone1, Edna Nsomba1,3, Dingase Dula1,3, John Ndaferankhande1, Joel Gondwe1, Marc Henrion1,2, Ben Morton1,2, Kondwani Jambo1,2, and Stephen Gordon1,2,3 on behalf of MARVELS Consortium       

Affiliation(s):

1. Malawi-Liverpool Wellcome Programme
2. Liverpool School of Tropical Medicine,
3. Queen Elizabeth Central Hospital, Blantyre, Malawi

Email: fthole@mlw.mw

Introduction: Asymptomatic Streptococcus pneumoniae (SPN) colonization of the human nasopharynx is a necessary prerequisite for pneumococcal disease. Nasopharynx has been proposed as a marker for vaccine efficacy. Using the Liverpool School of Tropical Medicine (LSTM), UK, controlled human infection model (CHIM) that has been used to test the protection induced by vaccination against nasopharyngeal carriage, our feasibility study was conducted in the period between November 2019 and October 2020 in Blantyre, Malawi.

Objectives:

1. To establish pneumococcal nasopharyngeal carriage in a controlled human model.
2. To identify a dose of SPN serotype 6B (SPN6B) sufficient to establish nasopharyngeal carriage.

Methods: Adults aged 18-40 recruited in the study were inoculated with either of 20,000CFU/naris or 80,000CFU/naris of SPN6B or saline. Nasal wash samples collected were assessed using culture and lytA Polymerase Chain Reaction (lytA PCR). Immunological response was measured on serum and nasal mucosal biopsy. All the tests were done at screening (pre inoculation) and days 2, 7 and 14 post inoculation.

Results: SPN6B colonization occurred in 3/9, 4/9 and 0/6 participants in the 20,000 CFU/naris, 80,000 CFU/naris and saline groups, respectively.  Of the 20,000 CFU/naris carriages, 2 carried for all 3 days post inoculation and 1 for 2 days while in the 80,000 CFU/naris group 2 carried in all 3 days post inoculation, 1 carried for 2 days and the other on day 2. 29.2% (7/24) of the participants carried naturally. Proinflammatory nasal mucosal responses and altered mucosal recruitment of immune cells were associated with SPN6B carriage, prior to and after bacterial inoculation respectively with no association to serum anti-capsular antibody

Conclusion: A controlled human pneumococcal carriage model may be used to test novel vaccines in Malawi as participants were able to carry the inoculated SPN6B. Use of lytA/6B PCR to increase detection of the different serotypes. (currently in process).      

P107.A001346.  HUMORAL IMMUNE RESPONSES TO A PNEUMOCOCCAL SEROTYPE-INDEPENDENT VACCINE CANDIDATE AND THEIR CORRELATION WITH PROTECTION AGAINST COLONISATION IN MALAWI.

Author(s): Tembo G.1, Solórzano, C.2, Chaponda M1, Kamng’ona R1, Sichone1, Galafa B.1, Mkandawire C.1,    Chirwa A.1, Nsomba E.1, Dula D.1, Chikaonda T1, Tarsi Hill S.3, Pang Y.3, McIlgorm A.3, Entwistle, C.3, Jambo, K.1,2, Gordon SB.1,2, Bailey, C.3, Ferreira DM.2  

Affiliation(s):

1. Malawi- Liverpool Wellcome Trust, Blantyre, Malawi
2. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3. ImmunoBiology Ltd, Cambridge, United Kingdom

Email: gtembo@medcol.mw

Introduction: Vaccines that confer serotype-independent protection and with low production costs are required to reduce the burden of diseases caused by Streptococcus pneumoniae (SPN). The development of these improved vaccines requires the identification of protein-based candidates that elicit protective immune responses. PnuBioVax (PBV) is a novel serotype-independent pneumococcal multi-protein vaccine candidate that has shown safety and immunogenicity in a Phase I Trial. Data from our collaborators’ Experimental Human Pneumococcal Challenge (EHPC) model in Liverpool showed that in colonised individuals, high anti-PBV antibody titres pre-inoculation correlated with early clearance of pneumococci from the nasopharynx.

Objectives: To investigate whether PBV-specific antibody levels correlate with protection against Pneumococcal challenge.

Methods: In an EHPC study, 18 healthy young adults were challenged with Streptococcus pneumoniae and 6 were given normal saline control. Pre- and post-inoculation sera and nasal wash samples were used to measure anti-PBV systemic and mucosal IgG antibody titers.

Results: In the challenged group, 7 out of 18 participants had nasopharyngeal carriage of pneumococci post-inoculation. We established the presence of naturally-acquired systemic and mucosal anti-PBV antibody titers in baseline samples from all 24 participants, however, we found no correlation with protection from pneumococcal carriage. In participants who established carriage, a significant depletion of mucosal anti-PBV antibody titers 2 days post-inoculation suggests that anti-PBV IgG antibodies are involved in the control of a carriage episode.

Conclusion: These data confirm that anti PBV-IgG antibodies are present in sera and nasal wash of healthy Malawian young adults.  We plan to do further work to establish the impact of PBV vaccination on the levels and functional capacity of anti-PBV antibodies, and correlate the same with establishment of nasopharyngeal carriage of pneumococci.

P108.A001153.  THE IMPACT OF PCV-13 VACCINATION ON THE LEVELS OF PROTECTIVE IGG ANTIBODIES AGAINST STREPTOCOCCUS PNEUMONIAE IN MALAWIAN HEALTHY YOUNG ADULTS      

Author(s): Tembo G.1, Chaponda M.1, Kamng’ona R.1, Sichone S.1, Galafa B.1, Chimgoneko L.1, Thole F.1, Mkandawire C.1, Chirwa A.1, Nsomba E.1, Dula D.1, Chikaonda T.1, Morton B.1,2, Jambo, K.1,2, Gordon SB.1,2,

Affiliation(s):

1. Malawi- Liverpool Wellcome Programme for Tropical Clinical Research, Blantyre, Malawi.
2. Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

Email: gtembo@mlw.mw

Introduction: Following the introduction of PCV-13 vaccination in Malawi, invasive pneumococcal disease has declined but carriage of vaccine-serotype Streptococcus pneumoniae is still highly prevalent in children and adults.  Asymptomatic pneumococcal carriage is an immunizing event but also a primary reservoir for transmission and a prerequisite for invasive pneumococcal disease. Identifying the immunological correlates of protection that reduce transmission by decreasing pneumococcal carriage is a priority in preventing disease in at-risk populations. Previous data from our collaborators in Liverpool showed that PCV induced high levels of IgG to 6B pneumococcal capsular polysaccharide (6B CPS-IgG) in serum and lung mucosa, and was associated with a low pneumococcal carriage density. We aim to establish the impact of PCV 13-induced 6B CPS-IgG antibodies in protection against pneumococcal carriage in the Malawian adult population.

Objectives: To compare the concentration of 6B pneumococcal CPS-specific IgG antibodies in serum and nasal wash samples before and after vaccination, in colonized and non-colonized individuals.

Methods: In a recently established Experimental Human Pneumococcal Challenge model in Malawi, 200 participants were randomized to receive either PCV13 or placebo before nasopharyngeal challenge with a safe dose of Streptococcus pneumoniae. Sera and nasal wash samples were collected pre- and post- vaccination as well as from pre-and post-pneumococcal challenge. The concentration of anti-6B CPS IgG and IgA antibodies, was measured using the World Health Organization (WHO) standardized enzyme-linked immunosorbent assay (ELISA) method.

Results: Preliminary data from 65 participants shows that PCV-13 increases anti-6B CPS-specific IgG antibody levels in serum. We will present data showing the fold-change in anti-6B CPS IgG and IgA one month after participants received either PCV13 or placebo.

Conclusion: Our hypothesis is that both baseline immunology and response to PCV-13 is different in Malawi compared to the UK. These data will be presented and discussed.

P109.A001246. ASSOCIATION BETWEEN CIRCULATING PNEUMOCOCCAL SEROTYPE 6B POLYSACCHARIDE SPECIFIC IGG MEMORY B CELLS AND NASAL ANTIBODIES IN PROTECTION AGAINST EXPERIMENTAL PNEUMOCOCCAL CARRIAGE IN MALAWIAN ADULTS

Author(s): Chaponda M1, Pennington SH2, Ferreira D2,3, Tembo G1, Mitsi E2,3, Kamng’ona R1, 1Chikaonda T1, Dula D1, Sichone S, Galafa B, Jambo K1,2, Gordon SB1,2.

Affiliation(s):

1. Malawi Liverpool Wellcome Programme
2. Liverpool School of Tropical Medicine
3. University of Oxford

Email: mmayuni@mlw.mw

Introduction: Protection after pneumococcal vaccination relies on both protective antigen specific memory B cells and antibody levels. Antigen-specific memory B cells are critical for long-term protection against colonization and disease. Our Experimental Pneumococcal Human Infection Challenge Model (EHPC) in Liverpool has shown that polysaccharide specific memory B cells protect against colonization. The immune correlates of protection against pneumococcal carriage in Malawi remain unidentified. We are investigating whether polysaccharide specific memory B cells associate with antibodies levels and protect against pneumococcal carriage in an EHPC model in Malawian adults.

Objectives:

1. To measure the frequency of pneumococcal serotype 6B polysaccharide-specific IgG memory B cells and the concentration of pneumococcal serotype 6B polysaccharide specific IgG antibodies at pre- and post (5 weeks) vaccination, and at post (2, 7 and 14 days) pneumococcal challenge.
2. To determine the association between pneumococcal serotype 6B polysaccharide-specific IgG memory B cells and pneumococcal serotype 6B polysaccharide-specific IgG nasal antibodies.

Methods: Nasal wash and peripheral blood mononuclear cells (PBMCs) collected from 80 participants as part of the pneumococcal infection challenge model the MARVELS PCV13 study. Participants were in two groups, 40 participants received Pneumococcal Conjugate Vaccine 13 and the other 40 placebo. Five weeks post vaccination participants were then inoculated with 80,000 CFUs of pneumococcal serotype 6B and assessed of pneumococcal carriage at 2,7,14 days post inoculation.

Results: Our Liverpool data indicate that naturally acquired PS-specific memory B cells, but not levels of circulating IgG at time of pneumococcal exposure, are associated with protection against carriage acquisition. Our Malawian preliminary data on 30 samples shows no statistically significant differences of pneumococcal IgG levels between baseline samples and 5 weeks post vaccination.

Conclusion: The full set of Malawian data on the association of memory B cells pneumococcal carriage will be completed in 2023.

P110.A001299.  CELLULAR INFLAMMATION AND EXPERIMENTAL PNEUMOCOCCAL SEROTYPE 6B CARRIAGE IN HEALTHY MALAWIAN ADULTS

Author(s): Raphael Kamng’ona1,5, Mphatso Mayuni1,5, Godwin Tembo1,5, Gift Chiwala 1,5, Lorenzo Chimgoneko1,5, Ben Morton1,2,3,4, Sarah Burra,2, Tarsizio Chikaonda1,5, Edna Nsomba1,5, Lucinda Manda-Taylor1,5, Marc Henrion 1,2, Ndaziona P Banda4,5, Jamie Rylance1,2,4, Daniela M Ferreira2, Kondwani Jambo1,2, and Stephen B Gordon 1,2,4.      

Affiliation(s):

1. Malawi-Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre, Malawi
2. Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
3. Liverpool University Hospitals NHS Foundation Trust Liverpool L9 7AL, United Kingdom
4. Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
5. College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi

Email: rkamng’ona@mlw.mw

Introduction: Pneumococcal related illnesses remain a major public health challenge, particularly in Africa where persistence pneumococcal carriage remain high despite the introduction of PCV13 vaccine. It is established that immune responses induced by respiratory pathogens are generally compartmentalised to the respiratory mucosa.

Objectives: To explore whether nasal pneumococcal challenge or experimental pneumococcal carriage induced cellular responses in the nasal mucosa.

Methods: We recruited 24 Healthy student volunteers and inoculated with saline (6), 20,000 CFU/naris (9) or 80,000 CFU/naris (9) of Streptococcus pneumoniae serotype 6B. Nasal samples were taken at Pre-inoculation, 2,7- and 14-days post-inoculation. We measured cytokine levels and the change in immune cells counts in nasal lining fluid and mucosal biopsies at different time points. We used 38 multiplex Luminex to measure different cytokines and flowcytometry to identify nasal cells.

Results: We observed an increase in neutrophil counts (p = 0.004), neutrophil: T cell ratio (p < 0.001) at day 7 compared to baseline in noncarriers unlike in carriers /controls. There were no differences in the frequencies of B cells, GD T cells, MAIT cells and monocytes overtime and across the study groups. We observed higher levels of IFN-α2, IL-6, GM-CSF, IL12p40, IFN-γ, IL-10, sCD40L, IL-12p70, IL-15, MIP-1β and IL-1β at baseline in those subjects that developed experimental pneumococcal carriage compared to those that did not or the controls.

Conclusion: The data suggests that experimental carriage following inoculation might be associated with a specific baseline inflammatory milieu, and that the clearance of inoculum without establishment of carriage might be associated with robust cellular infiltration of the nasal mucosa in day 7 samples. We are currently building on this data to determine the nasal immunological patterns following PCV13 vaccination in Malawian adults.

COVID-19 IMMUNOLOGY ABSTRACTS – POSTER

P111.A001079.  PREVALENCE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 IGG ANTIBODIES IN URBAN AND RURAL MALAWI BETWEEN FEBRUARY 2021 AND APRIL 2022: A POPULATION-BASED COHORT STUDY   

Author(s): Louis Banda1, Antonia Ho2, Stephen Kasenda1*, Annie Mwale3, Alison Price1, Estelle McLean1, Jonathan M Read4, Chris Jewell4, David Chaima5, Ellen Hughes2, Brian Willett2, Mia Crampin1, Tonney S. Nyirenda5, Abena S. Amoah1     

Affiliation(s):

1. Malawi Epidemiology and Intervention Research Unit
2. MRC-University of Glasgow Centre for Virus Research
3. Public Health Institute of Malawi; 4. University of Lancaster
4. Kamuzu University of Health Sciences   

Email: Antonia.Ho@glasgow.ac.uk

Introduction: Malawi has experienced four waves of COVID-19, but the extent of SARS-CoV-2 exposure and transmission is unclear due to a high proportion of asymptomatic infection and limited testing capacity.

Objectives: To estimate SARS-CoV-2 seroprevalence and associated sociodemographic factors in rural and urban Malawi between February 2021 and April 2022.

Methods: We performed a longitudinal population-based study recruiting randomly selected households in rural Karonga and urban Lilongwe. We implemented 3-monthly serosurveys over 12 months (survey 1, February-May 2021; survey 2, June-September 2021; survey 3, October-December 2021; survey 4, January-April 2022), testing for SARS-CoV-2 S1 IgG using an enzyme-linked immunosorbent assay. We estimated population seroprevalence among unvaccinated individuals and the odds of seroconversion between serosurveys using Bayesian logistic regression, adjusting for age, sex, occupation type, rural-urban site, and assay sensitivity and specificity.

Results: We enrolled 2005 participants (rural n=1005, urban n=1000) from 625 households. Median age was 22.7 years (IQR 11.8-39.5); 55.8% participants were female. In unvaccinated participants aged >5 years, SARS-CoV-2 seroprevalence increased from 41.1% (95% credible interval (CrI) 36.1-46.4%) to 70.7% (64.7-76.2%) in rural participants, and 58.4% (50.6-66.3%) to 79.0% (71.7-85.3%) in urban participants, between Surveys 1 and 4. Compared to rural participants, odds of SARS-CoV-2 seropositivity in urban participants was ~2-fold greater in Survey 1 (adjusted odds ratio (aOR) 2.15, 95%CrI 1.66-2.85) but there was no difference in seroconversion risk between subsequent surveys. Compared to participants aged >30 years, those 5-15 years had reduced odds of SARS-CoV-2 seropositivity during Survey 1 (aOR 0.30, 0.21-0.43) and reduced odds of seroconversion between Surveys 3 and 4 (aOR 0.41, 0.20-0.80). Sex, household size, and occupation were not associated with seropositivity.

Conclusion: Our study provides insights into the evolving epidemiology of SARS-CoV-2 exposure in Malawi, with differential SARS-CoV-2 seropositivity in urban and rural settings and across age groups over the study period.

P112.A001368.  SERO-PREVALENCE OF SARS-COV-2 AMONG MOTHERS LIVING WITH HIV ON LIFE-LONG ANTIRETROVIRAL THERAPY (ART) IN MALAWI – PEPFAR-PROMOTE STUDY     

Author(s): F Chauwa1,2, G Pidini1,4, L Gadama1,2,4, S Dadabhai1,3,5, J Aizire3, 6, T.E Taha3,7, and M.G Fowler4

Affiliation(s):

1. Johns Hopkins Research Project, KUHeS affiliate, Malawi,
2. Department of Obstetrics and Gynaecology, KUHeS, Malawi, 
3. Johns Hopkins Bloomberg School of Public Health, Baltimore, USA,
4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA,
5. Department of Pathology, Johns Hopkins School of Medicine, Baltimore, USA

Email: fcchauwa@jhp.mw

Introduction:  SARS-CoV-2 infection has resulted in significant mortality and morbidity globally. There is less information available about the history of SARS-CoV-2 infection in subpopulations, such as people living with HIV who may be at higher risk of severe disease and mortality due to immune compromise.

Objectives: To measure the proportion of mothers living with HIV in the PEPFAR-PROMOTE cohort with past SARS-CoV-2 infection, which could have effects on long-term health of participants.

Methods:  We retrospectively estimated SARS-CoV-2 antibody prevalence within the established PEPFAR observational cohort by testing stored plasma samples collected between January 2019 to September 2021 in Malawi, Zimbabwe and Uganda. The EUROIMMUN qualitative assay for IgG antibodies to SARS-CoV-2 spike protein were used in Malawi and Zimbabwe. An equivalent Roche assay was used in Uganda. Point prevalence estimates and 95% confidence intervals (CI) were calculated by age, education, marital status and viral load.

Results: We tested 1011 samples; 306 were from Malawi. Overall prevalence was 57.6% (95% CI: 54.5-60.7). Prevalence in Malawi was 57.3%. Median age for mothers with a positive or negative result was 36 and 35 years, respectively. Univariate prevalence rates for SARS-CoV-2 antibodies were as follows: married mother, 59.5%; no regular partner, 51.3%; secondary school education, 67.8%; no schooling, 36.7%; breastfeeding mothers 48.8%, non- breastfeeding mothers, 58.9%; detectable viral load, 51.3%; undetectable viral load, 58.2%. Prevalence in April to June 2021 was 37.5%; July to September 2021, 57.1%; and October to December 2021, 57.1%.

Conclusion: Seroprevalence of SARS-CoV-2 in this population of mothers living with HIV was high especially during the third wave of COVID-19. Stored samples provide a unique opportunity to characterize the epidemiology of emerging infections. Given that up to 20% of those infected with the COVID virus will develop “long-COVID”, it is important to measure seroprevalence to plan for health care needs.

P113.A001334.  NO EVIDENCE FOR PERSISTENT NASAL INFLAMMATION IN PREVIOUSLY HOSPITALISED SARS-COV-2 INFECTED MALAWIAN PATIENTS EXPERIENCING POST-ACUTE SEQUELAE OF COVID-19

Author(s): Janet T. Zambezi1, Mphatso Chaponda1, Herbert Thole1, Cat Anscombe1,2, Peter Mandala1, Wezi Kalua1, Barbara Katulula1, Nicholas Feasey2, Ben Morton1,2, Samantha Lissaeur 1,3, and Kondwani Jambo1,2

Affiliation(s):

1. Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2. Liverpool School Tropical Medicine, Liverpool, UK
3. University of Liverpool, Liverpool, UK

Email: jteezambezi@gmail.com

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes broad spectrum of clinical presentations from asymptomatic infection to severe coronavirus disease of 2019 (COVID-19). A proportion of COVID-19 patients experience persisting, new or recurring clinical symptoms post-acute illness, known as post-acute sequelae of COVID-19 (PASC), also known as long COVID.

Objectives: To determine whether PASC is associated with impaired resolution of inflammation in the nasal mucosa in individuals previously hospitalised with COVID-19.

Methods: We collected nasal cells from 39 hospitalised COVID-19 adults on admission and 6 months after hospitalisation. We performed flow cytometry-based immunophenotyping to identify distribution of immune cell populations associated with inflammation in the nasal mucosa. Clinical data was collected from routine COVID-19 surveillance case report forms at both visits to assess on-going PASC.

Results: There was a high neutrophil to T lymphocyte ratio in COVID-19 patients at hospitalisation compared to 6 months post hospitalisation (9.995 vs 2.717, p= 0.0251), indicating resolution of nasal inflammation following recovery. Out of the 39 participants, 23.1% has evidence of PASC at 6 months post hospitalisation. However, there was no significant difference in neutrophil to T lymphocyte ratio (2.9 vs 2.1, p=0.926) between those with or without PASC.

Conclusion: Our data suggests that nasal inflammation observed in hospitalised COVID-19 patients is unlikely to persist for 6 months and is also not associated with the development of PASC.        

ENVIRONMENTAL HEALTH ABSTRACTS – POSTER

P114.001306. PORE SIZE DETERMINATION ON LOCALLY AVAILABLE WOVEN FABRICS USED IN MAKING FACE MASKS FOR COVID-19 PROTECTION IN BLANTYRE, MALAWI. 

Author(s): Andrew Maulidi1, Chikondi Banda1, and Aeron Nahuku1           

Affiliation(s):

1. Kamuzu University of Health Sciences

Email: M201750033841@stud.medcol.mw

Introduction: COVID 19 is a highly contagious respiratory disease that was pronounced by WHO as a pandemic on 11th March, 2020 because of its increased transmission across the globe. Recently, 84,024 cases and 2,682 deaths has been recorded in Malawi as of 29th September, 2022. In order to curb its spread, use of facemasks particularly fabric/cloth facemasks have been common among the public together with other recommendations. Recent studies have shown that cloth masks are cheap, reusable and readily available but less efficient in blocking infectious aerosols as compared to clinical masks depending on the type of fabric used. However, there are inadequate systematic studies in Malawi to help the public make proper choices on best fabrics to use when making face masks against Covid-19.

Objectives: To determine pore sizes on locally available woven fabrics used in making face masks for Covid-19 protection in Blantyre, Malawi.

Methods: This study used 12 locally available woven fabrics that were purposively selected from Blantyre, Malawi whose types/names were identified by local suppliers. Pore size measurements were later done using a Carl Zeiss fluorescence microscope. MS-Excel, IBM SPSS v25 and ANOVA were used for data management and analysis respectively.

Results: Cloth materials’ pore sizes have ranged from 1.48 µm to 122.73 µm in width with the fabric of Satin being the smallest (Av. 9.42 µm) and 100% cotton being the largest (Av. 78.56). The mean pore sizes for Drill, WPoly-cotton and Gabardine among others were 13.63 µm, 16.06 µm and 18.23 µm respectively which correspond to other major studies.

Conclusion: Fabrics of Satin, Drill, WPoly-cotton and Gabardine can be used for making facemasks against Covid-19. For effective choices, usage of a different methodology is recommended in the future to ascertain pore sizes on these fabrics.

P115.A001222. ADHERENCE TO HOSPITAL WASTE DISPOSAL MANAGEMENT AT MANGOCHI DISTRICT HOSPITAL, MALAWI

Author(s): Mercy S. Buluzi1, Daniel Banda1, Vincent Jumbe1, Adamson Muula1, Fanuel Lampiao1 and Tsilizani Kaombe1          

Affiliation(s):

1. Kamuzu University of Health Sciences

Email: mercybuluzibuluzi@gmail.com

Introduction: Hospital waste disposal management is the process of collecting, transporting, processing, or disposing of, managing, and monitoring waste materials generated during diagnosis, treatment, and immunizations of humans and animals.

Objectives: To assess adherence to hospital waste disposal management processes at Mangochi District Hospital, Malawi.

Methods: A cross-sectional study using focus group discussion using purposive sampling, a questionnaire, and observations was conducted. The study population included the cleaners, ground laborers, incinerator assistants, and also waste generators (Nurses, clinicians, lab technicians, and charges from Theatre, OPD, and Pediatric, Labor ward, Laboratory, and infection prevention coordinators.

Results: Results from the study were that needle prick incidences were high at 42.6% among 89 workers (both caners and waste generators) at Mangochi District Hospital by June 2019. From the focus group discussion, we found that refresher training on hospital waste management is not provided at the Mangochi District Hospital, particularly for cleaners, to remind them of their responsibilities and introduce them to new information.

Conclusion: The study concluded that there is low compliance with the standard of hospital waste disposal management at Mangochi District Hospital. Segregation of wastes into infectious and non-infectious waste and color coding practices in the surveyed departments was poor, no regular training, and furthermore, untrained cleaners were involved in the medical waste management process. Some incinerators lack ash pits for ash collection, and some equipment, such as chimneys, covers for the waste feeding door, and covers for the ashes removing door, are missing from manual incinerators.

P116.A001260. WATER, SANITATION, AND HYGIENE (WASH) INTERVENTIONS IMPACT ON DIARRHOEAL DISEASES IN CHILDREN UNDER FIVE: AN OVERVIEW OF SYSTEMATIC REVIEWS      

Author(s): Lomuthando Nthakomwa1, Ruth Vellemu1, Themba Mzembe, Sahra Mohamed1, Maame Peterson1, Chimwemwe Chifungo1, Nyovani Madise1, Leyla Abdullahi1, Michael G Chipeta1,           

Affiliation(s):

1. African Institute for Development Policy

Email: Ruth.Vellemu@afidep.org

Introduction: WASH interventions are believed to aid in child health and well-being.

Objectives: To conduct an overview of systematic reviews examining the effectiveness of Water, Sanitation and Hygiene (WASH) interventions on reducing diarrhoea diseases among children under five in LMICs

Methods: We conducted our searches in PubMed, Cochrane Library, Epistemonikos and the International Initiative for Impact Evaluation (3ie) databases for systematic reviews published between January 2000 and November 2021. We tabulated study characteristics and quantitative data and assessed study quality. We assessed the methodological quality of the included reviews using the AMSTAR-2 Tool (A Measurement Tool to Assess Systematic Reviews).

Results: We found 803 articles and remained with four reviews for inclusion in our review after title, abstract and full-text screening. Our analysis showed that improved water quality was effective in reducing diarrhoea incidence as reported in three out of the four reviews with risk ratios (RR) of 0.60 (95% CI: 0.53 – 0.68), 0.62 (95% CI: 0.53 – 0.72), and 0.66 (95% CI: 0.60 – 0.71).

Education on handwashing with soap provision proved to be effective in two studies and analysis suggests that handwashing with soap leads to a 27% decrease in the risk of diarrhoea. The second study reported that hygiene interventions reduce diarrhoea compared to no intervention (30% reduction before adjustment for non-blinding). On the other hand, sanitation interventions showed no significant improvement towards diarrhoea incidences.

Conclusion: WASH interventions are effective in lessening diarrhoeal disease prevalence among children under five in LMICs. However, since the included reviews were of low-moderate quality, then robust, high-quality research is needed to make more conclusive claims.

P117A.A001304. ACTIVITY CONCENTRATIONS DUE TO NATURALLY OCCURRING RADIOACTIVE MATERIALS IN CEMENTS AND THEIR ASSOCIATED HEALTH RISKS: A REVIEW ON MALAWIAN CEMENT INDUSTRY

Author(s): Aeron Nahuku1, Bernard Thole 2, and Chikumbutso Kaonga 2.

Affiliation(s): 

1. Department Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Malawi
2. Department of Biochemical Sciences, School of Applied Sciences and Technology, Malawi University of Business and Applied Sciences, Malawi

Email: anahuku@kuhes.ac.mw

Introduction: Cement is one of the main basic building materials whose industry plays an important role in any national economy particularly for a developing country like Malawi. However, it contains Naturally Occurring Radioactive Materials (NORMs) which essentially get inherited through its raw materials from the earth. Studies have shown that elevated levels of NORMs in cement can pose health concerns on the public like cancer etc. To reduce such effects, assessment of radiation exposure contributed by the cement industry becomes paramount now that it accounts to almost 50% of the total dose on humans. In Malawi, studies on NORMs activity concentrations and their risks on health from locally produced cement are currently unavailable or limited.

Objectives: To assess data availability of activity concentrations of selected NORMs in locally produced cements in Malawi and their associated health risks on the public based on UNCEAR and ICRP standards.

Methods: A total of 34 countries were purposively selected through a desk review for data availability on activity concentration on NORMs from cement in various countries but also those produced locally in Malawi and their associated risks on health. MS-Excel was used for data organization and management while IBM SPSS version 23 was used for analysis.

Results: Activity concentrations findings have ranged from 4.85 – 208.6 Bq.kg-1, 3.70 – 115.3 Bq.kg-1 and 1 – 607.6 Bq.kg-1 for Ra-226, Th-232 and K-40 respectively with elevated levels in some countries. All reported values were below the UNCEAR limits hence posing no risk to the public but with no similar studies reported for Malawi.

Conclusion: The unavailability of similar studies in Malawi shows that health risks posed by NORMs in locally produced cement is unavailable or scanty. In future, similar studies on Malawian cement industry are highly recommended.

EPIDEMIOLOGY & PUBLICH HEALTH ABSTRACTS – POSTER

P118.A001325.  RESPONSE RATE OF STANDARD HEPATITIS B VIRUS VACCINATION AMONG PEOPLE LIVING WITH HIV IN BLANTYRE, MALAWI          

Author(s): Maxwell Yohane1, Mulinda Nyirenda1, Johnstone Kumwenda1, Sufia Dadabhai1, and Taha Taha1

Affiliation(s)

1. Johns Hopkins Research Project, Blantyre Malawi

Email: myohane@jhp.mw

Introduction: Hepatitis B virus (HBV) infection is a major cause of chronic liver disease worldwide. While vaccination is the current cornerstone of prevention strategies for HBV, the response rate to standard vaccination is suboptimal in those living with HIV. A host of studies document overall response rates range from 30-70% following a standard three-dose series.

Objectives: To evaluate the response rate of standard HBV vaccination in people living with human immunodeficiency virus (HIV) /AIDS (PLWHA) in Blantyre, Malawi.

Methods: A descriptive sub-analysis of screening data of local participants evaluated as eligible for participation in a multisite clinical trial evaluating the enhancement of Hepatitis B vaccination. Participants were recruited from sensitized health centres around Blantyre. The screening eligibility criteria included age ≥ 18years, positive HIV status currently on ART, prior Hepatitis B Engerix-B vaccination and voluntary informed consent to participate in the study screening procedures. Blood specimens were collected and tested for HIV viral load, CD4+ count, liver function tests, HBsAg, HBsAb and HBcAb. The information was collected into an excel sheet and descriptive analysis was done using excel to report frequencies.

Results: We screened 68 participants aged 27- 66 years and 56 (82%) were female. All patients were on Tenofovir/Lamivudine/Dolutegravir regimen for a duration of 2- 48 months. The CD4+ cell count ranged from 112 – 1651 cells and 60 (88%) participants had undetectable viral loads. Hepatitis B Virus vaccination receipt duration prior to screening date was 4-49 months. Liver function was abnormal in 20 (28.5%). Only 10 (14.5%) participants had received 3 doses of Engerix-B HBV vaccination. The positivity rates for the HBV tests were 82% (n=56) for HBsAg, 64.7% (n=44) for HBsAb and 55.9% (n=38) for HBcAb.

Conclusion: The response rate of HBV vaccination among PLWHIV in Blantyre was 64.7% despite only 14.5 % receiving 3 Engerix-B vaccine doses.

P119.A001410.  ACCEPTABILITY OF COMMUNITY-BASED VOLUNTEER DEFAULTER TRACING PROGRAM FOR UNDER-FIVE CHILDREN IMMUNIZATION SERVICES AMONG CHILD CAREGIVERS IN RUMPHI DISTRICT, MALAWI: A FACILITY-BASED CROSS-SECTIONAL STUDY        

Author(s): Tapiwa Ntwere1, Francis Njala1, Mike Chisema2, Temwa Mzengeza2, Tadala Minyaliwa1, Linda Chirwa1, Steve Macheso3, Doreen Ali4, Atupele Kapito-Tembo1

Affiliation(s):

1. Kamuzu University of Health Sciences, Public health department, School of Global and Public Health
2. Malawi Ministry of Health Expanded Program on Immunisation Unit
3. UNICEF Malawi
4. Malawi Ministry of Health Community Health Section

Email: tttwere@kuhes.ac.mw

Introduction: Community defaulter tracing is one of the strategies used to improve health services uptake and outcomes including for under-five immunization coverage. From 2018 to 2021, the Malawi Ministry of Health piloted a two-arm community-based volunteer defaulter tracing program in Rumphi district using mother care group volunteers (MCGs) and religious leaders (RLs) to learn lessons before national scale-up.

Objectives: To assess the acceptability of community-based volunteer defaulter tracing program for underfive children immunization by child caregivers in Rumphi district.

Methods: Cross-sectional facility-based surveys were conducted in 4 health facilities in Rumphi district in 2021 and 2022. From each intervention arm, 2 health facilities were sampled, one a low performing and one a high performing based on pentavalent-3 vaccine coverage. Health facility exit interviews were conducted on randomly sampled caregivers of under-five children attending immunization clinics in the sampled facilities. A standardized questionnaire was used to collect data on socio-demographics, views and perceptions on the defaulter tracing program. Data were analyzed using Stata.

Results: A total of 247 caregivers were enrolled; mean age was 27 years (SD 7) and 99.6% were females. Ninety-six percent (96%) of the caregivers reported that it was acceptable for them to be visited in their home by community-based volunteers if their child missed a vaccine. Acceptability in the MCG and religious leaders’ arms was 96% and 97%, respectively. When the caregivers were asked to indicate their preferred approach for the defaulter tracing, the following approaches were mentioned; involvement of church leaders (89%), involvement of MCGs (87%), home visits by health workers (71%), educating child caregivers (34%), use of phone reminder messages (31%) and male involvement (3%).

Conclusion: Community-based volunteer defaulter tracing of under-five children for immunization was highly acceptable among the caregivers. Alternative defaulter tracing approaches like phone messages reminders should be considered. The role of male involvement in defaulter tracing for under-five immunization in this setting needs to be assessed.           

P120.A001378.  WHY CHILD CAREGIVERS OF CHILDREN AGED 12-59 MONTHS STOP ATTENDING UNDER-FIVE CLINICS: FINDINGS FROM PILOT STUDY ON INTEGRATION OF VITAMIN A SUPPLEMENTATION IN IMMUNIZATION SERVICES

Author(s):  Atupele Kapito-Tembo1, Tapiwa Ntwere2, Francis Njala2, Mike Chisema 3, Temwa Mzengeza 3. Dennis Mwagomba3, Frank Msiska 4, Lusungu Chitete 5, Chikondi Makawa 5, Jeanne Ejigui 5, Mamadou Ndiaye 5, Janet Guta4, and Felix Pensulo6

Affiliation(s):

1. Kamuzu University of Health Sciences, Public Health Department, School of Global and Public Health
2. Kamuzu University of Health Sciences-MAC Communicable Diseases Action Center
3. Malawi Ministry of Health Expanded Program on Immunisation EPI unit
4. Malawi Ministry of Health Nutrition Unit
5. Lusungu Chitete – UNICEF Malawi
6. Felix Pensulo – Malawi Ministry of Health Directorate of HIV/AIDs and Nutrition

Email: akapito@kuhes.ac.mw          

Introduction: The Malawi Ministry of Health piloted integration of Vitamin A supplementation (VAS) in under-five children in routine immunisation in 10 districts from 2018 to 2020. VAS coverage was found to be lower in children 12-59 months compared to children 6-11 months due to low attendance of under-five clinics by caregivers with older children. There is need to identify reasons for low attendance to inform strategies to improve uptake of VAS and immunisations in Malawi.

Objective: To identify reasons why child caregivers with children aged 12-59 months stop attending under-five clinics for routine child health services in Malawi.

Methods: A cross-sectional community-based household survey was conducted in 5 pilot districts in 2021. A two-stage cluster design sampling was used to select 38 enumeration areas (EAs) in each district based on probability proportional to population size. In each EA, 8 households with at least one child aged 6-59 months were randomly selected. Child caregivers were interviewed using standardized questionnaires and information on socio-demographics, attendance of child clinics, VAS and immunizations was collected. Descriptive analysis of data was done using Stata software.

Results: Of the 1,505 child caregivers enrolled, 91% mentioned that they had a child aged 12-59 months. Fifteen percent (15%) of caregivers mentioned that they had stopped attending the routine under-five clinic with an older child and this ranged from 8% to 27% across the districts. Among the child caregivers who stopped attending the routine under-five clinics, the most common reasons were: child is grown or healthy therefore no need (24%); lost health passport book for the child (18%); caregiver is ignorant on need to continue attending clinic (15%); child caregiver got sick (13%) and caregiver busy (9%).

Conclusion: The proportion of child caregivers with children aged 12-59 months who stop attending under-five clinics is high and varies across the districts. There is need for intensified awareness among the child caregivers on the need and importance of continued under-five clinic attendance as well as identification of innovative strategies or platforms to reach these children with VAS and immunization services.

P121.A001333.  ATTENDANCE OF UNDER-FIVE IMMUNIZATION CLINICS DURING THE COVID-19 PANDEMIC IN THREE DISTRICTS IN MALAWI: A FACILITY-BASED CROSS-SECTIONAL SURVEY

Author(s):  Vongaishe Monalisa Chafewa1, Andrew Bauleni2, Linda Chirwa1, Mike Chisema3, Temwa Mzengeza3, and Atupele Kapito-Tembo1          

Affiliation(s):

1. Kamuzu University of Health Sciences, Department of Public Health, School of Global and Public Health
2. Kamuzu University of Health Sciences-MAC Communicable Diseases Action Center
3. Malawi Ministry of Health Expanded Program on Immunisation unit

Email: monaleetee@gmail.com

Introduction: In Malawi, COVID-19 was first diagnosed in March 2020. One of the transmission prevention measures implemented by the government was decongestion of publicly accessed areas including in health facilities.  This could have led to disruption in delivery and access to healthcare services. Under-five immunization clinics are the main delivery points for child vaccines in Malawi and their disruption due to COVID-19 may cause a decline in vaccination coverage. There is need to understand to what extent COVID-19 affected immunization clinics’ attendance.

Objective: To determine the extent to which caregivers’ attendance of under-five immunization clinics was affected by COVID-19 pandemic.

Methods: A cross-sectional facility-based survey was conducted in districts of Kasungu, Mulanje (March 2021) and Rumphi (February 2022). Exit interviews were conducted in 8 randomly sampled health facilities among caregivers of under-five children attending immunization services. Information on demographics and attendance during COVID-19 pandemic was collected. Descriptive data were analyzed using Stata statistical package.

Results: A total of 247 child caregivers of whom 99.6% were female with a mean age of 26 years were enrolled. Twenty-one percent (21%) of the caregivers reported that COVID-19 pandemic had affected their attendance of immunization clinics and ranged from 12% in Kasungu to 26% in Rumphi district. Child caregivers mentioned were still comfortable attending clinics during the pandemic because: they could not afford to the miss vaccine (53%); were encouraged by healthcare workers (37%); clinics observed preventive measures (21%) and had a mask to protect self (21%). Overall, only 5% reported to have missed a clinic visit due to the pandemic.

Conclusions: Child caregivers Immunization clinics attendance was affected by COVID-19 pandemic, however, missing of visits was uncommon. Children were still able to access vaccination during the pandemic because caregivers acknowledged its importance, healthcare workers encouraged the caregivers and preventive measures were being observed.

P122.A001382. COVID-19 VACCINE EXPRESS STRATEGY IN MALAWI: AN EFFORT TO REACH THE UN-REACH        

Author(s): Ghanashyam Sethy1, Mike Chisema2, Lokesh Sharma1, Krupal Joshi3, Sanjay Singhal, Patrick Omar Nicks1, Steve Macheso1, Tedla Damtea1,4   , Antoinette Eleonore Ba5 , Collins Mitambo6 , Mavuto Thomas7 , Beverly Laher8, and JohnPhuka8.         

Affiliation(s):

1. UNICEF Country Office, Malawi.
2. Ministry of Health, Govt. of Malawi, Malawi.
3. Department of Community and Family Medicine, All India Institute of Medical Sciences Rajkot, Gujarat, India.
4. LIKA UFPE, Brazil
5. UNICEF, RO, Kenya
6. PHIM-Ministry of Health, Malawi
7. Health Education Services, Ministry of Health, Malawi.
8. School of Global & Public Health, KUHeS, Malawi.

Email: blaher@medcol.mw

Introduction: Malawi received 2,425,790 doses of the Covid-19 vaccine. At first vaccination targeted populations at high risk of mortality from COVID-19, then everyone. However, the uptake of the vaccines remained slow, with the consumption of 1,290,145 doses over eight months from March to October 2021, with a mean daily vaccination rate of around 1854 (95 %CI: 1292–2415). A situational analysis revealed several challenges therefore. Hence, a project, “Covid-19 Vaccination Express (CVE)”, was implemented to increase vaccine uptake in the population. 

Objective: To establish the impact of “Covid-19 Vaccination express” (CVE) on vaccine uptake in Malawi.

Methods: A retrospective cross-sectional study comparing the daily vaccine administration rate for CVE with regular COVID immunization (nRCV). RCV was collected between March 2021 and October 2021. While data on CVE was gathered between 5 November 2021 and 31 December 2021. Data was collected on (1) the total number and type of vaccine dose administered; and (2) demographic information, such as age, gender, occupation, presence of comorbidities, whether the person receiving the vaccine received their first dose or second dose.

Results: From March-December 2021, a total of 1,866,623 COVID-19 vaccine doses were administered, out of which 1,290,145 doses were administered at a mean daily vaccination rate of 1854 (95 % CI: 1292–2415) doses as a part of RCV, and 576,478 doses were administered at a mean daily vaccination rate of 3312 (95 % CI: 2377–4248) doses as a part of CVE. Comparing the mean daily doses (Astra Zeneca, AZ doses 1 & 2) administered in the CVE and RCV showed that the mean daily doses of AZ vaccine administered were significantly higher in the CVE (p < 0.05).

Conclusion: CVE successfully increased the uptake of the Covid-19 vaccine.

P123.A001508. VALIDITY OF PARENTAL RECALL TO ESTIMATE VACCINATION COVERAGE: EVIDENCE FROM NINE DISTRICTS IN MALAWI

Author(s): Vincent Samuel Phiri1, Christopher Stanley2, Harrison Msuku2, Jobiba Chinkhumba1,2, Atupele Kapito Tembo1,2 and Don Mathanga1,2

Affiliation(s):

1. School of Global and Public Health, Kamuzu University of Health Sciences
2. Malaria Alert Centre, Kamuzu University of Health Sciences

Email: vsamuel@kuhes.ac.mw        

Introduction: During household surveys, vaccination coverage is commonly estimated through vaccination cards and parental recall. Although data from vaccination cards are more reliable than parental recall, both approaches are prone to selection and information bias. At times, vaccination cards may not be available because of loss or misplacement necessitating the use of parental recall as alternative.

Objectives:

1. To compare validity of the vaccination coverage from two sources (vaccination cards and parental recall)
2. To assess individual and household level factors associated with recall bias

Methods: The vaccination coverage of the parental recall and vaccination card were calculated separately for each vaccine. The level of agreement was computed between the estimates from the parental recall and vaccination cards. Sensitivity and specificity of parental recall were computed. The study also examined the factors that would be associated with recall bias. Multiple logistic regression model by vaccine type were fitted where odds ratios and 95% confidence intervals were reported.

Results: The vaccination coverage for BCG was 98.6 for card-based and 98.1 for parental recall. The vaccination coverage for OPV was 98.9 for card-based and 98.1 for parental recall. For PCV, it was 99.6 for card-based and 97.4 for parental recall. For measles was 84.1 for card-based and 88.0 for parental recall. The results show a high level of agreement between parental recall and card-based (>97%) across all vaccines. The parental recall bias was minimal ranging from 1.13 to 6.66. The sensitivity of parental recall was almost 100% with low specificity. Factors such as parental and child age were associated with parental recall bias for PCV and measles

Conclusion: The study has demonstrated and supported the need to use parental recall to estimate the vaccination coverage for different vaccine types which can be used instead of or in the absence of card-based data or records.

HEALTH SYSTEMS & POLICY ABSTRACTS – POSTER

P124.A001074. WHATSAPP BASED TRIALS OF IMPROVED PRACTICES (TIPS): A STRATEGY FOR CONTROLLING HYPERGLYCEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT KAMUZU CENTRAL HOSPITAL

Author(s): Sainab Matiki1, Gabriella Chiutsi-Phiri1, and Getrude Mpwhanthe1

Affiliation(s):

1. Lilongwe University of Agriculture and Natural Resources, Lilongwe Malawi

Email: smatiki52@gmail.com

Introduction: The cornerstone of Type 2 Diabetes Mellitus (T2DM) management is promoting a lifestyle that includes a healthy diet, regular exercise and maintenance of a healthy body weight. In Malawi, individuals with T2DM have poor nutritional choices, limited involvement in daily physical exercise, glycemic status is above the clinically glycemic target (A1C <8%) and overweight and obesity are becoming more prevalent among adults living with the condition.

Objective: To promote management of T2DM using Trials of Improved Practices (TIPs) through WhatsApp messaging.

Methods: This was a 12-weeks TIPs intervention-control quasi-experiment involving 50 participants with uncontrolled glycemic status (A1C ≥8%) who attended the outpatient diabetes clinic at Kamuzu Central Hospital in Lilongwe. Trials of improved practices was implemented using three visits. The intervention group went through the first, second (counselling and WhatsApp motivational messaging) and third visit while the control group only went through the first and third visit. Data was analysed using IBM SPSS version 20.0. Comparison between the intervention and control group were performed using independent t-test and fisher’s exact test at baseline and endline. Paired t-test and Wilcoxon ranked test were used to test for the differences within each group from baseline to endline.

Results: After 12 weeks, the intervention groups median A1C level significantly decreased from baseline to endline. The control groups A1C level remained high both at baseline and endline. Fruit and vegetable intake greatly improved in the intervention group while it reduced in the control group.

Conclusion: The study showed that individualized counselling through WhatsApp based TIPs can improve glycemic status, dietary intake, weight status and physical activity level among T2DM patients with suboptimal glycemic status.

P125.A001315. EVALUATION OF USE OF ELECTRONIC INFORMED CONSENT IN A PNEUMOCOCCAL HUMAN INFECTION STUDY IN BLANTYRE, MALAWI

Author(s): Dula D1, Gondwe J1, Chirwa AE1, Nsomba E1, Nkhoma V1, Mangani M1, Ngoliwa C1, Chakwiya C1, Toto N1, Sochera T1, Morton B1, Gordon SB1, and MARVELS Consortium

Affiliation(s): 

1. Malawi Liverpool Wellcome Clinical Research Programme       

Email: ddula@mlw.mw

Introduction: Informed consent involves providing information to a participant in a comprehensible language and ask questions to aid voluntary participation. Electronic informed consent (eIC), or e-consenting, uses electronic gadgets to supplement or replace paper- based consenting. Data and Clinical Research Support Unit at MLW proposed piloting e-consenting to NHSRC at a symposium in October 2021.  Following NHSRC approval on 29 October 2021, e-consenting was adopted in a DB RCT of pneumococcal vaccine or placebo and experimental pneumococcal carriage.

Objectives: To describe the implementation process, advantages, and challenges with e-consenting in a DBRCT in Blantyre, Malawi

Methods: The study site was QECH and period was April to September 2022. An e-consenting standard operating procedure was developed. Healthy, literate adults aged 18-40 years, who owned cell phones, did not have visual, hearing or motor skills impartment were recruited. Ethics- stamped Participant Information Sheets (PIS), Assessment of Understanding (AOU) and consent forms were digitized in ODK on tablets with touchscreen capabilities. Inbuilt edit quality checks were configured in e-consents. Verbal consent to undergo dual consenting was sought. Participants self-administered the e-consent in the presence of a research personnel who troubleshooted.  A paper-based quiz was administered to assess understanding. Participants signed and study staff countersigned. The e-consent was exported to the data server, printed and a copy provided to the participant.

Results: 155/278 (55.8%) participants underwent e-consenting. Advantages were user friendliness, reduction in documentation errors, immediate exportation of consents to secure servers. Challenges faced included: difficult digitization process of ethics-stamped documents, volunteer lack of familiarity with tablet user interface, requirement of working internet and printer.

Conclusion: E-consenting potential gains in error minimization and user-friendliness come at high resource demand (cost of staff, internet, electronic gadgets). Research is needed to ensure inclusion of individuals with hearing, visual or motor skill impairment.

P126.A001362. HDS EXPLORER WEB AND MOBILE APP REVOLUTIONIZING HEALTH AND DEMOGRAPHIC SURVEILLANCE RESEARCH STUDIES IN SOUTHERN MALAWI           

Author(s): Alfred Matengeni1, Ernest Matola1, Paulo Filimone6, Peter Ntenda1, Clarissa Valim3, Samson Gowa1, Harrison Msuku1, Wangisani Kumalakwaanthu1, Charles Mangani2, Lauren Cohee4, Karl Sydel5, Terrie Taylor5, Don P. Mathanga1,2    

Affiliation(s):

1. MAC- Communicable Disease Action Center (MAC-CDAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
2. School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
3. Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
4. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
5. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
6. Philimone’s Group, Maputo, Mocambique.         

Email: amatengeni@mac.kuhes.ac.mw

Introduction: Health and Demographics Surveillance Systems (HDSS) allow accurate electronic capture and prompt access to data, supporting development of data-driven policies through an understanding of local community health issues. Furthermore, HDSS allows improved management of research studies, while monitoring recruitment, visits, and other study procedures. Some widely employed HDSS cannot work on mobile devices or offline, and hence, are not appropriate for resource-limited settings. Others, including OpenHDS, ceased to be supported, have limited inbuilt data validation, uses mirth connect during synchronization making system complex and bulky, which affects efficiency.  HDS Explorer2 can work offline, is user-friendly can be configured in any Android version and because of its seamless integration with any version of Open Data Kit (ODK), can manage questionnaires. It allows management of subject visits for surveillance and cohort studies.

Objective: To assess a new HDSS – HDS Explorer 2 – developed to capture and manage registries, and cross-sectional and cohort malaria research studies in Southern Malawi.

Methods: We evaluated system benchmarks including synchronization speed, data compression, accuracy of data validation at synchronization, ability to manage questionnaire completion, and participant follow-up. The system was assessed in the management of cross-sectional census, surveillance studies capturing about 6,000 individual health center visits, community and hospital-based 10 cohort studies including 102,804 subjects and up to 64,000 visits.

Results: HDS Explorer2 combined with ODK allowed preventing missed and repeated eCRFs and missed follow-up visits. Synchronization was fast. Validation scripts prevented capture and synchronization of incorrect data. It was easy to learn. Thanks to its data compression algorithms, it keeps information of key demographic events throughout one’s life span. Media files allowed real-time queries based on longitudinal data, for accurately capturing anthropometric measures.

Conclusion: HDS Explorer2 is a robust system providing high-quality data and improved management of health services and research studies.

P127.A001367. ASSESSING EFFECTIVENESS AND ACCEPTABILITY OF A COMBINED NEUROCOGNITIVE DEVELOPMENT ASSESSMENT TOOL (STREAM APP) ON CHILDREN AGED 0 TO 6 YEARS IN MALAWI

Author(s): Allan Bennie1      

Affiliation(s):

1. Blantyre Malaria Project, Blantyre Malawi

Email: allanbennie536@gmail.com

Introduction: Studies have shown that 10 to 20 % of the children and adolescents worldwide have mental health issues which include neurodevelopmental disorders. It is believed that there is lack of training of allied workers in identification, management as well as referral of children and adolescents with these conditions. Many studies in Malawi and other low resource settings assess neurocognitive development and mental health through standardized clinical assessment with Western tools which is often culturally inappropriate. This study aims at filling this gap through measurement of children’s abilities using the Malawi Developmental Assessment Tool (MDAT), Screening Tool for Autism (START), Developmental Electronic Platform (DEEP) and (PCI) Parent Child Interaction using tablet-based platforms.

Objective: To assess the effectiveness and acceptability of the combined neurodevelopmental assessment tool (STREAM) on children aged 0-6years in Malawi.

Methods: The study has employed both qualitative and quantitative research methodologies. It has targeted 2000 participants of which 1,850 are from a community sample and 150 from enriched sample of children at high risk of neurodevelopmental disorders. The study uses, MDAT, DEEP, START and PCI tools to collect data by non-health professionals.

Expected results: The study has approached 796 families with 63 not eligible and 6 not interested. We have assessed 439 (222 boys, average age 2.33 years) representing 24 % of the total sample and 28 participants (14 boys average age 2.70 years) from the enriched sample (19% of total sample). Almost 95% of the enrolled participants found the tool acceptable with most assessments taking 1 to 2.5 hours, with very few having concerns about the procedure. Most children, from both samples, were able to provide meaningful data for all tasks. The was able to red-flag children with neurodevelopmental disorders.

Conclusion: The unified STREAM APP may be a more successful scalable way to assess and detect children’s neurodevelopmental disorders in Malawi and other low-income countries which in future may lead to referrals of children to services which could improve their mental health and general wellbeing.

P128.A001132. RESEARCH ETHICS COMMITTEES IN MALAWI DURING THE COVID-19 PANDEMIC

Author(s): Tiwonge Kumwenda Mtande1,2, Alfred Maluwa 3, and Francis Masiye1,2,3

Affiliation(s):

1. Centre for Bioethics in Eastern and Southern Africa (CEBESA), Kamuzu University of Health Sciences, Malawi.
2. Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
3. Directorate of Research, Postgraduate Studies and Outreach, Malawi University of Science and Technology, Ndata Farm, Thyolo, Malawi.

Email: tmtande@kuhes.ac.mw

Introduction: Despite the growth of research in Malawi, there are few insights into the operations of Research Ethics Committees (RECs) during public health emergencies. Therefore, we conducted an empirical study to investigate operations and experiences of three RECs in the context of the COVID-19 pandemic.

Objectives: To explore the experiences of REC members and administrators during the COVID 19 pandemic in Malawii.

Objective: To identify ethical concerns raised when reviewing research protocols during the COVID 19 pandemic.

Methods:  Fifteen key informants were purposively selected from three RECs to take part in-depth interviews. The interview guide had questions around procedures for conducting protocol review meetings and ethical issues that stimulated debates during review meetings in the middle of the COVID 19 pandemic. Interviews were conducted in English and recorded. Audio recordings were transcribed verbatim and the data was analysed thematically. The data was collected between February and April 2021.

Results: A majority of participants reported that each REC developed its own guidance document which had some differences, including remuneration of research participants.  Most participants reported that RECs were promoting rapid reviews of protocols and virtual meetings during the COVID-19, but there were operational challenges accompanying these new approaches. In terms of ethical issues, the following were reported; research participant remuneration considering the high cost of living and risks associated with COVID 19; inadequate safety information for trials involving herbal medicine; challenges adhering to ICH GCP for clinical trials conducted in routine clinical settings and debates surrounding a waiver of consent.

Conclusion: A National guideline for conducting research during emergency situations is important to reduce discrepancies.  Similarly, rapid reviews of more than minimal risk studies need appropriate ethics frameworks backed by national guidelines.  Finally, Malawian RECs may need to embrace public health research ethics which differs from conventional research ethics.

P129.A001211. INTEGRATING DATA SYSTEMS FOR MANAGING AND PROCESSING DATA IN TYVAC CENSUS – A NESTED STUDY IN THE RANDOMIZED TYPHOID CONJUGATE VACCINE CLINICAL TRIAL

Author(s): Richard Wachepa1, Nyengo Chavula1, Priyanka Patel1, Petro Chilinga1, Bernadette Payesa1, Effort Kachitsa, Theressa Misiri1, Felistas Mkwasigile1, Vincent Kantunga-Phiri1, Lumbani Makhaza1, Katheleen Neuzil2, Melita A. Gordon1,3,4

Affiliation(s):

1. Malawi Liverpool Welcome Trust
2. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
3. Institute of Infection, Veterinary and Ecological Science, University of Liverpool, United Kingdom
4. University of Malawi, College of Medicine

Email: rwachepa@mlw.mw

Introduction: Over 28,00 children between the age of 9 months and less than 12 years residing in Ndirande and Zingwangwa were vaccinated with Typhoid Conjugated vaccine (Vi-TCV) in 2018. To yield good quality data we integrated data systems at data collection level, data processing level and data reporting level.

Objective: To investigate how many of the vaccinated children remain within the passive surveillance catchment areas.

Methods: Data was collected electronically using Open Data Kit (ODK) on an android device. To completement to ODK functionality, three inhouse applications were used; 1) ODK lookup updater application – Enforced data validation at the point of data collection. 2) PID search application – verification of participant information. 3) Electronic Participant locator (ePAL) – Collect geo-coordinates using high resolution offline maps and defined study boundaries. Data was synced to MSQL database through a secured socket layer (SSL). An inhouse web portal application was used for data access and dynamic visualization during the Census period. Scripts developed in STATA 15 were used for data extraction and data cleaning.

Results: Real-time data collection errors were reduced through validation rule and constraints configured during ODK from development. This was further enhanced by using inhouse applications that complemented ODK Collect, this approach improved data quality and data completeness. The Census survey identified 12,957 (46%) vaccinated children in the passive surveillance catchment area, from these 7,994 (62%) were identified using the PID search application.

Conclusion: Integrating inhouse applications and secure data systems with ODK helped the study team to efficiently manage and process the study data. Data collected was of high quality and the process qualifies to be used in future studies to come.

P130.A001143. SAINTS COMMUNITY ENGAGEMENT IN CHIKWAWA: EXPERIENCES AND LESSONS

Author(s): Georgina Makuta1, Helen Dale2, Esmelda Chirwa1,2, Elvis Moyo1, Yamikani Dickson1, Kestern Mkoola1, Theressa Misiri1, Felistas Mwakaseghile1, and Melita Gordon1,2       

Affiliation(s):

1. Malawi Liverpool Wellcome Programme
2. University of Liverpool

Email: gmakuta@mlw.mw

Introduction: Community Engagement activities are key to make research relevant and sustainable, through consulting and empowering the community that will be impacted by study activities and research outcomes. We conducted an extensive community engagement program in Chikwawa district, Malawi as part of Sero epidemiology in Africa of Invasive Non-Typhoidal Salmonella (SAiNTS) study. The SAiNTS study enrolled 2428 children aged 0-5 years. Challenges experienced whilst undertaking study activities included: lack of exposure to research, wide geographical study area, severe flooding, COVID-19 and misconceptions.

Many communities had not been previously exposed to research activities. Study Enumeration Areas (EAs) were widely geographically spread. Study activities suspended due to severe floods. Communities were unable to differentiate between healthcare workers administering the COVID-19 vaccine and SAiNTS study staff. Some community members were hesitant to have blood samples collected due to misconceptions associated with bloodsucking.

Objective:  To understand immunity against NTS to inform vaccine studies.

Methods: To address these challenges, we employed an extensive community engagement program, through the Malawi Liverpool Wellcome Trust (MLW) department of science and communication. Activities Included were, seeking permission from local community leaders, raising study awareness, helping communities understand the study and addressing misconceptions associated with blood samples. Key messages were communicated through stakeholder meetings, including District Executive committee (DEC), Health facility staff (50-Nurses and Medical Assistants),100 Health Surveillance Assistants, 40 community volunteers, Community Liaison Team members (CoLT) and Community Advisory Group (CAG), 300-chiefs,780 different committee members from the community and 15,000- 18,000 community members. Sensitization was done through presentations, group discussions, van sensitization, film showings demonstrating blood sample collection and local leaders narrating their experiences with research.

Results: A post-recruitment Focus Group Discussion(FGD), concluded that van sensitization and film shows improved awareness and recruitment.

Conclusion: Multiple channels of communication are required to reach the community, particularly in challenging environmental and remote settings.

P131.A001117. “GUIDANCE SHOULD HAVE BEEN THERE 15 YEARS AGO” RESEARCH STAKEHOLDERS’ PERSPECTIVES ON ANCILLARY CARE IN THE GLOBAL SOUTH: A CASE STUDY OF MALAWI        

Author(s): Blessings M. Kapumba1,2, Deborah Nyirenda2, Nicola Desmond3, Janet Seeley1

Affiliation(s):

1. London School of Hygiene and Tropical Medicine, London, United Kingdom
2. Malawi-Liverpool Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
3. Liverpool School of Tropical Medicine, Liverpool, United Kingdom

Email: bkapumba@mlw.mw

Introduction: Medical researchers in resource-constrained settings must make a difficult moral decision about the provision of ancillary care to their participants during research owing to additional health care needs outside the scope of the research, and which are not adequately provided for by the local health care system.

Objective: To examine research stakeholder perceptions and experiences in Malawi about the practice and ethics of ancillary care to inform the development of relevant and acceptable standard guidelines and recommendations for resource-constrained settings.

Methods: We conducted 45 qualitative in-depth interviews with key research stakeholders in Malawi, including researchers, health officials, research ethics committee members, research participants and grants officers from international research funding organisations.

Results: All stakeholders perceived provision of ancillary care to have potential health benefits to study participants in biomedical research, but they also had concerns, particularly related to the absence of guidance to support it. Some suggested that consideration for ancillary care provision could be possible on a case-by-case basis but that the majority of support should be directed towards the public health system more widely. Stakeholders raised concerns about potential tensions in terms of funding, for example balancing study demands with addressing participants’ additional health needs.

Conclusion: Our empirical findings highlight the complexities and current gaps in the provision of ancillary care in Malawi and for other RCS more generally. To promote the provision of ancillary care, we recommend that current national and international research ethics guidelines include standard guidance applicable to specific research settings.

P132.A001357. KNOWLEDGE, ATTITUDES AND EXPERIENCES AMONG CHILD CAREGIVERS OF UNDER-FIVE CHILDREN TOWARDS COMMUNITY-BASED VOLUNTEER DEFAULTER TRACING PROGRAM FOR IMMUNIZATIONS IN RUMPHI DISTRICT, MALAWI: FINDINGS PILOT STUDY    

Author(s): Linda Chirwa1, Francis Njala1, Mike Chisema2, Temwa Mzengeza2, Doreen Ali3, Precious Phiri3, Steve Macheso4, Sethy Ghanashyam Sethy, Atupele Kapito-Tembo1

Affiliation(s):

1. Kamuzu University of Health Sciences, Department of Public Health, School of Global and Public Health
2. Malawi Ministry of Health Expanded Program on Immunisation unit
3. Malawi Ministry of Health Community Health Section
4. UNICEF Malawi

Email: lchirwa@mac.kuhes.ac.mw

Introduction: In 2020, the Malawi Ministry of Health piloted a two-arm community-based volunteer defaulter tracing program for under-five immunization using mother care groups (MCGs) and religious leaders (RLs) community volunteers to improve vaccine uptake in Rumphi district. 

Objective: To assess the knowledge, attitudes and experiences among child caregivers of under-five children towards the pilot community-based volunteer defaulter tracing program for immunizations in Rumphi district. 

Methods: A cross-sectional facility-based survey was conducted in Rumphi district in 2022 in 4 randomly sampled health facilities, 2 from each of the intervention arms (MCGs and RLs) . Facility exit interviews using a standardized questionnaire was administered among child caregivers attending the sampled facilities. Information on knowledge, attitudes and experiences towards the pilot program was collected. Descriptive data analysis was done using Stata.

Results: A total of 127 child caregivers were enrolled and 100% were females.  Seventy-two percent (72%) of the caregivers had heard about the existence of the pilot defaulter tracing program. Ninety-four (94%) of caregivers had a positive attitude towards the program and were of the view that it was relevant in their communities. Thirteen (13%) of the caregivers mentioned that their children had missed vaccines and among those that missed vaccines, 35% were traced and followed up in their homes and brought back to care. Among the child caregivers, whose children had missed vaccines, the community-based cadres who traced them were: MCGs (33%), RLs (33%) and community health workers (33%).

Conclusion: Most child caregivers had knowledge on the existence and had a positive attitude towards the program. However, not all children who had missed vaccines were traced. There is a great need to identify approaches to strengthen the pilot defaulter tracing program to ensure that all children who miss vaccines are followed up by the community volunteers and brought back to care.

P133.A001363. PREDICTORS OF PAEDIATRIC INPATIENT ABSCONDMENT IN FOUR DISTRICT HOSPITALS IN MALAWI

Author(s): Kelvin Maziya1, Madalitso D. Zulu1, Harrison Msuku2, Christopher C. Stanley2, Don P. Mathanga2,3, Tisungane Mvalo1,4           

Affiliation(s):

1. University of North Carolina Project Malawi (UNCPM), Lilongwe, Malawi
2. Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
3. School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre
4. Malawi University of North Carolina at Chapel Hill, North Carolina, USA

Email: maziyakelvin@gmail.com

Introduction: Patient absconding poses risks to patients, healthcare system and community because it is associated with prolonged recovery period, uncompleted treatment, death, increased costs for the health system and community. The magnitude, reasons and impact of absconding for medical illness remains unclear in Malawi and other sub-Saharan African settings.

Objective: To assess predictors of absconding among paediatric patients in four hospitals in Malawi using a case control design.

Methods: This study analyzed data from the on-going hospital surveillance of Malaria Vaccine Implementation Program (MVIP) in Malawi’s four district hospitals of Balaka, Machinga, Mchinji and Ntchisi.  The cases and controls were from children aged 1-59 months who were hospitalized with medical illness who were enrolled between 1 Apr 2019 – 31 July 2022. 461 patients of abscondment (cases) matched on 1:1 with controls based on location and time of admission. Adjusted odds ratio for abscondment were estimated using conditional logistic regression model.

Results: Guardians of boys were likely to abscond than guardians of girls ([OR:1.5]; [95% CI: 1.08-2.21]; [P-value: 0.02]). The guardians of children with severe aneamia secondary to malaria were likely to abscond than guardians of children with malaria ([OR: 3.89]; [95% CI: 1.53-9.93]; [P-value: 0.004]). Guardians of children that stayed in the hospital for >3 days were likely to abscond than guardians of children that stayed for ≤3 days ([OR:2.69]; [95% CI: 1.79-2.21], P-value=<0.001]). However, guardian of children with pneumonia were unlikely to abscond than guardians of children with malaria ([OR:0.23]; [95% CI=0.09-0.61], [P-value=0.003]).

Conclusion: Strategies to reduce abscondment should target guardian whose children are males, children with severe aneamia secondary to malaria, and those who have stayed in the hospital for more than 3 days.

P135.A001430. RESPONDING TO THE CHALLENGES OF A DUAL PANDEMIC:  HOW OUTREACH MOBILE HEALTH CLINICS MAINTAINED HIV TESTING AND LINKAGE SERVICES IN THE FACE OF COVID-19

Author(s): Nelson Khozomba1; Joyce Jere1; Mphatso Phiri1; Beth Geoffroy2; Molly Brostrom2; and Chifundo Chomanika1     

Affiliation(s):

1. Global AIDS Interfaith Alliance (GAIA), Limbe, Malawi
2. GAIA Global Health, California, USA

Email: nelsonkhozomba@gaiamalawi.org

Introduction: COVID-19 caused a major setback in HIV/AIDS care globally, with large declines in HIV testing services (HTS) provided. COVID-19 threatens Malawi’s progress to achieve UNAIDS 95-95-95 targets. GAIA Malawi operates outreach mobile clinics, improving access to integrated HIV and primary health care services for rural communities. In a public-private partnership with the Ministry of Health, seven clinics serve 35 sites weekly across three districts, providing 250,000 client visits annually. 

Objective: To review clinic data and estimate the pandemic’s impact on client attendance HTS.

Methods: GAIA compiled routine HTS data from clinics in Mangochi, Mulanje and Phalombe districts for 21 months prior and following the announcement of the pandemic and described and compared testing outputs over time and with national data publicly available.

Results: In stark contrast to the global trend, and a 37% decline in Malawi nationally, HIV testing at GAIA mobile clinics increased by 22%, averaging 1272 tests per clinic between April 2020-December 2021 compared with 1042 during the 21 months prior.  Of the 7,736 people GAIA tested, 86% were female and 2.9% tested positive compared with 2.3% of people tested nationally. GAIA reached 90% of those positive for follow-up and 88% initiated ART. During this period, the clinics operated 98% of the time and facilitating COVID19 vaccinations by government community health workers at mobile clinic sites.

Conclusion: COVID-19 challenged health providers’ abilities to provide HIV testing services.  Leveraging community trust and local government partnership, GAIA’s mobile clinics maintained access to high quality, easily accessible HTS throughout the pandemic through smart pivots – adding staff to reduce visit length, promoting distancing; protecting staff and clients with PPE; altering clinic workflow; and increasing handwashing and ventilation. This flexible, community-based outreach approach to care provision is an effective model for rural health system strengthening and rapid crisis response.

P136.A001317. EXPLORING SOCIAL AND HEALTH SUPPORT SERVICES FOR PEOPLE LIVING WITH HIV AND MENTAL ILLNESS IN SOUTHWESTERN UGANDA: A CROSS-SECTIONAL STUDY

Author(s): Lorna Atimango1, Rita Akatusasira1, Walter Turyahebwa2, Lenah Kwagala3, Emmanuel Aliruku4, Christine K Karungi5, Edith K Wakida6, Celestino Obua7, and Clara Atuhaire5     

Affiliation(s):

1. Department of Medicine, Mbarara University of Science and Technology, Mbarara Uganda.
2. Department of Pharmacy, Mbarara University of Science and Technology Mbarara Uganda
3. Department of Nursing Mbarara University of Science and Technology, Mbarara Uganda
4. Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara Uganda.
5. Office of Research Administration, Mbarara University of Science and Technology, Mbarara Uganda
6. Department of Medical Education, California University of Science and Medicine, San Bernardino, California, USA
7. Office of the Vice Chancellor, Mbarara University of Science and Technology

Email: atimangolornadoone@gmail.com

Introduction: The high prevalence of mental disorders among people living with HIV is often associated with suboptimal HIV treatment outcomes and increased mortality. Failure to address the mental health disorders among people living with HIV is bound to exacerbate the many social and economic barriers to accessing adequate and sustained care, therefore increasing mortality and morbidity among people living with both HIV and mental illness.

Objective: To assess the social and health support services available for people living with HIV and mental illness in southwestern Uganda.

Methods: The study was a cross-sectional qualitative study that employed a purposive technique of selecting study participants. We used semi-structured questionnaires to conduct in-depth interviews with 18 patients with HIV and mental illness receiving treatment at the health facilities. We also conducted key informant interviews with five primary health care workers from five-health centre IVs in three districts of Ibanda, Rubirizi and Kanungu located in Southwestern Uganda. Audio recordings from interviews were translated and transcribed verbatim. Data was entered into the qualitative software Atlas T.1 version 7 and thematically analyzed.

Results: The participants reported the presence of HIV care services in the health facilities. However, they complained of lack of routine mental health diagnosis and irregular supply of mental health medications at the health facilities. We also found a shortage of social support from health facilities and a lack of a structural social support for patients with HIV and mental illness within the community.

Conclusion: Living with HIV and mental illness as a co-morbidity increases burden on patients in accessing health and social support services. Health facilities need training of health personnel in management and early diagnosis of mental illness in order to have an integrative treatment of mental illness in HIV.          

P137.A001071. THE PREVALENCE OF SCHISTOSOMA MANSONI INFECTION AMONG ADULTS WITH CHRONIC NON–COMMUNICABLE DISEASES IN MALAWI

Author(s): Wongani Nyangulu1, Christina Sadimba1, Joyce Nyirenda1, George Twaibu1, John Kamwendo1, Kelvin Chawawa1, Angella Masano1, Elizabeth Chilinda1, Sekeleghe Kayuni 2,3, Adamson Muula4, and Kenneth Maleta1

Affiliation(s)

1. Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3. MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
4. Department of Community & Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi

Email: wnyangulu@kuhes.ac.mw

Introduction: Schistosomiasis is a parasitic infectious disease caused by flatworms of the Schistosoma genus. In Malawi, it is a top 20 cause of outpatient department visits in health facilities. Schistosomiasis is a major but neglected cause of non-communicable diseases. While much is known about the contribution of S. haematobium to the NCD burden in Malawi, the role of S. mansoni remains largely unknown.

Objectives: To estimate prevalence of S. mansoni in adults with NCDs in Mangochi, and evaluate association between infection and NCDs.

Methods: We conducted a cross-sectional study at Mangochi District Hospital. Adults over 18 years diagnosed with NCDs (n = 414), admitted or attending weekly outpatient clinics were recruited between August 2021 and February 2022. Data were collected on sociodemographic characteristics, medical history, body weight, blood pressure, and fasting blood glucose. Stool and midstream urine were collected for Kato Katz (KK) microscopy and urine point of care -circulating cathodic antigen (POC-CCA) tests respectively. We computed prevalence of S. mansoni as number of positive KK and CCA tests, each divided by total submitted samples. Univariate and multivariable logistic regression were done to evaluate risk factors of NCDs and association between S. mansoni infection and NCDs.

Results: We recruited 414 participants, mean age 57 years (SD 16), 67% of whom were female. Prevalence of S. mansoni based on urine CCA was 15% (95% CI: 11 – 19) and 0% on KK microscopy. S. mansoni infection was not significantly associated with hypertension (OR: 1.2, 95% CI: 0.5 – 3.1), diabetes (OR: 0.6, 95% CI: 0.3 – 1.10) or heart disease (OR: 2.0, 95% CI: 0.4 – 10).

Conclusion: We observed moderate prevalence of S. mansoni infection among adults in the study per WHO classification of endemicity. This is within the range observed in children in Mangochi from 10 – 56.7%.

P138.A001111. TOWARDS IMPROVED PALLIATIVE CARE; KAMUZU UNIVERSITY OF HEALTH SCIENCES GRADUATES FIRST SPECIALIST PALLIATIVE CARE PROVIDERS

Author(s): D Kwaitana1, M Nkhoma1, M Makwero1, and J Bates1

Affiliation (s):

1. Kamuzu University of Health Sciences, Blantyre Campus, Malawi

Email: dkwaitana@kuhes.ac.mw

Introduction: The need for palliative care keeps on increasing in Malawi due to the ever-increasing numbers of chronic non-communicable diseases but also HIV and AIDS. Previously, opportunities for specialist palliative care training were limited and only offered outside the country. If Malawi is to provide quality and accessible palliative care to all in need, numbers of locally-well-trained professionals in palliative care must increase.

Methods: A full time three-year mature-entry BSc Palliative Care programme was initiated in 2018. The programme enrolls nurses and clinical officers with a minimum of a diploma qualification in their respective fields. Lecturers with specialist palliative care postgraduate qualifications run the programme with support from family medicine faculty within the School of Medicine and Oral Health. Visiting lecturers with vast academic and research experience from reputable institutions have significantly helped in both curriculum development and teaching. 

Results: Since its inception, the BSc Palliative Care Programme has enrolled 4 cohorts of students with an average of 15 students per class. The first cohort of students has graduated in 2022. Interest from prospective students is increasing. Plans are underway to transition from full-time to block-release mode of teaching to increase enrolment both nationally and across the region.  Some students have dropped out of the course due to challenges in raising school fees.  Local faculty numbers are small, and the course has relied on teaching expertise from a variety of places to cover all the modules.

Conclusion: Graduation of the first cohort of BSc Palliative Care students marks a milestone for this programme – one of the few post-basic training programmes available to nurses and clinical officers in the region.  Expansion of experienced teaching faculty and bursary funding opportunities for students will help the future growth and development of this programme.

P139.A001414. PSYCHOSOCIAL TRANSITION OF CARE FROM ICU TO THE WARD: PERSPECTIVES OF PATIENTS, FAMILIES, AND MULTIDISCIPLINARY TEAMS AT QUEEN ELIZABETH CENTRAL HOSPITAL

Author(s): Wyness Tengeneza Gondwe1, and Shelley Schmollgruber2

Affiliation(s):

1. Kamuzu University of Health Sciences, School of Nursing, Department of Adult Health Nursing.
2. University of the Witwatersrand, School of Therapeutics, Department of Nursing Education

Email: wynessgondwe@kuhes.ac.mw

Introduction: Transfer of patients from Intensive Care Unit (ICU) can be exciting as it signals patients’ improvement, however, it can also cause transition anxiety to patients and their families.   Effectively minimizing ICU transition anxiety depends on the ability of multidisciplinary teams especially nurses to recognize and react appropriately to factors that hinder transition before, during and after ICU transfer.

Objectives:

1. To explore patients recently transferred from ICU and their families’ perspectives on the transition of care from ICU to the ward.
2. To explore medical clinicians and nurses’ perspectives on transition of care from ICU to the ward.

Methods: A descriptive qualitative design was used. Four recently discharged ICU patients, five families, 11 ICU and 12 ward multidisciplinary teams purposively selected, participated in the study. Data were collected through semi-structured individual interviews which were tape recorded and transcribed word for word. Data were analyzed using content analysis.

Results: Overall, the perception was that ICU transitional care was inadequate before, during and after ICU transfer. Two emergent themes described patients and families’ perceptions: Just told transferred and Lacking information; four described ICU multidisciplinary team’s perceptions: Psychosocial care is not taken into account, We do not prepare them very well, We have a gap, We do not follow them unless otherwise indicated; and three themes described ward multidisciplinary team’s perceptions: Care is a bit sub-optimal, Transferred your patient, Our patient when in ward.

Conclusion: Suggested strategies to help facilitate psychosocial ICU transitional care included: (1) ICU and ward nurses should increase the involvement of, communication and interactions with patients and families; (2) ward nurses should conduct pre-transfer visits of patients and families in ICU; (3) ICU nurses should conduct follow-up visits of patients and families on the wards; (4) ICU nurses should provide consultative services on the ward.”

P140.001228. IDENTIFYING BARRIERS TO AMBULATORY CARE AMONG RURAL RESIDENTS OF KONO DISTRICT, SIERRA LEONE: A CROSS-SECTIONAL STUDY   

Author(s): Michael Mhango1, Foday Boima 1, Yusupha Dibba 1, Gerald Young 3, Emily Dally 2, Julia Higgins 2, Vivian Chung 2, Mohamed Bailor Barrie 1, Chiyembekezo Kachimanga 4 and Jean Gregory Jerome 1      

Affiliation(s):

1. Partners In Health, Sierra Leone
2. Partners In Health, Boston, MA USA
3. Ministry of Health and Sanitation, Sierra Leone
4. Partners In Health, Malawi”         

Email: mmhango@pih.org

Introduction: There is limited data on the barriers to outpatient healthcare access, especially at the district level in low resource countries. We aimed to assess four primary care facilities supported by Partners In Health (PIH) and the Sierra Leone Ministry of Health and Sanitation (MoHS) in Kono district, Sierra Leone.  

Objective: To assess the healthcare utilization among community members

Methods: We conducted a cross-sectional community-based household and individual surveys among men and women (≥15-49 years), and children (<5 years) in four catchment areas: Sewafe, Konbayendeh, Gandorhun, and Kayima in Kono district, Sierra Leone between December 2019 and March 2020. Sampling clusters were selected using a two-stage sampling scheme and descriptive statistics was utilized.  

Results: Out of 487 households, 1,425 people were interviewed: 42.6% men, 35.5% women, and 21.9% children. We observed a drop-off in the proportion of respondents who expressed symptoms, sought facility-based care for their symptoms, and saw a trained healthcare provider in women (76.4% vs 55.2% vs 47.7%), men (82.0% vs 62.2% vs 48.5%), and children (84.4% vs 69.4% vs 63.6%). Sixty percent of respondents stated not being able to afford visit costs and 15% stated not being able to afford transport costs as a primary reason for not seeking healthcare. Participants reported the most common issues with their quality of healthcare: lack of essential medicines (41%), long wait times (33%), and high service costs (14%).

Conclusion: We identified significant barriers to accessing outpatient healthcare, including the inability to afford the care cost, difficulty reaching the facility due to distance and other reasons. We also identified facility and system-level barriers, including long wait times at the facility, poor quality care, lack of drugs/equipment, and issues with the providers’ services. Addressing these barriers, we will implement PIH 5 model i.e the provision of staff, stuff, space, system, and social support.

P141.A001516.  USING CONTINUOUS QUALITY IMPROVEMENT TO BUILD RESILIENT VMMC SERVICES DURING WEATHER INDUCED EMERGENCIES IN CHIKWAWA DISTRICT

Author(s): Oscar Kuboma1, Stefano Mjuweni1, Misheck Chiwanda1, Tionge Kayira1, Sarah Sakanda1, James Odek2, Jeroen Van’t Pad Bosch1, Fidelis Sindani1, William Twahirwa1

Affiliation(s):

1. Jhpiego Malawi Country Office
2. USAID”    

Email: Oscar.Kuboma@jhpiego.org

Introduction: In 2022 cyclones Ana and Dumako caused severe flooding in Chikwawa district, reducing the capacity to sustain health care services including Voluntary Medical Male Circumcisions (VMMC). Flooding exacerbated the existing impacts of the COVID-19 pandemic. Potential VMMC clients were displaced to camps, roads were washed away, safe water was scarce, and structures, including health care facilities that provide VMMC services, were damaged. Despite these obstacles, the USAID-funded VMMC project ‘EMPOWER’ met its objectives. The project engaged relevant stakeholders and re-strategized.

Objectives:

1. To systematically identify challenges,
2. To analyze the pattern of flooding disasters,
3. To develop VMMC service provision strategies to fit those circumstances

Methods: The project employed the Deming / PDCA quality management cycle to optimize its implementation model tailored to the circumstances. Closure of sites in flood-affected areas and intensification of VMMC services in less-affected areas; locating community mobilizers and providing VMMC services close to camps; increasing focus on schools through VMMC champions; and working through female sex workers in hotspot areas to boost demand were among the strategies employed. EMPOWER created demand for VMMC services among Chewa traditional group, dambwe, who valued VMMC.

Results: EMPOWER project achieved better quarterly performance both as percent and actual VMMCs in Quarter two of FY22 (81%, 6122 VMMCs) than in Quarter two of FY21 (70% 5251 MCs). Before cyclones in January 2022, the project achieved 799 MCs (10.6% of the quarterly target) compared to 5323 VMMCs (71% of the quarterly target) performance in February and March 2022.    

Conclusion: The use of the CQI model to help with project implementation during disasters can improve project performance. It is critical to have disaster management plans in place, ensure good communication within the project and with stakeholders, as well as the ability to reschedule project activities while monitoring the disaster response.

P142.001242. EVALUATION OF A LOW-COST CONTINUOUS NEONATAL TEMPERATURE MONITOR FOR LOW-RESOURCE SETTINGS    

Author(s): Prince Mtenthaonga1, Christina Samuel3, Rowland Mjumira1, Maureen Valle1, Lucky Mangwiro1, Taylor Boles3, Sonia Sosa Saenz3, Ryan Johnston3, Megan Heenan3, Joseph Bailey3, Keith Payea4, Robert Miros4, Maria Oden3,5, Rebecca Richards-Kortum3,5, Queen Dube1,2, and Kondwani Kawaza1,2

Affiliation(s):

1. Department of Pediatrics, Kamuzu University of Health Sciences, Malawi
2. Department of Pediatrics, Queen Elizabeth Central Hospital, Malawi
3. Rice 360 Institute for Global Health Technologies, Rice University, TX, USA
4. 3rd Stone Design, CA, USA
5. Department of Bioengineering, Rice University, TX, USA.

Email: mtenthaprince@gmail.com

Introduction: Neonatal hypothermia (<36.5°C) is a significant contributor to neonatal morbidity and mortality in low-resource NICUs. Temperature monitoring is an integral part of care for every small and sick newborn. Unavailability of continuous patient monitoring devices in low-resource settings (LRSs) overburdens caregivers with conducting frequent axillary temperature measurements. Celsi Monitor, a low-cost device consisting of a monitor that displays skin temperature, a reusable temperature probe and abdominal belt.

Objectives: To assess accuracy and safety of Celsi Monitor.

Methods: A prospective study took place at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. All study participants completed written informed consent approved from the National Health Science Research Committee in Malawi. Forty-five neonates receiving treatment in the neonatal ward at QECH were enrolled. Nineteen participants were enrolled in March 2020 and 26 were enrolled between December to June 2021. Both the Celsi Monitor and a reference Patient Monitor (PM), Philips Intellivue MP30, continuously recorded temperature for a period of three, six and twelve hours. The impact of the temperature sensor attachment mechanisms on the newborn skin was assessed one hour after removal of both monitors.

Results: Bland-Altman analysis for measurements at five-minute intervals showed a mean bias of 0.05°C and 95% limits of agreement of -0.31 to +0.41°C compared to a reference standard. The bias and LOA are within our goal of clinical bias of <0.3°C. The Celsi Monitor belt resulted in minimal skin irritation in 3.9% of participants one hour after both sensors were removed as compared with the PM disposable sticker 7.7%. No participants exhibited skin irritation that had potential to harm the neonate.

Conclusion: Celsi Monitor safely and accurately measures skin temperature continuously in neonates. Larger clinical studies are warranted to validate the use of Celsi Monitor as a standard of care for temperature monitoring for newborns in LRSs.

P143.A001253. STORAGE CONDITIONS AND ITS IMPACT ON PHARMACEUTICAL QUALITY IN SOUTHERN MALAWI 

Author(s): Francis Chiumia1, Happy Nyirongo1, Elizabeth Kampira2, Adamson Muula3, and Felix Khuluza1

Affiliation(s):

1. Department of Pharmacy, Kamuzu University of Health Sciences, Malawi
2. Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, Malawi
3. Department of Community and Environmental Health, Kamuzu University of Health Sciences, Malawi”    “Aim

Email: fkchiumia@kuhes.ac.mw

Objective: To assess the effect of temperature on the quality of medicines in Southern Malawi.

Methods: This was a longitudinal study in 23 randomly health facilities in Zomba, Machinga and Nsanje districts. We used Tempmate® M1 temperature data loggers to record temperatures every 15 minutes in the storage facilities. Firstly, we collected medicine samples and subjected them to laboratory analysis to determine the content and release of the active pharmaceutical ingredients (API). We retained some of the samples within the facility and re-tested them in three-month intervals.  We used thin-layer chromatography (TLC) and disintegration test methods for screening and high-performance liquid chromatography or ultra-violet/visible spectrophotometer and dissolution test for pharmacopeial confirmation.

Results: Storage-in-a-Box TM (SIAB) facilities had lower mean kinetic temperature (MKT) of 25.4oC, (95% CI, 24.9 oC – 25.9 oC), as compared to non-SIAB facilities with MKT of 27.5 oC, (95% CI, 27.3 oC – 27.8 oC), p <0.001. Of the 235 medicine samples, 11.8% degraded on storage. Among them, 8.5% decreased content of API, (p<0.001) and 4.3% failed in-vitro disintegration (p<0.001). Medicine degradation was associated with primary packaging material and manufacturer. Medicines packed in aluminium strips were less likely to degrade as compared to those packed in plastic containers, OR 0.44, (95% CI 0.19 – 0.98), p <0.045. Imported medicines were also less prone to degrade upon storage as compare to locally manufactured medicines, OR 0.16 (95% CI 0.07 – 0.37), p< 0.001.  There was no linear relationship between the MKT of the storage facilities and the rate of degradation.

Conclusion: Our results suggest that degradation of medicine on the shelf was dependent on the inherent properties of the formulation, location of production and quality of packaging material. Although the temperatures in the facilities were high, there was no direct impact on rate of deterioration.

HERBAL MEDICINE ABSTRACTS – POSTERS

P144.A001511.  BIOACTIVE COMPOUNDS IN SELECTED MEDICINAL PLANTS USED BY TRADITIONAL HERBAL PRACTITIONERS IN MALAWI

Author(s): Friday Fosta Fred Masumbu1, David Tembo2, Anthony Mwakikunga3, Bonface Mwamatope4, and John Finias Kamanula1           

Affiliation(s):

1. Mzuzu University, Department of Chemistry,
2. Malawi University of Business Applied Sciences, Department of Physics and Biochemical Sciences
3. Kamuzu University of Health Sciences, Department of Biomedical Sciences
4. Lilongwe University of Agriculture and Natural Resources, Department of Basic Sciences

Email: kwatenetikugonje@gmail.com

Introduction: Cancer is causing significant deaths in Malawi. Chemotherapy, one of the cancer treatments, is sometimes not successful due to drug resistance that accompanies the treatment. Existing anticancer drugs also attack normal cells with side effects. Some plants contain phenolics, flavonoids and alkaloids which have anticancer properties. Herbalists in Mzimba and Nkhata Bay districts claim to treat different cancers using herbal medicines without scientific studies to validate such claims.

Objective: To evaluate phytochemical composition, antioxidant activity and fingerprinted anticancer phytoconstituents of Piliostigma thonningii, Psorospermum febrifugum, Inula glomerata, Zanthoxylum chalybeum and Monotes africana that are claimed to treat cancer by traditional herbal practitioners in Mzimba and Nkhata Bay districts.

Methods: Crude extracts were analysed for total phenolic content (TPC), total flavonoid content (TFC), total alkaloid content (TAC) including FRAP and DPPH antioxidant activity using standard spectrophotometric assays. Sequential extraction was done to obtain hexane, dichloromethane and methanol fractions. Fingerprinting of anticancer compounds was achieved through GC-MS analysis.

Results: The TPC, TFC and TAC ranged from 539 ± 0 mg GAE/g DW to 4602 ± 32 mg GAE/g DW, 6.18 ± 0.12 to 64.04 ± 0.16 mg QE/g DW and 19.25 ± 0.07 to 76.05 ± 0.36 mg CE/g DW, respectively. FRAP antioxidant activity ranged from 1230 ± 7 to 68728 ± 25 mg TEAC/g while SA50 of the extracts ranged from 0.09 ± 0.01 to 1.57 ± 0.01 μg/mL of extract. The fingerprinting identified both known and unknown anticancer compounds.

Conclusion: Lower SA50 (<50 ug/mL) implies that the selected herbs have stronger DPPH antioxidant activity. Higher total phytochemical levels and presence of anticancer compounds in the fractions suggest that these herbs would be used to manage cancer. Future work including in vivo anticancer activity using cell lines and anticancer studies of the unknown compounds would complement our findings.            

P145.A001476. PHARMACOGNOSTIC STUDY OF MARKETED MORINGA OLEIFERA LAM AND MONDIA WHITEI (HOOK.F.)  HERBAL MEDICINAL PRODUCTS IN BLANTYRE URBAN PHARMACIES IN MALAWI  

Author(s): Ibrahim Chikowe1, Louis Masunga Munyenyembe1, Violet Nyirenda1, Justice Hanleck Chioza1, Happy Nyirongo1, Timothy Tywell Mguntha2.

Affiliation(s):

1. Pharmacy Department, Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi.
2. Chemistry Department, University of Malawi, Zomba, Malawi.

Email:  chikoweib@yahoo.co.uk

Introduction: Increase in the preference of HMPs to conventional medicines has led to the proliferation of substandard and falsified products on the market to meet the demand, which has escalated the risk of poor quality HMPs and need for their routine monitoring and regulation.

Objective: To assess the pharmacognostic properties of Moringa oleifera Lam and Mondia whitei (Hook.f.) marketed in Blantyre urban, Malawi to confirm the identity of label claims. 

Methods: The herbs were identified using a preliminary survey in the pharmacies prior to laboratory analysis. Thin layer chromatography (TLC), microscopy, pH, microbial content, ash value, water and alcohol extractive values and heavy metal analysis were evaluated using methods reported in published literature.

Results: TLC and microscopy were used to confirm the identity of the herbs. The TLC results were different from literature, but microscopy results were similar. Microbial content ranged from was 0 to 1.6 ×105. Heavy metals were not detected in all samples except for a single Moringa oleifera Lam sample from one company but were within limits according to WHO guidelines. Alcohol soluble extractives for company C Mondia whitei (Hook.f.) were twice as much as for company A, while water extractive values for company C were slightly higher. Moringa oleifera Lam alcohol extractive value for company A and B were similar (ranging from 6-6.99%) and the water extractive values ranged from 10.6-12.2%. pH tests showed that all the samples were acidic.

Conclusion: While some results were comparable to literature data, others were not comparable. However, this was expected as literature shows that variations are inevitable due to many factors such as climate, soil, product processing and sample preparations differences. As such conclusions were not possible and it is recommended that further studies should be done to develop local standards for quality control and identification of HMPs.

HIV EPIDEMIOLOGY PREVENTION & TREATMENT  ABSTRACTS – POSTERS

P146.A001295.  IMPACT OF ART DURATION AND ART MANAGEMENT APPROACH ON EARLY MORTALITY FROM HIV-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN AFRICA

Author(s): Melanie Moyo1,2, Newton Kalata3, James Jafali1 David Lawrence4,5, Síle  Molloy6,7, Henry Mwandumba1,8, Johnstone Kumwenda2, Thomas S Harrison6, Joseph Jarvis4,5 and the AMBITION-cm and ACTA Study Groups.

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Medicine, Kamuzu University of Health Sciences, Malawi
3. Centers of Disease Control, Malawi
4. Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
5. Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
6. Centre for Global Health, Institute of Infection and Immunity, St George’s University of London, London, UK
7. Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa.
8. Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK”      “Introduction: More than half of patients diagnosed with cryptococcal meningitis are ART-experienced. Observation of increased mortality in PLHIV who present with cryptococcal meningitis within 14 days of (re-)initiating ART has not been confirmed.

Email: mmoyo@kuhes.ac.mw

Objectives:

1. To assess whether patients who are diagnosed with cryptococcal meningitis within 14 days of ART (re)initiation are at higher risk of mortality,
2. To evaluate the impact on mortality of ART interruption at diagnosis of cryptococcal meningitis in this patient group.

Methods: We retrospectively analysed combined data from ACTA and AMBITION-cm trials.

Results: Patients who had (re-)initiated ART within 14 days had relatively higher CD4 counts, lower viral loads and higher fungal burden at baseline when compared to those on ART for >14 days. When compared to ART naïve participants, mortality risk was higher at all time points, in those on ART for <14 days than those on ART for longer; hazard ratio [HR] 1.41 vs 0.91 at 2 weeks, 1.2 vs 0.94 at 10 weeks. ART interruption showed a trend towards lower risk of mortality at all time points in recent ART (re)initiators. Conversely, the odds of mortality were higher in patients on ART for more than 14 days if ART was interrupted at enrolment (HRs 1.89, 1.55 and 1.1) and the difference was significant at the 1-week time point (p 0.048).

Conclusion: These findings point towards increased mortality risk from cryptococcal meningitis in recent ART (re)initiators which is abated by ART interruption but suggest an unfavourable effect of ART interruption in patients on ART for longer than 14 days at diagnosis of cryptococcal meningitis. We recommend caution in the clinical decision to interrupt ART in CM patients on ART for >14 days and join calls for investment in consistent implementation of CrAg screening in eligible patients to prevent ART initiation in the presence of cryptococcosis.

P147.A001259. HIV treatment disruptions among teens and female sex workers due to COVID-19: a cohort study

Author(s): Tionenji Zolowere1, Limbanazo Matandika2, Augustine Choko 3, and Victor Mwapasa 4       

Affiliation(s):

1. International Treatment Preparedness Coalition
2. Center for Bioethics in Southern and Eastern Africa (CEBESA), Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
3. Malawi Liverpool Wellcome Trust, P.O. Box 30096. Chichiri, Blantyre 3. Malawi,
4. Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi”          

Email: limbamindiera@gmail.com

Introduction: COVID-19 has caused significant disruptions to health systems and other parts of human life.

Objective: To assess the impact of COVID-19 on antiretroviral therapy (ART) retention among Female Sex Workers and Adolescents Living with HIV (FSW ALHIV).

Methods: A mixed-methods retrospective cohort study was conducted at three drop-in-centers (DICs) and six teen clubs (TC’s). A questionnaire was used to abstract data from FSW ALHIV ART registers retrospectively from May-Oct 2019 and May-Oct 2020 post Covid-19. We conducted 30 In-depths interviews with FSW, ALHIV and health care workers and 3 focus groups discussions with ALHIV and FSW respectively. We compared the proportion of client’s retained before and after Covid-19 using a Chi-squared test. All qualitative data were digitally recorded and transcribed verbatim and were thematically analysed.

Results: Data on 210 FSWs and 305 ALHIV were extracted with overall mean age of mean age of 28.5 years and 15.8 years respectively. Of the 305 adolescents in the dataset, only 10/305 (3.3%) were not retained in HIV care. Of the 10 who were not retained in care 7/10 (70%) were lost to care during the COVID-19 period compared to 3/10 (30%) before COVID-19, p=0.422. And All 210 FSWs were alive and on ART by the end of the follow-up time, with no defaults during the COVID-19 period. Barriers to continuum of care arose from intervention, challenges at intervention and client level. These challenges hindered implementation, frustrated clients, reduce morale, impacted clients engagement which resulted in missed opportunities for testing new clients and retaining clients in care.

Conclusion: COVID-19 did not seem to impact retention in care among female sex workers and teens in this study. Short follow-up time may explain this finding yet the need to address barriers to retention in care remains.

P148.A001147. IMPACT OF COVID-19 ON ANTI-RETROVIRAL THERAPY OUTCOMES AT PARTNERS IN HOPE, LILONGWE, MALAWI

Author(s): Marlone Lifumba1, Beverly Laher1, Hitler Sigauke2, John Phuka1           

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Partners in Hope

Email: marlonelifumba@gmail.com

Introduction: Anti-retroviral therapy improves the health of people living with HIV. Optimal adherence to antiretroviral therapy is key to ensuring good outcomes and is measured through viral counts: estimated at 65% in 2019. With covid-19 affecting health service delivery across the world, adherence is not spared.

Objective: To assess risk factors; and trends in ART outcomes during and prior to covid-19.

Methods: The study utilised retrospective cohort design, recruiting HIV clients through their files and Antiretroviral therapy (plus viral load) registers who were in care since 2018. In total, 82 clients were recruited using systematic random sampling by a checklist. Descriptive analysis of risk factors was done just as logistic regression (fisher’s exact) at 95% confidence level and paired Wilcoxon rank sum test of primary outcomes incidences.

Results: The mean age of participants was 43 (SD±13). More than half of the participants were female (62%). The study observed a drop in ART adherence; from 78.05% (p=0.0000) in 2019 to 37.8% (p=0.0000) in 2021. Other outcomes such as sickness of study participants did not vary significantly; 5 cases (6.1%; p=0.5466) were sick in 2019, while in 2021, there were 7 cases (8.5%; 0.0595). Similarly, treatment failure: 2 cases (2.44%; p=0.0135) in 2019 and only 1 case (1.22%; p=0.2542) in 2021 was observed.

Conclusion: Covid-19 had a negative impact on ART adherence at the facility resulting in different ART outcomes.

P149.A001224.  ENGAGING AND KEEPING MEN IN HIV CARE: TRACING OUTCOMES AND CHARACTERISTICS OF MEN LOST- TO-FOLLOW-UP AT 20 HEALTH FACILITIES IN MALAWI

Author(s): Kathryn Dovel1,2, Kelvin Balakasi2, Julie Hubbard1,2, Misheck Mphande2, Joep J van Oosterhout1,2, Risa Hoffman1, Brooke Nichols4-6, Sam Phiri2,3, Agnes Moses2, Morna Cornell7, Thomas J. Coates1, and Augustine Choko3

Affiliation(s):

1. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
2. Partners in Hope, Malawi
3. Kamuzu University of Health Sciences, Blantyre Malawi
4. Boston University, Department of Global Health, School of Public Health, Boston, United States
5. Amsterdam Universitair Medische Centra, Medische Microbiologie & Infectiepreventie, Amsterdam, Netherlands
6. University of the Witwatersrand, Department of Internal Medicine, Faculty of Health Sciences, Johannesburg, South Africa
7. University of Cape Town, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa”      

Email: kelvin@pihmalawi.com

Introduction: Compared to women, men are less likely to be retained in HIV care. To improve this, we must understand the characteristics of men disengaged.

Objectives:

1. To ascertain outcomes for men documented as disengaged in medical records
2. To describe outcomes of men identified as disengaged

Methods:  We conducted medical chart reviews at 20-PIH supported health facilities between August 2020-November 2021 to identify disengaged men, defined as never initiated ART, recently initiated but missed first appointment by ≥7-days or defaulted (missed last ART appointment by ≥28-days). Men identified as disengaged were traced (up to 3-phone or in-person attempts) and disengagement ascertained using personal medical records and self-reports. Those confirmed as disengaged completed a survey to understand men’s socio-demographics and barriers to care.

Results: We identified 1,303 men who were disengaged from care and successfully traced 682/1,303 (52%). Common reasons for failed tracing were inaccurate residential details, moved outside facility catchment area, and temporary travelled. Of those successfully traced, 219/682 (32%) were alive on ART- misclassified as disengaged at study site or silent transfer. 416/682 (61%) were confirmed as disengaged, and 89% (365/416) of those had defaulted from ART care. Median age of men confirmed as disengaged was 39 (IQR 35-46) years, median duration on ART 2.5 (IQR 2.1- 3.0) years and missed the last appointment by a median of 40 (IQR 25-52) days. 32% (133/416) had spent ≥14days away from home in the past 12-months, 73% (304/416) anticipated stigma/discrimination from status disclosure and 41% (171/416) had not disclosed their HIV status to anyone except to their spouse.

Conclusion: Nearly a third of men successfully traced were actively in HIV care. Men who were confirmed as disengaged had high levels of mobility, fear of stigma and limited social support for HIV care. These findings highlight the need for improved documentation to optimize tracing efforts and to develop interventions to improve treatment continuity among men.

P150.A001519. FOLLOW-UP OUTCOMES ON CLIENTS DEEMED TO HAVE INTERRUPTED ANTIRETROVIRAL THERAPY IN A MILITARY HIV PROGRAM IN MALAWI      

Author(s): Adrian Musiige1, Annie Kanyemba1, Lawrence Kasenda1, Kondwani Kalima1, Newman Mzama1, Chimwemwe Jere1, Chester Makhuwira2, Gertrude Ngwata2, Kingsley Magomero2 and Jeroen van’t Pad Bosch1

Affiliation(s):

1. Jhpiego Malawi
2. Malawi Defense Force

Email: Adrian.Musiige@Jhpiego.org

Introduction: Thirteen Malawi Defense Force (MDF) health facilities across nine districts serve military families and surrounding civilian communities. Their cohort grew by only 247 clients from October 2020 to September 2021 despite initiating 1,008 clients on ART during the same period, with the Electronic Medical Record Systems (EMRS) indicating high numbers of clients Interrupted In Treatment (IIT).

Objective: To describe follow-up outcomes on clients deemed to have interrupt treatment per EMRS records. 

Methods: We defined an IIT as a client who missed ART refill for more than 28 days. We retrospectively analyzed routine data for all 510 IITs for July to December 2021 per EMRS’ of five ART sites serving 3,589 clients. Expert Clients(ECs) followed up IITs using phone calls and home visits. ECs recorded follow up outcomes in facility registers.  Data were analyzed in Excel.

Results: More than half of the IITs were aged between 15 and 34 years. 174(34%) were determined Lost To Follow Up(LTFU); 126(25%) were returned to care; 90(18%) had Self-Transferred Out(STO) to different treatment facilities; 54(11%) were on ART per source documents but presumed IIT in EMRS because of delayed entry; 35(7%) were yet to be contacted; 23(5%) were located but didn’t restart treatment citing reasons such as faith healing; 8(2%) had died. 90 STO and 54 delayed EMRS entries out of 510 presumed IITs (28%) were still on ART. Over 50% of clients determined LTFU (34%) had stopped ART or transferred out within a year of initiating ART.

Conclusion: STOs and delays in EMRS data entry were important contributors to EMRS IIT figures. Effective adherence support for 15-34-year old clients in the first year of treatment is necessary to reduce IIT. Point of care data entry, and ability to trace clients across facilities in EMRS’ is necessary to improve reliability of EMRS cohort reports.

P151.A001277.  MALE-SPECIFIC ART COUNSELING CURRICULUM IS FEASIBLE IN MALAWI: A MIXED METHODS DESCRIPTION OF CURRICULUM CONTENT AND QUALITY OF IMPLEMENTATION  

Author(s): Misheck Mphande1, Isabella Robson1, Julie Hubbard1, Elijah Chikuse1, Eric Lungu1, Jiyoung Lee2, Khumbo Phiri1, Joseph Daniels3, Morna Cornell4, Sam Phiri1,5, Kathryn Doverl1,2

Affiliation(s):

1. Partners in Hope, Malawi
2. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
3. Edson College of Nursing and Health Innovation
4. University of Cape Town, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa
5. Kamuzu University of Health Sciences, Blantyre Malawi

Email: misheck@pihmalawi.com

Introduction: General antiretroviral therapy (ART) counselling does not meet men’s unique needs in sub-Saharan Africa. Client-cantered counselling tailored to men is needed to promote ART engagement.

Objectives: To develop a male-specific ART counselling curriculum in Malawi using the ADAPT framework.

Methods: We modified the general ART counselling curriculum from the Malawi Ministry of Health (MOH) for men using five steps: scoping review of primary barriers to ART engagement; mapping of gaps in MOH curriculum; adapting and piloting new curriculum, and finalizing curriculum in stakeholder and health care worker (HCW) workshops. The modified curriculum was implemented by trained male HCWs (nurse (n-=10) and lay cadre (n=10)) in 20 health facilities between August-November 2021. Sessions were recorded to assess quality and conducted focus group discussions (FGD) with HCWs at 6- and 12-months after rollout to understand implementation barriers and facilitators. 50 Sessions and FGDs were translated, transcribed and analysed using thematic analysis guided by the WHO Quality Counselling Guidelines.

Results: The final curriculum included 4 new and 3 modified themes, covered in 18 topics. All sessions used non-judgmental language. Most HCWs asked open-ended questions frequently (n=46, 92%) and incorporated motivational explanations for how ART contributes to men’s life goals (n=42, 84%). Few sessions included individually-tailored action plans for clients to overcome barriers (n=9, 18%). Occasionally topics on self-compassion and safe sex were not covered (n=16, and n=11) despite being key components. HCWs believed that using male HCWs, keeping detailed notes, and having ongoing professional development facilitated implementation. Barriers included length of curriculum and client hesitancy to participate in developing tailored action plans. Findings were similar across cadres.

Conclusion: Developing and implementing quality male-specific ART counselling using nurses and/or lay cadre is feasible. Strategies to increase men in HCW roles and to improve HCWs’ skillsets in developing tailored action plans are needed.

P152.A001189. TRACKING THE HIV 90-90-90 AND 95-95-95 IMPLEMENTATION STRATEGIES: THE SOUTH AFRICAN CASE STUDY

Author(s): J C Y Nyasulu1, 4, I Maposa 2, B Sikhakhane 3, H Pandya 1

Affiliation(s):

1. Division of Health Systems and Public health, Department of Global Health, Faculty of Mdicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
2. Department of Epidemiology and Biostatics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa,
3. Gauteng Provincial Department of Health, Republic of South Africa,
4. AFRIQUIP, Department of Health-Systems Strengthening, Johannesburg, South Africa

Email: jnyasulu@sun.ac.za

Introduction: South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults.

Objective: To track the HIV 90-90-90 and 95-95-95 implementation strategies in the City of Johannesburg (COJ), SA.

Methods: We applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2022, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data was extracted from these databases into MS Excel 2010 spreadsheets and analysed with STATA 15, Stata Corp using a two-tailed t-test at a 5% level of significance.

Results: By March 2022, which is 15 months after 2020 Dec, CoJ had reached 91-65-88. Overall, a significant increase was observed in the number of individuals tested for HIV  and retained in care, over the whole period of analysis beginning in April 2015. On the other hand, children aged 0-15yrs had demonstrated a significant increase in absolute numbers tested for HIV. The overall viral load (VL) suppression rates for children were lower than those of adults. There were significant decreases for overall HIV positivity rate over the 6yr period.

Conclusion: This study has established positive progress made by the City of Johannesburg towards HIV services access and HIV positivity rate. Children aged 0-15yrs, continue to lag behind and overall gaps in linkage to care after testing positive have been highlighted. Therefore, we need revised and renewed innovative approaches to increase access by children and finding those missed during the 90-90-90 era to reach the 95-95-95 set targets in RSA.

P153A.001244. FINDING MEN IN NEED OF HIV TESTING SERVICES WHO DO NOT ATTEND HEALTH FACILITIES: A COMMUNITY-REPRESENTATIVE SURVEY IN MALAWI

Author(s): Eric Lungu1, Marguerite Thorp2, Kelvin Balakasi1, Pericles Kalande1, Joep van Oosterhout1,2, Christian Stillson5, Shaukat Khan5, Brooke Nichols3,4, Kathryn Dovel1, 2

Affiliation(s):

1. Partners in Hope, Lilongwe, Malawi
2. University of California Los Angeles (UCLA), David Geffen School of Medicine – Division of Infectious Diseases, Los Angeles, United States
3. Department of Global Health, School of Public Health, Boston University, Boston, MA, 02118, USA
4. Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
5. Clinton Health Access Initiative, Boston, 02127, USA         

Email: eric@pihmalawi.com

Introduction: Men in sub-Saharan Africa have unmet needs for HIV testing services. Most community-based strategies target men at drinking spots, or sporting events. However, there is little evidence that the majority of men in need of HIV testing frequent these venues from a population perspective.

Objective: To identify where men who had not tested for HIV and not attended a health facility in the last 12 months spend their time.

Methods: Men from 36 villages in rural Malawi completed a community-representative survey (n=1160). Inclusion criteria for the parent survey were: male; aged 15-65 years; never tested HIV-positive; and residing in a study village. We conducted a sub-analysis of men who had not attended health facilities using descriptive statistics to understand where men spent time when not working, and if they were willing to use HIV self-test kit (HIVST) in the community.

Results: 116/1160 (10%) of men had not tested for HIV and had not attended a health facility in the last 12 months. Among those, 56% had never tested for HIV. 53% were self-employed – most worked mornings (70%) and few worked on Sundays (10%). Only 28% reported drinking alcoholic beverages in the last 30 days and 10% spent time at drinking places. The most common place men spent time outside of work (with or without friends) was home (60%, usually on Saturdays and afternoons). The most common locations for socializing with friends were markets/trading posts (22%) and seated games (22%), both usually on Saturdays/Sundays. 91% of men were willing to use HIVST in the community (Table).

Conclusion: Reaching men in need of testing who do not attend health facilities may be most successful through targeted HIVST distribution on weekends at home, markets, trading posts and places where seated games are played.      

P155.A001457. MALE PARTNER ENGAGEMENT IN HIV TESTING USING HIV SELF-TESTING KIT AMONG MALE PARTNERS OF HIV-NEGATIVE PREGNANT WOMEN

Author(s): Annie Thom1, Maganizo Chagomerana1,2, Agatha Bula1. Michael Herce2, Mitch Matoga1, Irving Hoffman1,3, and Mina C. Hosseinipour1,2         

Affiliation(s):

1. UNC Project, Lilongwe, Malawi
2. Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
3. Division of Infectious Diseases, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Email: athom@unclilongwe.org

Introduction: In Malawi, HIV testing uptake among men remains lower than among women resulting in poor outcomes along the HIV-care cascade. HIV self-testing (HIVST) is an emerging approach to HIV testing in which individuals collect their own specimen, perform the test and interpret results.

Objectives: To assess if giving a notification slip plus HIVST kit to HIV-negative pregnant women attending antenatal care for male partner HIV testing at home was acceptable and evaluated their experiences offering the HIVST kit to their male partners.

Methods: We conducted 20 In-depth interviews (IDI) in Chichewa with purposely selected women who received notification slip and an HIVST from 200 HIV negative pregnant women who participated in a cohort study at Bwaila Hospital in Lilongwe, Malawi. These were audio recorded, transcribed and translated in English and analyzed using NVivo 12 software.

Results: More than half of the women (N=12) reported to have never heard about HIVST kits before the study.  After receiving the kit, all women thought the HIVST kit was a tool to help them know their husband’s HIV status. Most felt it was easy to give their partners the self-test kits and convince them to perform the test. None of them reported any social harm. They also reported that the instructions were easy to follow for their partners to perform the test. After using the kit, most of them reported that they found the results from the HIVST to be reliable despite being used to blood-based HIV tests. Women who did not use the HIVST kit reported not knowing how to use it or their husbands not wanting to test themselves.

Conclusion: Offering HIVST kit to their male partners was highly acceptable among HIV-negative pregnant women attending antenatal clinic. If well implemented, HIVST can increase uptake of HIV testing among men.”

P157.A001226. SERO-EPIDEMIOLOGY IN AFRICA OF INVASIVE NON-TYPHOIDAL SALMONELLOSIS (SAINTS STUDY); STUDY AIMS, DESIGN AND EARLY FINDINGS.

Author(s): Helen Dale1,2, *, Esmelda Chirwa2, *, Priyanka Patel2, Theresa Misiri2, Felistas Mwakiseghile2, Paul Kambiya2, Maurice Mbewe2, Innocent Kadwala2, Niza Silungwe2, Happy Banda2, Kenneth Chizani2, Georgina Makuta2, Marc Henrion2,5, Neil French1, Tonney Nyirenda2,4, and Melita Gordon1,2,3,4 on behalf of the Vacc-iNTS study team        

Affiliation(s):

1. University of Liverpool,
2. Malawi – Liverpool – Wellcome Programme,
3. Institution of Infection Veterinary & Ecological Sciences, University of Liverpool,
4. Kamuzu University of Health Sciences,
5. Liverpool School of Tropical Medicine

Email: hdale@mlw.mw

Introduction: Non-typhoidal Salmonella (NTS) are a major cause of paediatric bloodstream infections in sub-Saharan Africa. Understanding the seroepidemiology and correlates of protection (COP) for invasive NTS (iNTS) in relation to risk factors (malaria, anaemia, malnutrition) among children is needed to inform vaccine implementation.

Objective:  To understand the epidemiology of enteric NTS and subsequent acquisition of immunity in children; the impacts of gut health, risk factors and geographic setting; identify a population antibody COP; compare acquired immunity between invasive and asymptomatic NTS disease.

Methods: SAINTS is a prospective community cohort study collecting 3-monthly paired serology samples from 2500 children 0-5 years to measure age-stratified acquisition of lipopolysaccharide O-antigen antibody and serum bactericidal activity to the main serovars causing iNTS (Salmonella Typhimurium and Enteritidis). Children are selected from censused randomly selected households in Chikwawa, Malawi, covering areas with contrasting malaria burden. Data on risk factors, socioeconomic status, water and sanitation, is collected via rapid diagnostic tests (RDT), anthropometry, and electronic reporting. Stool samples are processed for NTS culture and pan-Salmonella PCR. Cases of iNTS disease are followed for longitudinal immunity. 2428 children have been enrolled.

Results: Salmonella stool positivity rate in healthy children is 5.3% (n=128): S. Typhimurium 16.4% (21), S. Enteritidis 12.5% (16), S. species 71.1% (91), S. Typhi 1.6% (2) and shows a seasonal pattern. Malaria RDT positivity at enrollment is 10.9% (262); 17.1% (210) in high and 4.3% (52) in low malaria transmission areas. Severe-acute malnutrition was present in 1.2% (31) by weight-for-height z-scores (<-3 SD) and 3.2% (79) by mid-upper arm circumference <12.5cm.

Conclusion: We will assess NTS immunity in relation to these epidemiological risk data to derive COP; identify windows of immune susceptibility; and inform vaccine implementation.   

P158.A001086. CASE-CONTROL INVESTIGATION OF INVASIVE SALMONELLA DISEASE IN MALAWI REVEALS NO EVIDENCE OF ENVIRONMENTAL OR ANIMAL TRANSMISSION OF INVASIVE STRAINS, AND SUPPORTS HUMAN TO HUMAN TRANSMISSION.

Author(s): Leonard Koolman1,2, Reenesh Prakash1,2, Yohane Diness1, Chisomo Msefula4, Tonney S. Nyirenda4, Franziska Olgemoeller1,3, Paul Wigley2, Blanca Perez-Sepulveda2, Jay C. D. Hinton2, Siân V. Owen2, Nicholas A. Feasey1,3, Philip M. Ashton1,2*, Melita A. Gordon1,2,4

Affiliation(s):

1. Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
2. Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, United Kingdom
3. Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom
4. Kamuzu University of Health Sciences, Blantyre, Malawi

Email: pashton@mlw.mw

Introduction: Invasive Salmonella infections cause significant morbidity and mortality in Sub-Saharan Africa. However, the routes of transmission are uncertain. We conducted a case-control study of index-case and geographically-matched control households in Blantyre, Malawi, sampling Salmonella isolates from index cases, healthy people, animals, and the household environment.

Objective:

Methods: Sixty index cases of human invasive Salmonella infection were recruited (March 2015-Oct 2016). Twenty-eight invasive Non-Typhoidal Salmonella (iNTS) disease and 32 typhoid patients consented to household sampling. Each index-case household was geographically matched to a control household. Extensive microbiological sampling included stool sampling from healthy household members, stool or rectal swabs from household-associated animals and boot-sock sampling of the household environment.

Results: 1203 samples from 120 households, yielded 43 non-Typhoidal Salmonella (NTS) isolates from 25 households (overall sample positivity 3.6%). In the 28 iNTS patients, disease was caused by 3 STs of Salmonella Typhimurium, mainly ST313. In contrast, the isolates from households spanned 15 sequence types (STs). Two S. Typhimurium isolates from index cases closely matched isolates from their respective asymptomatic household members (2 and 3 SNP differences respectively). Despite the recovery of a diverse range of NTS, there was no overlap between the STs causing iNTS disease with any environmental or animal isolates.

Conclusion: The finding of NTS strains from index cases that matched household members, coupled with lack of related animal or environmental isolates, supports a hypothesis of human to human transmission of iNTS infections in the household. The breadth of NTS strains found in animals and the household environment demonstrated the robustness of NTS sampling and culture methodology, and suggests a diverse ecology of Salmonella in this setting. Healthy S. Typhi carrier state was not detected. The lack of S. Typhi isolates from the household environment suggests that further methodological development is needed to culture S. Typhi from the environment.

P159.A001422.  PREVALENCE OF HBV, HCV AND HIV INFECTIONS AMONG INJURED PATIENTS AT QECH, BLANTYRE MALAWI.

Author(s): Edwin Lisimba1, Isabel Zgambo1, Fatsani Mutala1, Isaac Thom Shawa1 and Mulinda Nyirenda1,2,3

Affiliation(s):

1. Kamuzu University of Health Sciences, Medical Laboratory Science Department, Blantyre Malawi
2. Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital
3. Johns Hopkins Research Project

Email: edwinlisimbajr@gmail.com

Introduction: Injured patients are rarely screened for blood borne infections like Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV). This study defined the need for routine screening of these viruses by measuring their prevalence in injured adult patients at Queen Elizabeth Central Hospital.

Objectives: To ascertain the prevalence, demographic characteristics, as well as quantify the acceptability of HIV, HBV and HCV testing among adult injured patients presenting in AETC.

Methods: This was a cross-sectional study that recruited consented injured patients seeking trauma care at AETC from October to early November 2021. Demographic details, risk factors, injury history and a blood specimen for HIV, HBV and HCV testing were collected. Viral hepatitis and HIV markers were detected utilizing SD BIOLINE HBsAg, Rapid Anti-HCV and Determine HIV-1/2 test kits. Prevalence and acceptability were calculated as percentages.

Results:  The study team approached 94 injured patients of whom 64 (67%) accepted to participate in the study. Participants were predominantly male (n=49 (77.8%)), married (n= 40, 64%), manual labourers (n=26, 41%) with a median age of 29 years. Only 3%(n=2) were vaccinated for HBV. RTA related injuries were 36.5% (n=23) with 91%(n=47) sustaining soft tissue injuries that were treated as outpatients. Emergency care was accessed within 2-4hrs of being injured in 60% (n=38). The HBV, HCV, and HIV seroprevalence rates were 4.8%(n=3), 3.2% (n=2) and 22.2%(n=14) respectively; whereas the HBV/HIV co-infection was estimated at 1.6% (n=1).

Conclusion: The findings suggest that a substantial percentage of injured patients who seek medical care at the AETC harbour blood-borne viral infections which would otherwise remain undiagnosed without routine serological screening. Acceptable strategies for implementing routine testing for HIV, HBV and HCV testing in emergency care settings should be explored further.           

P160.A001159.  CIRCULATION OF ENDEMIC RESPIRATORY VIRUSES DURING THE COVID-19 PANDEMIC IN URBAN AND RURAL MALAWI

Author(s): Elen Vink1, Louis Banda2*, Abena S Amoah2, Brigitte Denis3, Stephen Kasenda2, Amelia Crampin2, Catherine Anscombe3, Antonia Ho1, Mavis Menyere3

Affiliation(s):

1. Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
2. Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
3. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi

Email: elen.vink@glasgow.ac.uk

Introduction: Many countries reported substantial reductions in the circulation of endemic respiratory viruses during the COVID-19 pandemic, which were attributed to non-pharmacological interventions (NPI). The circulation patterns of endemic respiratory viruses in the community in Malawi are unknown, particularly as no formal lockdown and few NPIs were adopted.

Objectives: To investigate the circulation patterns of endemic respiratory viruses during the COVID-19 pandemic in Malawi.

Methods: We conducted a prospective longitudinal cohort study of randomly selected households in urban Lilongwe and rural Karonga in Malawi, with 3-monthly visits at four timepoints between February 2021 and April 2022. Self-obtained upper respiratory tract samples (URT) were collected from a subset of adult participants at each visit. Comprehensive metadata including demographics, medical history, socioeconomic indicators, recent symptoms, prevention behaviours, and recent exposures were collected. SARS-CoV-2 PCR and multiplex RT-PCR testing for endemic respiratory viruses were performed on the URT samples.

Results: In total, 794 URT samples collected from 663 participants from 403 households were included in the analysis. Median age was 36.5 years (IQR 25.8 – 48.7), 56.7% were female, and 53.8% were recruited from Karonga. Overall, 5.4% (43/794) samples tested positive for one or more respiratory viruses; rhinovirus the most frequently detected (2.6%), followed by SARS-CoV-2 (1.4%), adenovirus (0.8%), bocavirus (0.4%), parainfluenza viruses (0.3%), hMPV (0.1%), and parechovirus (0.1%). Two participants had co-infections with SARS-CoV-2 and rhinovirus. No influenza viruses were detected. Higher levels of endemic virus circulation were detected in Karonga versus Lilongwe (p = 0.035) and during the hot wet season versus the cool dry season (p = 0.002).

Conclusion: Endemic respiratory viruses continued to circulate in the community in Malawi during the COVID-19 pandemic. However, the diversity of viruses detected diminished throughout 2021 suggesting that behaviour change and border closures may have had an impact on virus circulation.    

P161.A001251.  SEROPREVALENCE AND MOLECULAR EVIDENCE OF CHIKUNGUNYA VIRUS INFECTION AMONG FEBRILE OUTPATIENTS AT MZUZU CENTRAL HOSPITAL, NORTHERN MALAWI

Author(s): Flywell Kawonga1, 3, 4, Leonard E. G. Mboera4 Isaac T. Shawa5, Gerald Misinzo3,4 and Dylo Pemba2        

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2.  Vector Borne Disease Laboratory, University of Malawi, P.O Box 280, Zomba
3. Department of Veterinary Microbiology, Parasitology and Biotechnology, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O Box 3015, Morogoro Tanzania 
4. SACIDS African Centre of Excellence for Infectious Diseases of Humans and Animals, Sokoine University of Agriculture, P.O Box 3297 Morogoro, Tanzania
5.  Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi”

Email: flywellkawonga1993@gmail.com

Introduction: Chikungunya is a mosquito-borne viral disease caused by the Chikungunya virus (CHIKV) that clinically presents similar with other diseases such as Dengue, Malaria, Leptospirosis and Brucellosis. Hospitals and health care providers in Malawi do not usually include arbovirus infections as a differential diagnosis among febrile patients. We therefore sought to determine the seroprevalence of Chikungunya by detecting the antibodies against CHIKV and to molecularly confirm CHIKV genome in Northern Malawi among febrile patients.

Objectives: To determine the seroprevalence of CHIKV infection and to molecularly confirm the presence of CHIKV genome from febrile patients seeking healthcare at Mzuzu Central Hospital, Malawi

Methods: 119 serum samples were collected from malaria negative febrile patients in 2019 and tested for the presence or absence of specific antibodies against CHIKV using enzyme- linked immunosorbent assay (ELISA). A one step reverse transcriptase-polymerase chain reaction (RT-PCR) and agarose gel electrophoresis was done as a confirmatory test on randomly selected ELISA positive samples to amplify and detect CHIKV genomes.

Results: 61.3% of 119 serum samples analysed had detectable anti-CHIKV IgM antibodies. 14 CHIKV anti-IgM positive samples that were randomly selected for confirmation of ELISA results had detectable CHIKV RNA by PCR.  Most of the CHIKV infected individuals presented with fever (52%), joint pain (45%) and abdominal pain (42%).

Conclusion: The presence of anti-CHIKV IgM antibodies suggest the presence of recent CHIKV infection. Therefore accurate molecular laboratory assays such as PCR are highly recommended for CHIKV detection and confirmation for appropriate management of febrile patients in Mzuzu city, Malawi.          

INFECTIOUS DISEASES GENOMICS ABSTRACTS – POSTERS

P162.A001343.  IMPLEMENTATION OF STANDARDIZED BIOINFORMATICS PRACTICES, PIPELINES, AND DATA STRUCTURES IN SARS-COV-2 SEQUENCING AT KAMUZU UNIVERSITY OF HEALTH SCIENCES (KUHES)

Author(s): Samuel Gwayi1, Chimwemwe Mhango2, Jonathan Mandolo3, Wanangwa Ndovie2, Khuzwayo C. Jere1,2,3, Benjamin Kumwenda1,2, Philip Ashton2, and Arox W. Kamng’ona1,2

Affiliation(s):

1. Kamuzu University of Health Sciences (KUHeS), School of Life Sciences and Allied Health Professions, Blantyre, Malawi.
2. Malawi Liverpool Welcome Clinical Research Programme, Blantyre, Malawi
3. University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Clinical Infection, Microbiology and Immunology Department, Liverpool, United Kingdom

Email: awkamngona@kuhes.ac.mw

Introduction: The genomic analysis of SARS-CoV-2 significantly impacted on the global response to the COVID-19 pandemic. One of the main challenges for developing countries such as Malawi is lack of capacity to generate and analyze SARS-CoV-2 genomic sequence data.

Objective: To develop the bioinformatics pipelines, resources and skills needed to generate high-quality SARS-CoV-2 genome sequences and perform analysis to inform public health response and policy in Malawi.

Methods: Five bioinformaticians were trained on software and pipeline development for analysis and interpretation of SARS-CoV-2 genomic data. The training utilized whole genome sequences generated at the Malawi-Liverpool Wellcome Clinical Research Programme (MLW) using the MinION sequencing platform. The sequences were analysed using the Phylogenetic Assignment of Named Global Outbreak Lineages (PANGOLIN) software and Nextclade tools.

Results: We successfully developed an operating pipeline for the analysis of SARS-CoV2 genomic data. We managed to migrate the ARTIC pipeline using Cloud Infrastructure for Microbial Bioinformatics (CLIMB) server onto a containerized and dedicated SARS-CoV-2 infrastructure at KUHeS. We successfully deployed the analysis pipeline to test the performance of the ARTIC pipeline in analysing SARS-CoV-2 genomic data.

Conclusion:  We have developed a portable computing environment at KUHeS that allows for efficient and successful analysis of SARS-CoV-2 sequences in FASTQ from Illumina or FAST5 from Minion sequencers. Lineage prevalence reports are generated based on PANGOLIN and Nextclade output.    

P163.A001219. COMPARATIVE WHOLE GENOME ANALYSIS REVEALS RE-EMERGENCE OF TYPICAL HUMAN WA-LIKE AND DS-1-LIKE G3 ROTAVIRUSES AFTER ROTARIX VACCINE INTRODUCTION IN MALAWI          

Author(s): Chimwemwe Mhango1,2, Akuzike Banda3, End Chinyama1, Jonathan J. Mandolo1,2, Orpha Kumwenda1, Chikondi Malamba-Banda1,10,16,17, Kayla G. Barnes1, Benjamin Kumwenda2, Kondwani Jambo1,4, Celeste Donato5,6, Mathew D. Esona7, Peter N. Mwangi8, Duncan Steele7, Miren Iturriza-Gomara9, Nigel Cunliffe10,11, Valentine Ndze12, Arox Kamng’ona1,2, Francis Dennis13, Martin M. Nyaga8, Chrispin Chaguza10,14,15, and Khuzwayo Jere1,10,11,17″

Affiliation(s):

1. 1Malawi-Liverpool-Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
3. Department of Computer Science, Faculty of Science, University of Malawi
4. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
5. Enteric Diseases Group, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia
6. Department of Paediatrics, the University of Melbourne, Parkville 3010, Australia
7. Diarrhoeal Pathogens Research Unit, Sefako Makgatho Health Sciences University, Medunsa 0204, Pretoria, South Africa
8. Next Generation Sequencing Unit and Division of Virology, Faculty of Health Sciences, University of Free State, Bloemfontein 9300, South Africa.
9. Centre for Vaccine Innovation and Access, Program for Appropriate Technology in Health (PATH), Geneva 1218, Switzerland
10. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
11. NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom.
12. Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
13. Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana
14. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
15. NIHR Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom
16. Department of Biological Sciences, Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
17. Department of Medical Laboratory Sciences, Faculty of Biomedical Sciences and Health profession, Kamuzu University of Health Sciences, Blantyre, Malawi

Email: M201970135440@stud.medcol.mw

Introduction: Genotype G3 rotaviruses rank among the most common rotavirus strains. However, despite a robust long-term rotavirus surveillance system from 1997 in Blantyre, Malawi, these strains were last detected in 1999 and re-emerged in 2017, five years after introduction of Rotarix rotavirus vaccine.

Objective: To understand how G3 strains re-emerged in Malawi.

Methods: We sequenced and analysed randomly selected stool samples each month between November 2017 and August 2019 collected from children hospitalised with acute diarrhoea at the Queen Elizabeth Hospital in Blantyre, Malawi.

Results: Three genotypes G3P[4] (n=20), G3P[6] (n=1) and G3P[8] (n=6) were associated with the re-emergence of G3 strains in Malawi. The genotypes co-circulated at different time points and were associated with three typical human G3 strains consisting of either a Wa-like or DS-1-like genetic constellation and reassortant strains possessing Wa-like and DS-1-like genetic backbones. Time-resolved phylogenetic trees demonstrated that the strains shared an ancestor between 1996 to 2012 per segment of the re-emerged G3 strains suggesting a new introduction from outside the country due to limited genetic similarity with G3 strains which circulated before their disappearance in the late 1990s. Further analysis revealed reassortant DS-1-like G3P[4] strains acquired a Wa-like NSP2 and an artiodactyl-like VP3 genome segment through intergenogroup and intragenogroup interspecies reassortments respectively before importation into Malawi. Additionally, the re-emerged G3 strains contain amino acid substitutions within antigenic regions of VP4 proteins which could potentially impact binding of rotavirus vaccine-induced antibodies.

Conclusion: Our findings show multiple rather than a single genotype drove the re-emergence of G3 strains likely from other countries. These findings highlight the role of human mobility and genome reassortment events in dissemination and evolution of rotavirus strains in Malawi. Altogether, the finidings necessitatate the need for long-term genomic surveillance of rotavirus in high disease burden settings to inform disease prevention and control.

P164.A001361.  GENOMIC DIVERSITY OF G1P[8] ROTAVIRUSES BETWEEN 2015 AND 2019 WAS DRIVEN BY IMPORTATION, EVOLUTION, AS WELL AS REASSORTMENT EVENTS IN BLANTYRE, MALAWI.

Author(s): Chimwemwe Mhango1,2, Akuzike Banda3, End Chinyama1, Jonathan J. Mandolo1,2, Orpha Kumwenda1, Chikondi Malamba-Banda1,2,4, Kayla G. Barnes1, Benjamin Kumwenda2, Kondwani Jambo1,5, Celeste M. Donato6,7, Mathew D. Esona8, Peter N. Mwangi9, Duncan Steele8, Miren Iturriza-Gomara10, Nigel A. Cunliffe4,11, Valentine N. Ndze12, Arox Kamng’ona1,2, Chrispin Chaguza4,13,14, Francis E. Dennis15, Martin M. Nyaga9, and Khuzwayo C. Jere1,4,11

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
3. Department of Computer Science, Faculty of Science, University of Malawi
4. 4Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
5. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
6. Enteric Diseases Group, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia
7. Department of Paediatrics, the University of Melbourne, Parkville 3010, Australia
8. Diarrheal Pathogens Research Unit, Sefako Makgatho Health Sciences University, Medunsa 0204, Pretoria, South Africa
9. Next Generation Sequencing Unit and Division of Virology, Faculty of Health Sciences, University of Free State, Bloemfontein 9300, South Africa.
10. Centre for Vaccine Innovation and Access, Program for Appropriate Technology in Health (PATH), Geneva 1218, Switzerland
11. NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom.
12.  Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
13. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
14. NIHR Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom
15. Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana” 

Email: cmhango@mlw.mw

Introduction: G1P[8] strains are the most predominant rotaviruses globally and normally possess a Wa-like genetic backbone. However, G1P[8] strains that circulated between 2013 and 2014 in Blantyre, Malawi soon after the introduction of Rotarix rotavirus vaccine had a DS-1-like genetic backbone.

Objective: To explore the phylodynamics of G1P[8] strains between 2015 to 2019

Methods: We generated and analysed whole genome sequences for G1P[8] strains (n = 84) that circulated after 2014 (2015 – 2019) in Blantyre to determine their genomic composition and  phylodynamics.

Results: Whole genome sequencing (WGS) revealed that G1P[8] strains reverted to a Wa-like genomic constellation from 2015. Time-resolved phylogenetic trees revealed at most three novel G1P[8] Wa-like populations across all the 11 genome segments. Two distinct rotavirus populations emerged in 2013 and 2015, which were dissimilar to previously described G1P[8] populations but revealed a high nucleotide sequence identity (99.53 to 99.81%) to G1P[8] strains that circulated in Mozambique. A minor G1P[8] population emerged in 2017 which likely evolved from previously described G1P[8] strains from Malawi. WGS analysis suggests that genome evolution, intra-genogroup reassortment among Wa-like G1P[8] as well as intergenogroup reassortment between Wa-like G1P[8] and DS-1-like G2P[4] contributed to the genomic diversity of G1P[8] strains post 2014. Haplotype inference revealed vaccine use reduced G1P[8] genomic diversity in the post-vaccine period. 

Conclusion: Typical Wa-like G1P[8] rotavirus strains replaced DS-1-like G1P[8] rotavirus strains from 2015. Multiple Wa-like G1P[8] variants co-circulated between 2015 to 2019 in Blantyre that were likely driven by cross-border introductions, genetic evolution, inter as well as intra-genogroup reassortment and vaccine-induced immunological pressure.

INFECTIOUS DISEASES IMMUNOLOGY ABSTRACTS – POSTERS

P165.A001276.  ROTAVIRUS VP6-SPECIFIC CD4+ T CELLS ARE RARELY PRESENT IN MALAWIAN CHILDREN PRESENTING WITH LABORATORY-CONFIRMED SEVERE ROTAVIRUS GASTROENTERITIS

Author(s): Chikondi Malamba-Banda1,2,3,4, Chimwemwe Mhango1, Prisca Benedicto2,3,4, Jonathan Mandolo1, End Chinyama1, Nigel Cunliffe4, Miren Iturriza-Gomara4, Kondwani C. Jambo2,5, Khuzwayo C. Jere2,3,4

Affiliation(s):

1. Malawi University of Science and Technology, Thyolo, Malawi,
2. Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi,
3. Kamuzu University of Health Sciences, Blantyre, Malawi,
4.  University of Liverpool, UK,
5. Liverpool School of Tropical Medicine, UK          “Background

Email: cmalamba@mlw.mw

Introduction: Rotavirus-specific neutralizing antibodies are the primary effectors of protective immunity. Viral proteins (VP) 4, 6 and 7 have important antigenic properties and VP4/7 induces the production of neutralizing antibodies. In mouse models, memory VP6-specific CD4 T cells confer protection without the induction of neutralization antibodies. However, in humans, most work is focused on protection via neutralization antibodies, while the role of rotavirus-specific CD4+ T cells remains unclear.

Methods: Under-five children presenting with severe gastroenteritis were recruited at Queen Elizabeth Central Hospital in Blantyre, Malawi. Stool and blood samples were collected at acute and convalescent phases of infection. We screened for rotavirus in stool samples using Rotaclone Enzyme-Linked Immunosorbent Assay (ELISA) and performed flow cytometry-based immunophenotyping and intracellular cytokine staining for rotavirus-specific T cells.

Results: The proportion of CXCR3-CRTh2+CD4+ T cells was higher in children with rotavirus compared to non-rotavirus gastroenteritis during the acute phase of infection, but not during the convalescent phase. The enriched populations were a combination of central (CD45RA-CCR7+) and effector (CD45RA-CCR7-) memory cells. Unexpectedly, Rotavirus-specific VP6-specific CD4+ T cell responses were rare in children with rotavirus and non-rotavirus gastroenteritis at both acute and convalescent phases. In the VP6 stimulation responders, rotavirus VP6-specific CD4+ T cell responses were not associated with the infection phase or prognosis. However, TNF cytokine-secreting RV VP6-specific CD4+ T cells were the predominant responding cells, and this was also the case in the PMA/Ionomycin stimulation positive control. 

Conclusion: Our findings demonstrate limited induction of cytokine-producing VP6-specific CD4+ T cells in children presenting with laboratory-confirmed rotavirus infection, both at acute and convalescent phases. Further work should include the use of other types of rotavirus-specific viral proteins to stimulate the cells.

P166.A001366.  CIRCULATING CXCR5+PD1+ CD4+ T CELLS AND NK CELL SUBSETS ARE ALTERED IN HIV EXPOSED BUT NOT IN CMV INFECTED MALAWIAN INFANTS

Author(s): P. Benedicto-Matambo1,2,3, K.L. Flanagan4, A. Handley5,6, E. Mhango1, K. Barnes1, M. Mayuni, C. M. Banda1,2,3, C. Mhango1, I.T. Shawa1,2, D. Witte1, K.C. Jambo1,7, J. Bines5,6, N.A. Cunliffe1,3, M. Iturriza-Gomara3, K.C. Jere 1,2,3

Affiliation(s):

1. Malawi-Liverpool Wellcome- Clinical Research Programme, Malawi
2. Kamuzu University of Health Sciences, Malawi
3. University of Liverpool, Institute of Infection and Global Health, UK
4. Monash University, Australia
5. Murdoch Children’s Research Institute, Melbourne
6. University of Melbourne, Australia
7. Liverpool School of Tropical Medicine

Email: pmatambo@kuhes.ac.mw

Introduction: CMV and HIV are important immune manipulators that are implicated in driving defective immunity particularly in vulnerable children. As a population of HIV exposed but HIV uninfected keeps increasing following the increased ART coverage, mechanistic approaches are required to explain the impact of immune modulators such as HIV and CMV in endemic settings. A better understanding of these mechanisms is relevant for optimising benefits of vaccines to all the vulnerable infants in CMV and HIV endemic settings.

Objective: To understand whether CMV and HIV impacts infant immunity differently by leveraging samples from a Malawi dose ranging clinical trial.

Methods: NK cell subsets and CXCR5+PD1+CD4+ T cells were identified by immunophenotyping using flow cytometry from whole blood samples collected from Malawian infants at 6 weeks of age. CMV infection was determined using RT-PCR. Flow plots were generated using Flow jo software and analysis was done using GraphPad software.

Results: Our findings showed increased proportions of CXCR5+PD1+ CD4+ T among HIV exposed infants (n=29) compared to HIV unexposed infants (n=149) (p=<0.0001). Contrary, proportions of NK cell subsets, CD56DimCD16+ (p=0.0512) and CD56DimCD16-  (p=0.0701) were elevated among HIV unexposed infants.  CMV did not alter frequencies of both CXCR5+PD1+ cells and NK cell subsets in HIV unexposed infants (n=27).

Conclusion: Taken together, these findings highlight HIV exposure as an important modulator of infant innate and adaptive immunity. Limited impact of CMV shown here is reassuring in the context of infant immunity. Therefore, different vaccine strategies that are aimed at optimizing beneficial effects including the vulnerable HIV exposed infants need to be accelerated.         

P167.A001215. ALVEOLAR MACROPHAGES; A NEW HOME FOR HIV     

Author(s): Christine Mandalasi1, Dumizulu Tembo 1, Steve Mitini-Nkhoma 1,2, David V. Mhango1,2, Aaron P. Chirambo1,2, Cheusisime Kajanga 1, Elizabeth Chimbayo 1,3, David T. Mzinza 1,4, Kondwani C. Jambo 1,2, David G. Russell5, and Henry C. Mwandumba1,2

Affiliation(s):

1. Malawi-Liverpool-Wellcome Programme
2. Liverpool School of Hygiene and Tropical Medicine
3. University of Glasgow
4. Malawi University of Science and Technology
5. Cornell University

Email: christinemandalasi@gmail.com

Introduction: Despite ART being successful in clearing viremia in the periphery, a cure for HIV remains elusive. One of the major contributors to this is the presence of latently infected viral reservoirs. Recent studies have shown that mucosal regions such as the gut and lung are productive sites of viral persistence. However, a comprehensive description of the cell types that harbor HIV in these mucosal regions has yet to be conducted.

Objective: To ascertaining if Alveolar Macrophages (AMs); which are the most abundant phagocytes in the lung are a productive site of HIV. 

Methods: To achieve this, we are using a novel and sensitive Sup-T-GGR reporter cell line to probe HIV infection biology. The cell line allows detection and quantification of competent HIV in latently infected cells.  Sup-T-GGR cells highly express CD4, CCR5 and CXCR4, making them susceptible to HIV-1 infection. Upon HIV-1 entry, they express a Green Fluorescent Protein (GFP) which can be quantified.  AMs isolated from Broncho alveolar lavage (BAL) from asymptomatic HIV-infected individuals are activated using an exogenous stimulant and are co-cultured with Sup-T-GGRs to facilitate viral outgrowth. High viral load plasma is co-cultured with Sup-T-GGRs as a positive control. Viral outgrowth is quantified through flow cytometry.

Results: Flow cytometry analysis shows a positive GFP signal from high viral load plasma cell cultures. Sup-T-GGRs co-cultured with AMs from individuals on ART for more than 3 years also had GFP positive cells. 

Conclusion: AMs from individuals on prolonged ART produce competent viruses, showing that AMs are a site of viral persistence. Development of a cure is dependent on understanding the mechanisms involved in HIV infection. The lung as a site of viral production and persistence remains understudied. Further work will be done to assess the impact of epigenetic modifiers on viral outgrowth in AMs.

P168.A001348.  POOR CYTOTOXIC POTENTIAL AND DIFFERENTIAL LOCALIZATION OF DUODENAL CD8+ T CELLS

Author(s): Leonard Mvaya1, Trevor Khaba2, Agness E. Lakudzala1, Thandeka Nkosi3, Ndaru Jambo,1,4,5, Innocent Kadwala,1,4, Anstead Kankwatira1, Priyanka D. Patel1, Melita A. Gordon,1,5, Tonney S. Nyirenda,1,4, Kondwani C. Jambo,1,6 and Zaza M. Ndhlovu2,3,7

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2. HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
3. Africa Health Research Institute, Durban, South Africa.
4. Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi.
5. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
6. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
7. Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA.

Email: lmvaya@mlw.mw

Introduction: The duodenal mucosa is a reservoir of HIV infection during suppressive antiretroviral therapy (ART) despite harbouring abundant resident CD8+ T cells. I hypothesised that spatial segregation away from reservoir harbouring cells and poor cytotoxic function of resident CD8+ T cells are key factors that contribute to persistent HIV infection in the duodenum.

Objectives:

1. To define the phenotype and functional capacity of duodenal Tissue resident memory (Trm) CD8+ T cells.
2. To identify the anatomical localization of Trm CD8+ T cells relative to HIV susceptible CD4+ T cells.

Methods: Duodenal biopsy tissues and paired blood samples were collected from 33 individuals living with HIV (17 ART-; 16 ART+) and 18 HIV-uninfected adults. Duodenal and peripheral blood mononuclear cells were isolated and analysis was done by flow cytometry. Formalin-fixed paraffin-embedded duodenal tissue samples were processed and stained for immunofluorescence microscopy imaging and analysis.

Results: Phenotypic analysis identified abundant duodenal Trm cells defined as CD69+CD103hi (>75%) in HIV infected individuals and healthy controls. Most duodenal CD8+ Trm cells did not co-express pre-formed perforin and granzyme B (<1%). Immunofluorescence imaging revealed that bulk duodenal CD103+CD8+ T cells were localized in the intraepithelial region, while non-resident (CD103-CD8+ T cells) and CD4+ T cells were mostly localised in the lamina propria. On average, 99.99% (IQR 99.96-100) of HIV-specific CD8+ Trm cells detected in both ART- and ART+ individuals did not express perforin and granzyme B regardless of tissue localisation.

Conclusion: These data indicate that duodenal CD8+ Trm cells rarely co-express perforin and granzyme B, and mostly occupy regions spatially separated from HIV-susceptible lamina propria CD4+ T cells, both of which possibly contribute to HIV persistence.

P169.A001312. POLYCYTOTOXIC T LYMPHOCYTES IN HUMAN MYCOBACTERIUM TUBERCULOSIS INFECTION

Author(s): Aaron Chirambo1,2, David Mhango1,2, Christine Mandalasi1, Elizabeth Chimbayo1,3, Cheusisime Kajanga1, Steven Mitini-Nkhoma 1, Anstead Kankwatira1, Rose Malamba1, David Mzinza1, Marc Zumwinkel 4, Kondwani Jambo1,2, Steffen Stenger4, and Henry Mwandumba1,2    

Affiliation(s):

1. Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2. Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3. University of Glasgow, Glasgow, United Kingdom
4. University of Ulm, Germany         

Email: apchirambo@mlw.mw

Introduction: Mycobacterium tuberculosis (Mtb) exposure generates heterogeneous outcomes, ranging from pathogen clearance to development of tuberculosis (TB) disease. However, what determines the outcomes is not fully understood. Cytotoxic T lymphocytes (CTLs) have been shown to play a crucial role in Mtb infection by eliminating infected cells. CTLs exert their effector functions through cytokine production, death receptor engagement and production of cytotoxic granules containing perforin, granzymes and granulysin. Mtb-specific CTLs simultaneously producing the three granules have been termed polycytotoxic T lymphocytes (P-CTLs) and their frequency in blood correlates with control of progression from latent TB infection (LTBI) to TB disease. However, their frequency and function in the human lung, the primary site of infection, is not known.

Objective: To determine the frequency and role of lung P-CTLs in control of Mtb infection.

Methods: We recruited healthy adults from Blantyre, Malawi and collected peripheral blood and bronchoalveolar lavage (BAL) fluid. Peripheral blood mononuclear cells (PBMCs) and BAL cells were isolated from peripheral blood and BAL, respectively and ex vivo stimulation assays were performed with Mtb proteins. Flow cytometry was used to analyse the samples and data were analysed using FlowJo and Graphpad prism software.

Results: Following stimulation with Mtb proteins, (ESAT-6, CFP-10 and Mtb lysate) we can detect Mtb specific P-CTLs in both BAL and PBMCs. These findings are a foundation to further explore the role of P-CTLs in Mtb infection by correlating the frequency of the P-CTLs with the Mtb and HIV infection status of study participants.

Conclusion: In addition to HIV-uninfected adults, we will recruit people living with HIV (antiretroviral therapy (ART)-naïve and those on ART) as well as pulmonary TB patients. This approach will allow us to determine the frequency and function of P-CTLs in health and different disease states.

P170.A001300. INVESTIGATING THE IMMUNE LANDSCAPE IN THE LUNG AT THE SINGLE CELL OF FATAL COVID-19-PRELIMINARY RESULTS FROM COSMIC STUDY           

Author(s): James Tchado Nyirenda1,2, Charles Ndovie1,2, Watipenge Nyasulu1, Dennis Chasweka3, Thokozile Ngulube1, Kondwani Jambo1,6, Leonard Mvaya1, Joseph Phiri1, Charalampos Attipa1,6, Flora Chiwra2, Isabel Potani3, Kingsley Makwangwala3, Frank Ziwoya3, Abel Tembo3, Chikondi Makwinja3, Leticia Suwedi3, Ben Morton1, Stephen Kamiza2, Stanley Khoswe 3, Chisomo Phiri3, Benjamin Kumwenda2, Thomas Otto5, Olympia Hardy5, Deborah Nyirenda1, Wigel Voskuijil2,3, Christopher A. Moxon1,2,5

Affiliation(s):

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
3. The Childhood Acute Illness & Nutrition (CHAIN) Network, Kamuzu University of Health Sciences, Blantyre, Malawi
4. Kamuzu University of Science of Health Sciences, Blantyre, Malawi
5. Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity & Inflammation, University of Glasgow
6. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.

Email: jnyirenda@mlw.mw

Introduction: Several studies have investigated the immune and cellular responses to SARS-CoV-2 based on blood and bronchoalveolar fluid samples. Epithelial cells in alveoli and other cells in the lung are thought to be the primary targets for SARS- CoV-2, hence studying the cellular and immune responses in this compartment is important to understand the pathophysiology of COVID-19 However, only a few studies have systematically assessed the immune cell composition or response in the lung parenchyma and none have been conducted in Malawi. We aimed to fill this gap by investigating the cellular and immune responses to COVID-19 in the lung parenchyma, blood, and nasal compartment using a single-cell sequencing approach.

Objectives: To determine the extent to which immune responses in accessible samples (i.e., blood, nasal samples) predict the immune response in the lung. To determine whether deaths in SARS-CoV2 infected patients are truly from Covid-19 pneumonitis.

Methods: We recruited patients at Queen Elizabeth central hospital (QECH) who died from PCR-confirmed COVID-19 pneumonia as cases (8), non-COVID-19 pneumonia (5), and non-pneumonia (3) as controls respectively.  We performed single-cell sequencing on cells isolated from lung tissue, nasal scrapes, and blood from the three study groups.

Preliminary Results: Using dimensionality reduction techniques, we have demonstrated that there is an enrichment of neutrophils and depletion of lymphocytes in blood among the COVID-19 group. Furthermore, we have shown different clustering of the myeloid, lymphoid, and stromal cells in the lung. In the nasal, there are similar and distinct cell populations among the three groups.

Conclusion:  Using single-cell technology, we have shown that there are different cell clusters that could provide significant insights into the pathophysiology of COVID-19 in the lung, this could be crucial for the identification of therapeutic targets.

P171.A001318. A NEUTROPHIL SUBPOPULATION AND INFLAMMATORY CYTOKINES LEVELS IN CEREBRAL MALARIA

Author(s): Isabel Zgambo1,5, Kennedy Mulungu1,5, Watipenge Nyasulu1 Charles Ndovi1,5, James Nyirenda1,5, Thokozile Ngulube1, Charalampos Attipa1,2, Christopher Moxon1,3, Karl Sydel1,5, Yamikani Chimalizeni4, Terrie Taylor5

Affiliation(s):

1. Malawi-Liverpool Wellcome Trust Clinical Research Program
2. Liverpool School of Tropical Medicine
3. University of Glasgow
4. Department of Pediatrics, Kamuzu university of health sciences
5. Blantyre Malaria project

Email: izgambo@mlw.mw

Introduction: The role of neutrophils during malaria infection remains unclear despite studies finding upregulation of genes encoding neutrophil granules in children with cerebral malaria (CM). The neutrophils travelling to the site of infection are heterogenous, showing the presence of normal density neutrophils (NDN) and low-density neutrophils (LDN). The LDNs are implicated in several pathological conditions, however their role in the development of (CM) is not known. The inflammatory cytokines are thought to activate endothelial cells but how they contribute to the development of CM is not known.

Objectives: To quantify the presence of the LDN and their phenotypic profile in children with cerebral malaria and normal health controls. Assess the levels of inflammatory cytokines involved in the development of cerebral malaria

Methods: Children presenting with CM, non-CM and healthy controls were recruited. The NDN and LDN are separated by density gradient centrifugation. The LDN and NDN were immunophenotyped by flow cytometry after staining with CD66, CD14, CD16, CD62L, CD 15, CD 11b, CD 63, CD 177 and CD 10. The luminex assay was used to analyze IL-8, IL-10, IL-6, IL-12p70, IL-1b, TNF-a, IFN-y.

Results: Increased LDN were associated with CM compared to non-CM coma (P=0.004) and HC (P<0.0001). LDNs were associated with markers of activation (low CD62L, high CD66b) and immaturity (low CD16 and CD10). IFN-y(<0.0001), IL-6(<0.0001), IL-1b(<0.0001) and IL-12p70(p<0.0047) showed significant differences between the CM group and the healthy controls. There were no significant differences between cytokines levels between the CM and non-CM comatose children except for IL-12p70(0.0004).

Conclusion: The elevated levels of LDN’s and their activated phenotype indicate a possible role in the pathogenesis of CM. The absence of differences in the cytokines may reflect that or that inflammation is not necessary for disease or may reflect that at this interim stage that analyses are underpowered.

P172.A001274. INVESTIGATING ROLE OF NETS IN CEREBRAL MALARIA DISEASE

Author(s): Kennedy Mulungu1,2, Charles Ndovi1,2, Watipenge Nyasulu1,2, Yamikani Chimalizeni 6, Thokozile Ngulube1,2, James Nyirenda1,2, Isabel Zgambo1,2, Takondwa Namalima1,2 , Karl Sydel1,2,3,5, Charalampos Attipa1,2,3,4, Christopher Moxon1,2,3, Terrier Taylor 2.         

Affiliation(s):

1. Malawi-Liverpool Welcome Trust Clinical Research programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
2. Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre Malawi
3. Welcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow
4. Department of Clinical Sciences, Liverpool school of Tropical Medicine and, Liverpool, UK
5. Michigan State University, East Lansing, Michigan, USA
6. Department of Paediatrics, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital

Email: kmulungu@mlw.mw

Introduction: Neutrophil extracellular traps (NETs), released from neutrophils by a form of programmed cell death known as NETosis, are a putative defense mechanism against infection. NETs comprise a network of extracellular DNA strings and neutrophil granules. We hypothesize that the intravascular formation of NETs is present in cerebral malaria (CM) and are potentially contributing towards a vasculopathy.

Objectives: Determine the ex-vivo spontaneous NETotic ability of neutrophils isolated from patients and NETs concentration in their plasma.

Methods:  Whole blood was collected from children randomised in three groups: CM , Non-CM group and a healthy control (HC) group. Sandwich ELISA was used to measure the concentration of NETs in plasma represented by Neutrophil elastase and DNA complex. In a sub-set of cases ex-vivo spontaneous formation of NETs was evaluated using fluorescence microscopy from neutrophils isolated through magnetic negative selection and stained with SYTOX green and orange dyes.

Results: Plasma NETs were increased in CM(p<0.0001) compared to both non-CM and HC. Ex-vivo spontaneous formation of NETs was increased in CM (p<0.028) compared to HC and had a trend to be increased in CM (p=0.13) compared to non-CM.

Conclusions: Elevated NETS are associated with CM and given their potent ability for endothelial cell activation they could play a key role in blood-brain-barrier break down during CM pathogenesis.

P173.A001103. OPTIMISING VACCINATION FOR INTS DISEASE IN AFRICA: OptiVaNTS

Author(s): Agness Ethel Lakudzala1,3, Innocent Kadwala1, Chifundo Mkwangwanya1, Esmelda Chirwa1, Helen Dale1, Ndaru Jambo1, Tonney Nyirenda1,4, Kondwani Jambo1, and Melita Gordon1,2     

Affiliation(s):

1. Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
2. Department of Clinical Sciences, Liverpool School of Tropical Medicine Liverpool, United Kingdom
3. University of Liverpool
4. Kamuzu College of Health sciences (KUHeS)

Email: alakudzala@mlw.mw

Introduction: Invasive non-Typhoid salmonella (iNTS) is responsible for >500,000 illnesses, 77,500 deaths. Despite its high burden, iNTS remains a Neglected Infectious Disease. It is pre-dominantly a disease of infants in sub-Saharan Africa (sSA). The key feature of severe infection is systemic spread from the gut to systemic sites. The two major strategies to control these invasive infections are antimicrobial treatment and vaccination. However, emerging anti-microbial resistance limits benefit and there is no licensed vaccine currently available against iNTS.

Methods: This will be a lab based cross-sectional study conducting systems serology analysis utilising pre-existing serological samples from approved studies in Malawi and across sub-Saharan Africa.

Expected results: Firstly, Identification of functional-correlates of protection which may provide critical insights for the selection of promising adjuvants that may directly influence the functional (isotype, subclass, and Fc-glycosylation) quality of the humoral immune response. Secondly, data generated under this consortium is likely to provide key insights into the specific assays that interrogate and capture readouts of protective immunity. Linked to Ag discovery, qualified, and validated assays may be rapidly developed and deployed to support the evaluation of current and future vaccines. Finally, these data may provide critical clues for the generation of functionally optimized monoclonal therapeutics that can act to complement or replace current antibiotic strategies, considering the emergence of multi-drug resistance.

Conclusion:  This study will define the quantitative and functional correlates of protection, validated for children and populations most at risk of iNTS to be used for clinical and regulatory development of existing vaccines in clinical development. Furthermore, the novel humoral antigenic and functional correlates will form the basis of the next generation of vaccines design.

P174.A001115. HOW DOES MALARIA IMPACT GUT HEALTH AND ENTERIC NON-TYPHOIDAL SALMONELLA INFECTION EVENTS?           

Author(s): Esmelda Chirwa1,2, Helen Dale1, Tonney Nyirenda3, Robert Choy4 and Melita Gordon1,2

Affiliation(s):

1. University of Liverpool,
   1. Malawi Liverpool Wellcome Programme
   1. Kamuzu University of Health Sciences
2. PATH’s Center for Vaccine Innovation and Access

Email: echirwa@mlw.mw

Introduction: Non-Typhoidal Salmonella (NTS) infections in humans present as asymptomatic enteric NTS carriage (eNTS), diarrhoeal illness or invasive disease (iNTS). Enteric infections can lead to invasive disease and are the principal reservoir of community transmission. In 2017, it was estimated that iNTS disease was responsible for 535,000 illnesses and approximately 77,000 deaths globally, with mean all-age CFR of 14.5%. iNTS risk factors include HIV/AIDS, malaria, and malnutrition.  Many mechanisms have been proposed to explain how malaria increases susceptibility to iNTS disease (macrophage dysfunction, haemolysis). However, we also know that malaria disrupts the gastrointestinal tract, and many lines of evidence suggest that this is another way by which malaria increases susceptibility to iNTS. Evidence from murine models of co-infection suggests i) changes in gut barrier during malaria enhance microbial translocation from gut to systemic circulation, ii) mucosal inflammation promotes outgrowth of NTS in gut lumen. The impact of malaria on gut health in humans is, however, not known.

Objectives: Investigate whether malaria is associated with intestinal inflammation. Investigate whether intestinal inflammation is associated with a higher incidence of eNTS.

Methods: Leverage samples from SAiNTS, a prospective serological community cohort study which enrolled children aged 0-5 years in Chikwawa. Gut health of children will be studied in relation to their malaria status and eNTS events. These children are already characterized for malaria (MRDT/blood smears), acute/chronic malnutrition (MUAC, WHZ, HAZ), and eNTS (Salmonella detection: stool culture/PCR). Changes in gut health will be determined through biomarkers of gut function/inflammation.

Conclusion: Understanding the association between malaria and impaired gut health could suggest mechanisms for the role of malaria in enabling eNTS and iNTS. Improved understanding of the impact of malaria on gut inflammation could open alternative pathways to preventing iNTS, either by avoiding eNTS colonization or by preventing those colonizations from becoming iNTS cases.

MALARIA EPIDEMIOLOGY PREVENTION & TREATMENT  ABSTRACTS – POSTERS

P176.001465. DIFFERENT PATHS TO REDUCE MALARIA EXPOSURE WHEN OUTDOORS AT NIGHT BY MEMBERS IN RURAL MALAWI, CHIKWAWA DISTRICT 

Author(s): Lusungu Kayira1, Blessings Kaunda-Khangamwa2,3, Eleanor MacPherson4,5, Themba Mzilahowa1,2, and Federica Guglielmo2

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre Malawi
2. Malaria Alert- Communicable Diseases Action Centre, Blantyre Malawi
3. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
4. Liverpool School of Tropical Medicine, Liverpool United Kingdom
5. Malawi Liverpool Wellcome Trust, Blantyre Malawi

Email: lusunguhkayira@gmail.com

Introduction: Malaria in Malawi accounts for 34% of all outpatient visits and 40% of all hospital admissions among children under. Insecticide-Treated-Nets (ITNs) are the leading domestic tool for vector control. However, the intervention only provides 100% protection when under the bednet; leaving individuals outdoors during Anopheles feeding times of 6 pm and 6 am exposed to malaria transmission. Using a qualitative and in-depth lens, this work presents findings on ways people employ when outside the protection of a bednet outdoors to prevent malaria.

Methods: Participant observation and in-depth interviews and focus group discussions were conducted between November and December 2020 for two weeks and 9 weeks between August and December 2021in Chikwawa, Chikwansa Village.

Results: The study showed that community members interacted with malaria vectors outdoors for different reasons. To prevent malaria transmission during times that limit bednet usage, individuals took a different approach to reduce human-vector interaction. Cloth chasing was used by mothers to protect themselves and younger children from being bitten by mosquitoes as they remained outdoors. Additionally, participants used: covering themselves with a cloth; men created a physical barrier with full covering clothes when outdoors; burned cattle waste and neem leaves to repel mosquitoes; chased away mosquitoes using neem branches; and used coils when money was available.

Conclusion:  Though ITNs are recognised and accepted by users as the main vector control intervention in malaria prevention; individuals are unable to use them when outdoors taking part in different activities where a bednet cannot be used even when available. Therefore, looking into interventions that accommodate the factors which limit bednet usage provides a window of opportunity in the development of integrated and sustainable vector control strategies which respond to the needs of the users.

P177.A001370. ANOPHELES POPULATION REDUCTION RATE DUE TO INDOOR RESIDUAL SPRAYING AS COMPARED TO LONG LASTING INSECTICIDE TREATED NETS  

Author(s): L. Chamdimba1, M. Chiumia1, F. Sande1, M. Kamwana1, G. Kapito1, C. Banda1, L. Dandalo2, and T. Mzilahowa1    

Affiliation(s):

1. Malaria Alert Centre, P/Bag 360, Blantyre, Malawi
2. Malawi VectorLink Abt Associates, Lilongwe Malawi     

Email: lchamdimba@mac.kuhes.ac.mw

Introduction: Malaria is the main cause of mortality among under-five children and pregnant women in Malawi. Long-lasting insecticide treated mosquito nets (LLINs) and indoor residual spraying (IRS) are the major interventions that have been put in place. This study was aimed at comparing the rate at which IRS has reduced the Anopheles mosquito population against LLINs.

Methods: Mosquitoes were collected using pyrethrum spray catches (PSCs) and CDC-LTs in Kasungu, Salima and Chikwawa in July 2021 and June 2022 before and after LLINs distribution respectively. In Nkhatabay and Nkhotakota, they were collected in July 2021 and December 2021, before and after IRS respectively. CDC-LT were set in bedrooms with human baits in, positioned 50cm from sleeping space and 1.5m above the floor, 10 houses were randomly selected per sentinel site. Set at 6:00pm and retrieved at 6:00am. PSCs were conducted from 6:00am to 8:00am in 15 randomly selected houses per sentinel site.

Results: A total of 458 Anopheles mosquitoes were collected in July 2021 before LLINs distribution; 130 An.gambiae collected using PSCs and 63 using CDC-LTs. And 265 An.funestus were collected in the same month; 161 using PSCs and 104 using CDC-LT. After LLINs distribution in June 2022, 98 Anopheles gambiae were collected; 68 using PSCs and 30 using CDC-LTs, while 110 Anopheles funestus were collected in the same month;77 using PSCs and 33 using CDC-LTs. In July before IRS, a total of 1776 Anopheles mosquitoes were collected; 742 Anopheles funestus were collected using CDC-LTs, 998 using PSCs, 5 Anopheles gambiae using CDC-LTs and 31 using PSCs. After IRS in December, a total of 259 were collected; 135 Anopheles gambiae and 24 Anopheles funestus. Out of which 130 Anopheles funestus were collected using CDC-LTs, 105 using PSCs and 16 Anopheles gambiae using CDC-LTs and 24 using PSCs.

Conclusion:  A total of 1776 and 259 Anopheles mosquitoes were collected before and after IRS respectively, representing a reduction by 85% and a total of 458 and 208 collected before LLINs distribution respectively, representing a reduction of Anopheles abundance by 54.6%.

P178.A001389. COMPARING CHEMOPREVENTION APPROACHES FOR SCHOOL-BASED MALARIA CONTROL IN MACHINGA DISTRICT, MALAWI    

Author(s): Wangisani Kumalakwaanthu 1, Alick Sixpence 1, Alfred Matengeni 1, Laurence S. Magder 2, Karl B. Seydel 3, Miriam K. Laufer4, Don P. Mathanga1, Lauren M. Cohee4

Affiliation(s):

1. Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
   1. Department of Epidemiology & Public Health, University of Maryland
   1. Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
   1. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States

Email: wkumala@mac.kuhes.ac.mw

Introduction: Prevalence of Plasmodium falciparum (Pf) infection in school-age children (5-15 years, SAC) is often higher than in younger children and adults. Asymptomatic infection and uncomplicated malaria disease lead to decreased school attendance, impaired cognitive function, and continued parasite transmission. School-based preventative treatment is a promising strategy to reduce the burden of malaria among SAC. However, optimal design of an intervention is not clear.

Objectives: We aim to compare intermittent preventive treatment (IPT) and intermittent screening and treatment (IST) approaches.

Methods: We enrolled 746 primary-school students in a 3-arm randomized controlled clinical trial: IPT, IST, and control. All students in the IPT-arm and students with positive high-sensitivity rapid diagnostic test (hsRDT) in the IST-arm were treated to clear parasites and provide a period of prophylaxis. Girls <10 years old and all boys were treated with dihydroartemisinin-piperaquine (DP). Older girls were treated with chloroquine. The intervention was performed three times during the malaria transmission season (Feb-July 2022). At each visit, students were interviewed and a blood sample was obtained to characterize Pf infection. Outcomes including Pf infection, clinical malaria, anemia, cognitive/educational testing and household infection prevalence were assessed 6-8 weeks after the final intervention.

Results:  Pf prevalence in the IST-arm was 48% at the first intervention. 727 participants (97%) have outcome data. Results show a 50% reduction in the odds of anemia in the IPT-arm compared to control (OR:0.51;95%CI:0.29-0.89; p=0.02), but no reduction in anemia in the IST-arm (OR:0.81;95%CI:0.49-1.33; p=0.49). There was a 46% reduction in clinical malaria in the IPT-arm and no reduction in the IST-arm compared to control. Full outcome results will be presented.

Conclusion: The high prevalence of Pf infection in SAC was confirmed and results suggest the IST approach does not perform as well as IPT. Results of this trial will inform the design of school-based malaria chemoprevention programs.

P180.A001412. INVESTIGATING VITAL SIGN ALTERATIONS WITHIN 24 HOURS PRIOR TO DEATH IN CHILDREN WITH RETINOPATHY-POSITIVE CEREBRAL MALARIA AT QUEEN ELIZABETH CENTRAL HOSPITAL MALAWI

Author(s): Milcent Chintsanya1, Terrie E. Taylor2,3, and Karl B. Seydel2,3       

Affiliation(s):

• School of Public Health and Family Medicine, Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
  • Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
  • Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, East Lansing, Michigan, USA

Email: mchintsanya@gmail.com

Introduction: Malaria remains a major barrier to child health, development and survival. Plasmodium falciparum malaria, in particular causes high morbidity and mortality, especially in children below the age of 5. Malawi is one of the malaria-endemic countries in sub-Saharan Africa, and has high prevalence and incidence rates of infection and mortality from the disease. Cerebral malaria (CM) is a life-threatening complication of severe malaria. The presence of malarial retinopathy, improves specificity of the clinical diagnosis of CM by distinguishing between malarial coma and coma not caused by malaria. Monitoring vital signs determines the overall condition of CM patients. This study determined whether changes in vital signs within 24 hours of death in children with retinopathy positive cerebral malaria (RPCM) are predictors of mortality. 

Objectives: To determine if changes in vital signs predict death in children with RPCM.

Methods: This was a retrospective case-control study using data collected from children admitted to the PRW at QECH in Blantyre between 1997 and 2020. The cases were patients who died 24 hours or more after admission. They were matched on age, gender and year of admission to patients who survived. Analysis was performed using STATA v16 and JMP v16.1. Binary logistic regression was used to assess associations between changes in vital signs and death.

Results:  Blantyre Coma Score and respiratory rate were correlated with a fatal outcome whereas five of the seven vital signs (heart rate, temperature, oxygen saturation, systolic blood pressure and diastolic blood pressure) showed no correlation with death.

Conclusion: Changes in respiratory rate and Blantyre Coma Score have prognostic significance in the final 24 hours before death. Extra attention should be paid to these vital signs as they may help health care workers identify children who are at increased risk of deteriorating, that measures can be taken to improve outcome.      

MATERNAL NEONATAL AND CHILD HEALTH ABSTRACTS – POSTERS

P182.A001255. USING CO-DESIGN WORKSHOPS TO IDENTIFY BARRIERS, FACILITATORS, AND STRATEGIES FOR THE IMPLEMENTATION OF INTRAVENOUS IRON TO PREGNANT WOMEN WITH ANAEMIA IN ZOMBA DISTRICT, MALAWI          

Author(s): Elisabeth Mamani-Mategula1, Khic-Houy Prang2, Ebony Verbunt3, Effie Chipeta 4, and Lucinda Manda-Taylor5

Affiliation(s):

1. Elisabeth Mamani-Mategula-Training and Research Unit of Excellence
2. Khic-Houy Prang- University of Melbourne
3. Ebony Verbunt- University of Melbourne
4. Center for Reproductive Health
5. Kamuzu University of Health Science

Email: emategula@true.mw

Introduction: In LMICs, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated and adhered to. An alternative is intravenous (IV) iron which allows the saturation of the body’s iron stores quickly.  However, the acceptability of implementing IV iron into routine antenatal care in low-income, low-resource settings is unknown.

Objective: Using a co-design approach to identify barriers and facilitators, and develop strategies to inform the implementation of the trial

Methods: This qualitative study used a co-design workshop approach to engage different stakeholders, health workers and community members to inform community engagement and implementation of the REVAMP trial in the 8 health facilities in Zomba district. Firstly, formative research was conducted with policymakers and health managers to identify the touchpoints used for the two co-design workshop discussions. Data was collected through butcher notes, group discussions, stick notes, flip charts, and audio recordings. Data familiarisation followed, and themes were identified.

Results: From the two co-design workshops conducted, Lack of knowledge on anaemia treatment options, myths and misconceptions, lack of male involvement, long distances to clinics, health care provider’s attitude, cost of IV iron and shortage of resources were reported as barriers for accessing IV iron. Need for community sensitisation and awareness, health workers’ training and recruitment of additional staff were listed as facilitators.

Conclusion: The co-design workshop incorporated various inputs across all stakeholders for smooth implementation of IV iron intervention. A gap was revealed through this study that Malawi does not have IEC materials that target end-users on anaemia during pregnancy. Therefore, through this study IEC materials were developed and community sensitisation and awareness meetings were conducted. The briefing and orientation of health facility staff were also conducted for smooth implementation of the trial.

P183.A001247. DETERMINANTS OF IRON DEFICIENCY ANAEMIA AMONG NON-PREGNANT WOMEN OF REPRODUCTIVE AGE IN MALAWI        

Author(s): Andrew Chiwaya1, and William Stones1

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre Malawi

Email: andychiwaya2@gmail.com    

Introduction. In Malawi, the prevalence of Iron Deficiency Anaemia (IDA) among women of reproductive age is 15%. There is lack of up-to-date information on factors associated with IDA among women of reproductive age in Malawi. 

Objective: The study aimed at identifying factors that are associated with IDA among non-pregnant women of reproductive age in Malawi.

Methods:  This was a cross sectional study that used secondary data from the Malawi Micronutrient Survey, a sub study of the Malawi Demographic and Health Survey, 2015-16. A total of 751 non-pregnant women aged 15-49 years were included in the final analysis. The response variable was IDA with age, level of education, residence, wealth quintile, and region, parity, BMI, smoking status and contraceptive use as explanatory variables. Univariate and multivariate logistic regression analysis were carried to analyse the data.

Results:  IDA was statistically associated with age of the woman, type of residence (rural/urban), and contraceptive use. In the multivariate analysis, age (40-49) years (OR) (95% CI) 3.5 (1.4, 8.6), rural residence (OR) (95% CI) 0.3 (0.17, 0.61) were significantly associated with increased odds of IDA while injectable contraceptives (OR) (95% CI) 0.1 (0.057, 0.65), showed a protective effect on IDA.

Conclusion: To reduce IDA among women of reproductive age in Malawi, there is need to scale up family planning services. IDA prevention interventions should in particular target non-pregnant women living in rural areas and women aged 40-49 years.

P184.A001375. INTRAVENOUS IRON SUPPLEMENTATION DURING PREGNANCY DOES NOT INCREASE INFECTIOUS DISEASE RISK IN EARLY CHILDHOOD IN SOUTHERN MALAWI: A FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL       

Author(s): Glory Mzembe*1,2, Ernest Moya1,2, Gomezgani Mhango2, Mphatso Mwambinga2, Zinenani Truwah2, William Nkhono3, Ricardo Ataide3,4, Sant-Rayn Pasricha3, Martin Mwangi2, Kamija Phiri1,2           

Affiliation(s):

1. School of Public Health and Family Medicine, Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
   1. Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
   1. Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
   1. Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.

Email: glory.mzembe@yahoo.com

Introduction: Child morbidity in low- and middle-income countries (LMICs) is mainly driven by infectious diseases. Higher iron status in infants is associated with increased infection risk in this setting. Improved maternal iron status during pregnancy predicts higher iron status in infants. Compared to oral iron, intravenous (IV) iron significantly improves maternal iron stores and is considered for treating the highly prevalent anaemia in pregnancy in this setting. With several studies reporting higher iron status in infants of mothers with higher antenatal iron status, infants born to iron-replete mothers, enhanced by IV iron supplementation, could be at a greater infectious disease risk in this setting. This study aimed to determine whether children born to anaemic women who received IV iron during pregnancy have an increased risk of infectious disease-related morbidity in the first postpartum year compared to oral iron in Malawi, a LMIC.

Methods: 692 infants from a randomized controlled trial comparing IV to oral iron to treat anaemia in pregnancy in Blantyre and Zomba districts in Malawi (ACTRN12618001268235), were longitudinally followed up from birth to 12 months of age.  Data on all their medical care was followed in dedicated study clinics. We also routinely administered a morbidity questionnaire and conducted routine clinical and laboratory assessments every three months. The primary outcome was a composite incidence of clinical malaria, diarrhoea, or respiratory tract infections.

Results: Preliminary results, the incidence of disease was lower amongst infants born to mothers randomized to IV iron compared to oral iron, but the difference was statistically non-significant (1.81 versus 1.92 per person-year, incidence rate ratio (IRR) 0.76 [95% CI: 0.4-1.45]) p = 0.79.

Conclusion: There was no evidence that the use of IV iron in pregnancy increases infant’s infectious disease risk, implying that IV iron could be safe to use in LMIC.

P185.A001436. EXPERIENCES OF CAREGIVERS ON HEALTHCARE AND PSYCHOSOCIAL SERVICES AVAILABLE FOR CEREBRAL PALSY CHILDREN IN MANGOCHI DISTRICT

Author(s): Felistas Chiundira1, Anania Matenje1, Ruth Masese1, Mavuto Kawonga1, Chifundo Manong’a1, Beverly Laher1, and Towera Maleta1.

Affiliation(s):

1. Kamuzu University of Health Sciences, Mangochi, Malawi

Email: fchiundira@kuhes.ac.mw

Introduction: Children with Cerebral Palsy (CP) require multidisciplinary and holistic care in order to comprehensively manage their medical needs as well as maximize their developmental and educational potential. In addition, many children with Cerebral Palsy have complex limitations in self-care functions which renders them completely reliant on their caregivers. The provision of such care may therefore be detrimental and stressful to both the physical health and the psychological well-being of parents of children with Cerebral Palsy.

Objective: The study aimed at exploring experiences of caregivers on healthcare and psychosocial services available for children with Cerebral Palsy

Methods: The study utilized qualitative research design which was cross sectional in nature. The study was conducted at Mangochi District Hospital. Twelve caregivers of children with Cerebral Palsy were interviewed through face to face interview and the interview guides were used to obtain the required information. Convenient sampling was used, however, actual sample size depended on data saturation.

Results: The study found that majority of caregivers were satisfied with the Cerebral Palsy services provided for children at the hospital. There was short waiting time and the health workers were friendly to children and caregivers. However, some participants were not honoring appointment dates due to long travelling distances and lack of transport. Majority of caregivers reported that there was lack of assistive walking devices and playing materials to children in their homes. There was also lack of supervision and home visits for children with Cerebral Palsy. Some caregivers were unable to know the prognosis of the child’s illness and had little and inaccurate information about the child’s condition.

Recommendation: The study recommends provision of thorough information during monthly clinical reviews, conducting outreach services for children with CP, home visits by Health surveillance assistants and provision of assistive ambulation devices and play materials for children with Cerebral Palsy.

P186.A001252. MOTOR DEVELOPMENT OUTCOMES IN CHILDREN WITH HYDROCEPHALUS AFTER TREATMENT WITH ENDOSCOPIC THIRD VENTRICULOSTOMY AND VENTRICULOPERITONEAL SHUNT INSERTION AT QUEEN ELIZABETH CENTRAL HOSPITAL

Author(s): Martha Manda1, Eveness Nambuzi1, Frank kaphesi1, Clement Likalowa1, Tuntufye Mwambyale1, James Kaunda1, Patrick Kamalo2

Affiliations(s):

• Department of Physiotherapy, Kamuzu University of Health Sciences, Blantyre, Malawi
  • Blantyre Institute of Neurological Surgery, Queen Elizabeth Central Hospital, Department of Neurosurgery, Blantyre, Malawi

Email: mandamartha2000@gmail.com

Introduction: Ventriculoperitoneal shunt insertion (VPSI) and endoscopic third ventriculostomy (ETV) are the major procedures for treating pediatric hydrocephalus. However, studies comparing motor development following the two treatments are limited.

Objective: We aimed to determine motor development outcomes in children with hydrocephalus up to 2 years of age after undergoing ETV or VPSI, to identify which surgical approach yields better motor outcomes and may be most effective for Malawian children.

Methods: We recruited two groups: post-surgical group consisting of children with hydrocephalus treated with either ETV or VPSI, at least 6 months prior to this study; and pre-surgical group who were children with newly diagnosed hydrocephalus without treatment. The pre-surgical were controls for the post-surgical. Motor development was assessed using Malawi Development Assessment Tool (MDAT).

Results: A total of 37 children met the inclusion criteria: 25 post-surgical and 12 pre-surgical. Of the 25 in post-surgical group, 13 had ETV and 12 VPSI. MDAT revealed significant delay in gross and fine motor development in both groups. In relation to the control group (pre-surgical), those that underwent ETV in the post-surgical group developed normally more often than those with VPSI. Conversely, the extent of developmental delay was higher in those with VPSI than those with ETV.  However, no statistically significant differences were noted for all motor development domains between the two on MDAT (gross motor p = 0.400; fine motor p = 0.053, Pearson’s chi-squared test).

Conclusion: Children with hydrocephalus present with motor deficits that do not improve in the first six months of treatment with either ETV or VPSI which may necessitate early and intensive rehabilitation to restore motor function after surgery. Long follow-up studies with bigger sample sizes are required to detect the effect of treatment approaches.

P187.A001162. PREVALENCE OF ADVERSE BIRTH OUTCOMES AND EXTERNAL BIRTH DEFECTS AMONG WOMEN LIVING WITH HIV IN MALAWI

Author(s): George Bello1,2, Joshua Smith-Sreen4, Dhelia Williamson3, Frank Taulo6, Alinune Kabaghe4, Kerry Thomson9, Matthews Kagoli1, Sikhona Chipeta1, Ireen Namakhoma2, Rose Nyirenda1, Yusuf Babaye2, Andrew Auld4, Evelyn Kim4, Blackson Matatiyo5, Emmanuel Zenengeya5, Adamson S. Muula6, Ishmael Nyasulu7, Melba Filimina Gomes8, Luke Chiwala2, Moses Kamzati2, Jonathan Mkungudza1,2, Diana Valencia3, Cynthia Moore3, Gabrielle O’Malley9, and Nellie Wadonda-Kabondo4  

Affiliation(s):

1. Ministry of Health, Lilongwe, Malawi
2. International Training and Education Centre for Health, Lilongwe, Malawi
3. Centers for Disease Control and Prevention, Atlanta, Georgia, United States
4. Centers for Disease Control and Prevention-Malawi, Lilongwe, Malawi
5. National AIDS Commission, Lilongwe, Malawi
6. Kamuzu University of Health Sciences, Blantyre, Malawi
7. World Health Organization, Lilongwe, Malawi
8. World Health Organization, Geneva, Switzerland
9. The University of Washington, Seattle, Washington, United States

Email: msimkonda@itech-malawi.org           

Introduction: Routine surveillance for birth outcomes is essential to monitor safety of antiretroviral therapy (ART) during pregnancy among women living with HIV (WLHIV).

Objective: To examine the prevalence of adverse birth outcomes and major external birth defects (BDs) by maternal HIV and ART status in Malawi.

Methods: Adverse birth outcomes (prematurity, low birthweight) and BDs were recorded for all-live and stillbirths delivered at four Malawian hospitals from January 2016 to July 2020 and July 2021 to November 2021. BDs were confirmed by experts at the Centers for Disease Control and Prevention. Maternal characteristics were collected from interviews and health records. Pooled prevalence and crude prevalence ratios (cPRs) were calculated using maximum likelihood estimates for adverse outcomes and BDs.

Results: Among 173, 618 women with informative births, the median age was 24.0 years (IQR: 20.0-30.0) and 10.0% were HIV-positive. The prevalence of prematurity and low birthweight, respectively, was significantly higher for the following populations: ART naïve WLHIV (31.7%, 18.4%), WLHIV on ART (22.7%, 14.7%) and women with unknown HIV status (27.2%, 19.2%) than HIV-negative women (19.2%, 11.9%). The most prevalent BDs (excluding syndromes) were talipes equinovarus (17.2 per 10,000 births, 95% CI: 15.3, 19.3), neural tube defects (NTDs) (5.7, 95% CI: 4.6, 6.9), and hypospadias (7.6, 95% CI: 6.4, 9.0); higher prevalence of these conditions among WLHIV on ART than HIV-negative women. There was slightly higher likelihood of WLHIV on ART delivering a baby with an NTD than HIV-negative women (cPR :1.65, 95% CI: 0.95, 2.85).

Conclusions: Higher prevalence of adverse birth outcomes and BDs was observed among HIV-positive women. Further analyses are needed to understand the impact of a COVID-related data collection pause between 2020 and 2021, and to explore risk factors of HIV and ART status by ART regimen and timing for adverse outcomes and BDs among WLHIV in Malawi. 

P188.A001199. ASSOCIATION OF ANTENATAL CARE CONTACTS AND BIRTHWEIGHT AT ZOMBA CENTRAL   HOSPITAL, MALAWI            

Author(s): Lawrence Frank Nyambalo1, Patrick Chidzalo2, Don Mathanga1

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Malawi University of Science and Technology

Email: laurencenyambalo17@gmail.com

Introduction: Antenatal care can reduce health risks for mothers and their babies by monitoring pregnancies and screening for complications. The number of inadequate antenatal care contacts is associated with low birth weight, and therefore a higher probability of low birth weight newborns. To grow a healthy baby, mothers need good nutrition and rest, adequate antenatal care and a clean environment. A study was conducted to assess an association between number of antenatal care contacts and birth weight at Zomba, Central Hospital in Malawi.

Methods: An analysis of retrospective data of mothers (N=186) enrolled from registers from July 2021 to February 2022 was conducted. Mothers who delivered over this period were identified from the postnatal register and their antenatal records were traced retrospectively. The following data were extracted: low birth weight, age, malnutrition, malaria, chronic infection and educational level. Descriptive analysis and logistic regression were utilized using low birthweight as an outcome variable.

Results: The mean age of mothers was 25 years and most of the mothers reported during the third antenatal care contact representing 30.65% (n = 57).  The study showed that there was a statistical significant difference between birthweight and antenatal care contacts (p-value=0.0021). Logistic regression established that antenatal care contacts was significant (p-value<0.001). The odds that an attendee with low contacts delivers a low birthweight baby was 3.59 times that of attendee with higher contacts (Odds ratio =3.59 and 95 % confidence interval).

Conclusion: Increased antenatal care contacts are associated with improved birthweight among antenatal mothers.

P189.A001341. FROM MOTHER TO CHILD: MATERNAL VAGINAL MICROBES AND EARLY ONSET NEONATAL INFECTION IN A RESOURCE-LIMITED, HIGH-DISEASE BURDEN SETTING        

Author(s): Charlotte van der Veer1, Bridget Freyne1, Vita Nyasulu1, Baleke Ndamala1, Queen Dube2, Kondwani Kwaza2, Josephine Langton2, Luis Gadama2, Stephen B Gordon1, Enitan D Carrol3, Janneke van de Wijgert3, Neil French3, David Lissauer1, Maryke Nielsen1

Affiliation(s): 

1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme
2. Queen Elizabeth Central Hospital, Blantyre, Malawi
3. Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool     

Email: charlottevdveer@gmail.com

Introduction: Early Onset Neonatal Infection (EO-NI) has traditionally been associated with Gram-positive bacteria such as Streptococcus agalactiae (GBS). However, the roles of other suspected EO-NI causative micro-organisms (referred to as pathobionts) are incompletely understood. Additionally, a disrupted transmission of beneficial micro-organisms (e.g. lactobacilli) due to maternal vaginal dysbiosis may increase the infant’s vulnerability to infection with hospital- associated opportunistic pathogens.

Objective: To assess whether a Lactobacillus-deficient microbiome and/or carriage of pathobionts associates with EO-NI.

Methods: Vaginal swabs were collected prospectively in a maternal/neonatal cohort and nested case-control study at the Queen Elizabeth Central Hospital, Blantyre, Malawi. Extracted DNA was sequenced on the Illumina HiSeq platform using the 16srRNA V4 region. Data analysis and taxonomy assignment was done using DADA2 and the SILVA 16S reference database respectively. The relative abundances of key bacterial taxa were summarized into clinically relevant bacterial groups. Targeted PCR for pathobionts was performed for the nested case-control samples.

Results: A total of 544 samples (n=58 cases, n=67 controls, n=419 cohort) collected between January 2019 and March 2020, were successfully sequenced. Overall, the median relative abundance of Lactobacillus spp and bacterial vaginosis associated bacteria was 55.4% and 24.0% respectively and this did not significantly differ between cases and controls. Cases however had higher median relative abundance of pathobionts (0.4% vs 0.2%) compared to controls but not significantly so (p=0.152). Targeted pathobiont PCR showed a similar trend. Overall, Lactobacillus crispatus relative abundance was higher for mothers of term infants (≥ 37 weeks gestation; p=0.053) and Lactobacillus spp. dominance (>90% relative abundance) associated with normal birth weight (>2500g ; p=0.037). 

Conclusion: We observed a positive though non-significant trend for maternal pathobiont carriage and EO-NI Lactobacillus spp-dominance associated with having full term normal weight infants. We discuss these results in the context of developing interventions for low-resource, high-disease burden settings.

P190.A001234. PREVALENCE OF URINARY TRACT INFECTION AMONG PREGNANT WOMEN AT QUEEN ELIZABETH CENTRAL HOSPITAL IN BLANTYRE, AND ITS ASSOCIATION WITH ADVERSE DELIVERY OUTCOMES; A CROSS-SECTIONAL STUDY           

Author(s): Hussein H Twabi1,2, Yankho Zolowere3, Margaret Khonga4, Tonney Nyirenda4, Marriott1 Nliwasa, Chisomo Msefula1, 3, Charlotte van der Veer5,6, David Lissauer5,6, Luis Gadama4, Palwasha Khan1

Affiliation(s):

1. Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre Malawi
2. London School of Hygiene and Tropical Medicine, London United Kingdom
3. Queen Elizabeth Central Hospital, Blantyre Malawi
4. Kamuzu University of Health Sciences, Blantyre Malawi
5. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre Malawi
6. University of Liverpool, Liverpool, United Kingdom

Email: htwabi@kuhes.ac.mw

Background: There is a high prevalence of urinary tract infection in pregnancy, yet its association with adverse outcomes of pregnancy is not well studied. There is evidence of increasing antimicrobial resistance in organisms isolated from urine. However, the paucity of information on prevalence of UTI in pregnant women in Malawi highlights the need to clearly evaluate the epidemiology of this disease in this population.

Objectives: To examine the association between UTI and adverse delivery outcomes among a Malawian adult pregnant population with a gestational age of at least 32 weeks. Specifically, to investigate the prevalence of UTI; to determine whether UTI is associated with the prevalence of adverse delivery outcomes; and to describe the occurrence of antimicrobial resistance in organisms identified in urine.

Methods: This was a cross-sectional survey of data collected from 1 April 2015 to 30 March 2022 on pregnant females identified from the department of obstetrics and gynaecology at Queen Elizabeth Central Hospital, which uses a composite outcome created through theory-driven grouping of a priori defined variables. Multivariate logistic regression analysis was conducted to assess the association between UTI and adverse delivery outcomes while controlling for confounding variables.

Results: The prevalence of UTI in this population was 41.2% (95% CI of 36.0% to 46.4%). The crude odds of adverse delivery outcomes in participants with UTI was 1.95 (95% CI 1.24 to 3.10, p=0.004). 29.2% of the 35 urine cultures grew E. coli, and 8.2% grew Klebsiella pneumoniae. There were high levels of antimicrobial resistance demonstrated by the commonest isolates, especially Pseudomonas aeruginosa.

Conclusion: The results of this study suggest that having a UTI is associated with a greater prevalence of adverse delivery outcomes. Additional studies of a prospective cohort nature are required to rigorously investigate this association with confounders in mind, analysing each important outcome separately.

P191.A001373. ADVERSE BIRTH OUTCOMES ASSOCIATED WITH ANTIRETROVIRAL THERAPY DURING PREGNANCY    

Author(s): Nginache Nampota Nkomba 1,2, Andrea Buchwald, Osward M. Nyirenda1, Felix A. Mkandawire1, Samuel Meja3, Dominic Moyo3, Cristiana Cairo7, and Miriam K. Laufer2

Affiliation(s):

1. Blantyre Malaria Project, Blantyre, Malawi
2. Centre for Vaccine Development and Global Health, University of Maryland School of Maryland, Baltimore, USA
3. Kamuzu University of Health Sciences, Blantyre, Malawi
4.  
5. Institute of human immunology, University of Maryland School of Maryland, Baltimore, USA

Email: nnampota@bmp.medcol.mw

Introduction: We studied the relationship between ART exposure in pregnancy and birth outcomes in women carefully characterised by their HIV viral load (VL) levels during pregnancy.

Methods:

In a longitudinal cohort study in Malawi, we followed up pregnant women who presented for their first antenatal care (ANC) visit between 20 and 36 weeks of gestation and met the following criteria: HIV uninfected (HU); with HIV infection, on ART ≥six months before conception, undetectable VL at enrollment and delivery (HIV-lo); and with HIV infection, initiated ART at enrollment, VL ≥10,000 copies/ml at ANC (HIV-hi). At delivery, we evaluated low birth weight (LBW, <2500g), preterm birth (PTB, <37 weeks gestation), small for gestational age (SGA, <10th percentile for gestation), fetal death (pregnancy loss >28 weeks gestation) and early neonatal death (NND, <7 days of life) individually and as a composite outcome. We used multivariate regression to evaluate the impact of HIV and ART initiation timing on adverse outcomes. Relative risks (RR) were adjusted for parity.

Results: Among 517 pregnant women (141 HU, 293 HIV-lo, 83 HIV-hi), prevalence of adverse birth outcomes was 30.5%. The risk was higher among HIV-lo (prevalence 28%, RR 1.4, 95% CI 1.0-1.9) and HIV-hi (31.4%, RR 1.4, 95%CI 0.9-2.1) women compared to HU women (26.2%). The risk of SGA and either fetal death or early NND was two-fold higher in HIV-lo (RR 2.0, 95% CI 1.2-3.4, and RR 1.8, 95% CI 0.6-4.9) and HIV-hi (RR 2.0, 95% CI 1.1-3.7 and RR 2.4, 95% CI 0.7-7.5) arms than HU arm, respectively. PTB risk was not associated with HIV exposure status.

Conclusion: Pregnant women with HIV infection have a higher risk of adverse pregnancy outcomes than pregnant women without HIV infection.  Birth outcomes were similar among women who had suppressed VL throughout pregnancy and those that initiated ART during pregnancy.

P192.A001424. ACCEPTABILITY AND FEASIBILITY OF USING A MENTORED QUALITY IMPROVEMENT STRATEGY TO MONITOR ENGAGEMENT OF PERINATAL WOMEN IN OPTION B+ PROGRAM    

Author(s): Wiza Kumwenda1,2, Angela Bengston3, Mina Hosseinipour2,4, and Victor Mwapasa1        

1. Kamuzu University of Health Sciences, Blantyre Malawi
2. UNC Project, Lilongwe Malawi
3. Brown University
4. University of North Carolina Schools of Medicine and Public Health     

Email: m201980015424@stud.medcol.mw

Introduction: Option B+ is a public health program that provides lifelong antiretroviral therapy to all pregnant and breastfeeding women (PBW) living with HIV. Retention of PBW in Option B+ is essential but poor monitoring limits the ability to optimize retention outcomes. In Malawi, ~25% PBW in Option B+ are not retained-in-care within 12-months of enrollment. Process mapping and quality improvement (PROMAQI), a strategy that focuses on system optimization through continuous mentorship, may enhance retention. However, its application is limited in the Option B+ program.

Objective: To assess the acceptability and feasibility of PROMAQI among healthcare workers (HCWs) as a strategy for monitoring engagement of PBW in the Option B+ program.

Methods: A descriptive cross-sectional study using a mixed approach was conducted in April 2022 at five large urban health facilities implementing PROMAQI for 6-months in Lilongwe, Malawi. At 6-months, a 5-point Likert (1=worst to 5=best) scale tool was administered to 110 HCWs and in-depth interviews (IDIs) were done with purposively-selected HCWs QI team-members (n=11) and non-members (n=11) to assess acceptability and feasibility. Descriptive statistics were used to analyse quantitative data. Data from IDIs were transcribed and analysed thematically using Theoretical Framework of Acceptability (TFA) and Consolidated Framework for Implementation Research (CFIR) to identify drivers for PROMAQI acceptance and its barriers and facilitators to implementation respectively.

Results:  Among 110 participants, the majority (42%) had secondary certificates or diplomas (35%). Most (41%) were Health Surveillance Assistants/counsellors or Nurses (37%). The median score (IQR) for acceptability was 5(4-5) while for feasibility was 4 (4-5), with no differences by site. Using TFA, drivers were: 1) the belief that PROMAQI was addressing a relevant gap in Option B+ and would improve performance; 2) HCWs ability to implement and train others in PROMAQI; 3) the success of PROMAQI and its incorporation into routine work. Using CFIR, barriers were poor work attitude, time constraints, and workload associated with completion of QI-workbook. Facilitators were continuous communication between QI team-members and non-members, QI mentorship, training, and allowances.

Conclusion: PROMAQI is an acceptable and feasible strategy for monitoring engagement of PBW in Option B+ program. To optimise PROMAQI implementation, mechanism of dealing with HCW motivation, continuous QI mentorship, constant communication between QI team-members and non-members, and availability of resources are needed. This may contribute to improved retention for PBW in the Option B+ program.

P193.A001181. EVALUATING THE FIDELITY OF USING FINGERPRINT BIOMETRIC SYSTEMS TO MONITOR ENGAGEMENT OF PERINATAL WOMEN ENROLLED IN OPTION B+ PROGRAMME IN LILONGWE, MALAWI.         

Author(s): Wiza Kumwenda1,2, Sophie Lazar 2, Denzel Matiya 1, Shaphil Wallie 1, Madelyn Frey 2, and Angela Bengtson2   

Affiliation(s):

1. UNC Project, Lilongwe, Malawi
2. Brown University, United States  

Email: wkumwenda@unclilongwe.org

Introduction: Fingerprint biometric technology is emerging as one way of optimising client identification and monitoring of engagement to HIV care, hence it is key to evaluate its implementation.

Objective (s): a) To evaluate acceptability and feasibility of using fingerprint biometric system (FBS) to register visit attendance among women in Option B+ program b) To assess the fidelity of using FBS across large urban health facilities.

Methods: We enrolled 402 pregnant women at their first ANC visit across 5 large urban health facilities in Lilongwe, Malawi and followed them through 9 months postpartum (PP). Information on visit attendance was collected between 11-Feb-2020 and 03-Aug-2022 for all study visits at baseline, 6-weeks PP, 6-months PP and 9-months PP and usual care HIV visited in the FBS and study database. At 9-months PP, feasibility and acceptability of using FBS was assessed. Over the study period, fidelity was measured as the proportion of usual HIV care and study captured in both the study database and the FBS. Study database and biometric records were considered to be a match if they occurred within a +/-10-day window.

Results: Overall, 2857 visits were registered in both the study database and FBS and 1817 (64%) visits were matched. Matching varied by visit type (range: 38-99%). FBS was not used for 73/612 (12%) working days. Of which, 21(6%) days was system failure and 52 (14%) days was COVID-19 break. Among the participants, 354 (98%) reported FBS was easy to use, 339(94%) made it easier to engage in care, 301(83%)were comfortable to use, 270(75%) always used it as trained and 273(76%) would strongly recommend it to others.

Conclusion: Fingerprint biometric system was acceptable and feasible among perinatal women at 9 months PP. Fidelity to use FBS varied across visits thus further investigations are needed to explore factors affecting its implementation.

P194.001458.  EXPLORING ANTENATAL CARE-SEEKING BEHAVIOUR OF PREGNANT ADOLESCENT GIRLS AND INTERVENTIONS TO PROMOTE EARLY ANTENATAL ATTENDANCE IN MALAWI 

Author(s): Monica Patricia Malata1, Medrina Mtende1, Patani Mhango1, Luis Gadama2, David Lissauer 3, Linda Nyondo-Mipando3,4, Effie Chipeta1 and Diplomatic5

Affiliation(s):

1. Centre for Reproductive Health, Kamuzu University of Health Sciences
   1. Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences
   1. Malawi-Liverpool Wellcome Trust
   1. Department of Health Systems, Kamuzu University of Health Science
   1. Diplomatic Collaborations

Email: mpmalata@kuhes.ac.mw      

Introduction: Malawi has one of the highest rates of adolescent pregnancies and child marriages. Despite interventions to improve maternal outcomes, maternal related complications are the leading cause of death amongst young girls aged 15-19 years old. We explored the perceptions around factors affecting antenatal care-seeking behaviour of pregnant adolescent girls and potential interventions to promote early Antenatal Care (ANC) attendance in Malawi.

Methods:  We used an exploratory qualitative design. We interviewed pregnant adolescent girls, male partners, community leaders and health service providers. Using purposive sampling, we recruited participants from two health centres in Blantyre City and Mzimba District. We analysed the data using thematic content analysis and framed results using the socio-ecological framework for health seeking behaviour.

Results:  Adolescent ANC seeking behaviour is shaped by many factors. Individual factors such as their young age and unplanned pregnancy hinder adolescents from accepting and disclosing the pregnancy, thus delaying their access to services. Adolescents are also afraid of revealing their pregnancies to their family and friends and are often faced with the shame of dropping out of school. At the health system level, poor provider attitudes towards adolescents, long distances to facilities and inadequate drug supplies all serve as barriers. Furthermore, they are required to present to their first ANC with their partners, however not all adolescents are comfortable revealing their partners.

Youth friendly health services and exclusive adolescent antenatal care services were identified as potential interventions to promote early antenatal care attendance amongst adolescents in Malawi. These would promote confidentiality and their trust towards service providers.

Conclusion: Adolescent pregnancies are culturally unacceptable. As a result, pregnant adolescents face stigma and shame which contribute to non-disclosure and ANC attendance. There is a need for interventions that recognise the challenges that pregnant adolescents face while providing ANC services.   

P195.A001453. PERCEIVED BARRIERS AND FACILITATORS TO AND STRATEGIES FOR NORMALISING USS TO IMPROVE QUALITY OF ANC IN MALAWI.      

Bertha Maseko1, Annie Kuyere1, Leonard Mndala1, Chifundo Kondoni1, Luis Gadama1,2, Catherine Bamuya4, Adrian Malunga4 Nancy Medley3, Alinane Linda Nyondo-Mipando1,2,3, and David Lissauer1,3    

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Research Programme
2. Kamuzu University of Health Sciences
3. University of Liverpool
4. Malawi Epidemiology and Intervention Research Unit   

Email: bmaseko@mlw.mw

Introduction: Malawi has one of the highest rates of preterm birth in the world, currently estimated at up to 18.1 percent. Ultrasound Scanning (USS) measurement before 24 weeks of gestation is a recommended way of ascertaining an accurate gestational age thereby correctly diagnosing prematurity. An earlier study trained midwives across diverse sites in Malawi to date pregnancies and improve management. This study explored the barriers and facilitators to and strategies for normalization of USS in the routine antenatal care services in Malawi. 

Methods:  We conducted three participatory qualitative workshops using Gallery walks and Fishbone diagram tools to elicit barriers and facilitators to and strategies normalizing USS in routine Antenatal care services. Workshops were conducted in May 2022 in Blantyre, Lilongwe and Mzuzu.  Forty-eight (48) Midwives, Zonal maternal and neonatal managers, and nursing college tutors were invited from USS experienced, and USS naive sites participated in the workshops.  Discussions were audio recorded and recordings were transcribed directly into English and manually analysed and thematically compiled into affinity diagrams. We prioritised the barriers and facilitators to and strategies for USS normalization using Nominal group techniques.

Results: The main barriers to normalisation of USS in routine antenatal care include the limited number of midwives trained in conducting USS, lack of USS scanning machines and its accessories in the facilities, limited infrastructure such as dedicated rooms for USS and electricity, lack of community awareness on the services to dispel myths and misconceptions associated with USS and the lack of leadership support on the services. The facilitators include availability of resources both trained human and materials, support from district and central level health managers, coordinated activities at the facility to increase antenatal care days and accessibility of services as well as coordination with implementing partners and community sensitization about the services. The main strategies for optimal inclusion include of USS in routine care include pre- and in-service trainings, inclusion of USS machines and accessories in the implementation plans and updating antenatal registers to create demand for USS.

Conclusion: Addressing human and material resources, access to information and strengthening leadership and governance will facilitate USS service adoption into routine ANC.   There is a need to scale the training of USS scanning in both preservice and in-service training as well inclusion of this service in the antenatal health passport book to create to normalise the services.

P196.A001311. INITIAL ASSESSMENT OF ANTENATAL CARE SERVICES AT ZINGWANGWA HEALTH CENTRE, BLANTYRE, AS BASELINE FOR STARTING A CONTINUOUS QUALITY IMPROVEMENT Approach

Author(s): Dyson Mwandama1, Yankho Katundu Kanise1, Pauline Tonde2, Fidelis Sindani1, Nigel Livesley3, Jeroen van ‘t Pad Bosch1, and Anne Hyre4

Affiliation(s):

1. Jhpiego, Malawi

2. Zingwangwa Health Centre, Malawi

3. Jhpiego, Kenya

4. Jhpiego, Baltimore, USA

Email: fsindani@jhpiego.org

Introduction: Antenatal care provides an opportunity for life-saving monitoring, health promotion, and health system linkages through early detection and timely interventions. The Antenatal/Postnatal Research Collective (ARC) designed a quality improvement initiative to support Zingwangwa to apply QI methods to diagnose and understand the factors that are contributing to the poor quality ANC services.

Methods: The Zingwangwa Quality Improvement team assessed client flow mapping that an ANC mother passes through, and assessed 384 ANC mothers during their initial and subsequent visits on time of arrival and departure. Measurements included time spent at each component of ANC services, waiting time in between these components and total time spent at the ANC clinic. We collected data on the number of midwives and availability of functional equipment.

Results: The majority of clients 75.5% (290/384) arrived at the clinic between 8:30-9:30 am. The ANC clinic on Monday was reserved for subsequent ANC mothers. Tuesdays and Thursdays had almost same number of subsequent mothers attending clinics. On Wednesday, the clinic consulted both initial and subsequent ANC mothers. On Friday, the clinic saw almost 3.5 times of the initial ANC mothers seen on Wednesday. HTS was provided at an eight-minute walking distance outside the ANC building. There was wide variation on the number of clients and the mean time spent at the facility in hours per weekday; Monday 26 clients, spending average 2.9 (1:35-4:21) hours, Tuesday 88 clients, spending average 2.1(0:40-3:25), Wednesday 60 clients, average 3.2 (0:31-5:29), Thursday 95 clients, average 2.4 (1:05-4:43) and Friday 115 clients, average 3.9 (1:50-6:20).

Conclusion: The results illustrate the importance of identifying and testing new interventions and technologies to help the facility think about and plan how they might re-organize and restructure ANC services that are more personalized, intimate, informative and provided in a more caring environment.

P197.A001205. EFFICACY OF A CARE GROUP MODEL ON IMPROVING NUTRITION KNOWLEDGE, DIETARY PRACTICES AND NUTRITIONAL STATUS OF PREGNANT AND LACTATING ADOLESCENTS, AND CHILDREN AGED 0-23 MONTHS

Author(s): Gloria Chigona1, Lloyd Chauwa1, and Alexander A. Kalimbira1

Affiliation(s):

1. Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources

Introduction: In Malawi, community-based peer group nutrition intervention delivery platforms known as care groups are the primary structures that target pregnant and lactating women. Evidence shows that pregnant and lactating adolescents negligibly attend care groups, suggesting that they have limited access to impactful sources of knowledge and skills.

Objective: To assess the efficacy of regular attendance of care group cluster meetings on improving nutrition knowledge, dietary practices and nutritional status of pregnant and lactating adolescents and children aged 0-23 months.

Methods: An 11-week pre-post intervention quasi experimental design with 198 participants at baseline (99 intervention group, IG and 99 control group, CG) was conducted in Mchinji district in central Malawi. In the IG, three interactive sessions that provided nutrition information and showed possible pathways for improved nutrition through care group cluster meetings were conducted once every week to promote attendance. Quantitative and qualitative data were collected. Difference-in-Differences (DID) estimator, multivariate regression, paired t-tests and thematic analysis were used to analyse the data.

Results: Participants in the IG increased attendance of care group cluster meetings (p<0.0001); had improved knowledge on infant and young child feeding (p=0.035) and family planning (p=0.013); and improved feeding: minimum meal frequency (MMF) (p=0.014), minimum dietary diversity (MDD) (p=0.005), and minimum acceptable diet (MAD) (p=0.008) than those in the CG. Care group cluster attendance positively influenced achievement of MAD, MDD and women’s MDD, but did not influence contraceptive use and water, sanitation and hygiene. The intervention had no significant effect on nutritional status. Focus group discussions showed that busy schedules of facilitators, unsupportive guardians and several adolescent factors affected care group attendance.

Conclusion: There is potential to improve child feeding knowledge and practices, and family planning knowledge among pregnant and lactating adolescents if they have access to care group cluster meetings.

P198.A001184. DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF A RESPECTFUL MATERNAL AND NEWBORN CARE BUNDLE: A MIXED-METHODS STUDY IN MALAWI AND TANZANIA

Author(s): Bob Faque1, Idesi Chilinda1, Angela Chimwaza2, Dame Tina Lavender2          

• Kamuzu University of Health Sciences, Blantyre Malawi
  • Liverpool School of Tropical Medicine, Liverpool United Kingdom     

Email: ichilinda@kuhes.ac.mw

Introduction: Respectful care is a fundamental human right and a key determinant of quality care during childbearing. Evidence shows that disrespect and abuse remain prevalent, primarily in low and middle income countries. Mistreatment presents as physical, sexual and/or verbal abuse, stigma and discrimination, failure to meet professional standards of care and poor rapport between women and providers. Disrespectful care negatively impacts on childbirth experiences and actively deters women from attending health facilities, compromising care when services are available. The global community increasingly recognises similar mistreatment affecting new-borns, leading to calls for them to receive equal attention.

Objectives: To determine whether implementation of a sustainable Respectful Care Bundle, co-produced with stakeholders, including health workers, and service users across primary, secondary, and tertiary maternity facilities in Malawi and Tanzania, decreases woman-reported episodes of disrespectful care. The specific objectives of this study are to:  evaluate the effectiveness of the care bundle by healthcare workers, women and managers; assess the acceptability, sustainability and impact of the maternal and newborn care bundle roll -out.

Methods: Our study has 3 related phases: pre-implementation, implementation and evaluation. We will use mixed methods, including an interrupted time series (ITS), community surveys, process audit, resource utilization questionnaires, in-depth interviews, and structured observations. The ITS will cover more than 30,000 births in each country. Six hundred women will be included in each community survey: before and following intervention implementation. The study is being conducted at Bwaila, Ethel Mutharika and Mitundu Hospitals.

Conclusion:  It is expected that findings from this study will reduce the incidence of disrespectful care at in Mitundu, Bwaila and Ethel Mutharika hospitals with a high probability of successful roll-out at national level as well as to other low- and middle-income settings. 

P199.A001171. HEALTH CARE WORKERS AND KEY POLICY INFORMANT’S KNOWLEDGE OF THE USE OF CALCIUM AND LOW DOSE ASPIRIN FOR PREVENTION OF PREECLAMPSIA IN MALAWIAN WOMEN

Author(s): Memory M. Ngwira 1,2,4, Luis A. Gadama 1,2, Renuka Shanmugalingam 1,3,4,5, Angela Makris 1,3,4,5, and Annemarie Hennessy1,3,4           

Affiliation(s):

1. School of Medicine, Western Sydney University, Sydney Australia
2. Kamuzu University of Health Sciences, Malawi, Africa
3. Department of Renal Medicine, Liverpool Hospital, South Western Sydney Local Health District, Sydney Australia
4. Heart Research Institute, University of Sydney, Sydney Australia
5. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Email: moque87@gmail.com

Introduction: In developing countries such as Malawi, Africa, the burden of preeclampsia/eclampsia is worsened by lack of preventive interventions. Calcium and low dose aspirin has been recommended by World Health Organisation for prevention of preeclampsia. However, it was not evident that health workers and policy key informants were aware of this novel intervention in Malawi. The barriers to the use of calcium and aspirin for prevention of preeclampsia remained unknown in Malawi.

Objectives: This study investigated health care workers and key policy informant’s knowledge, and barriers to the use of calcium and aspirin for preventing preeclampsia in Blantyre and Lilongwe, Malawi.

Methods: A descriptive cross-sectional formative study using semi-structured In-Depth Interview (IDIs) was conducted at Queen Elizabeth Central Hospital (QECH), Reproductive Health Directorate, and the United Nations Population Development Fund (UNFPA) Office in 2021. Data was analyzed using NVIVO™ software. Thematic content analysis was used to analyze and interpret the findings. Emerging themes were then developed inductively and deductively.

Results: Doctors had greater knowledge of the use of calcium and aspirin for prevention of preeclampsia compared to nurses and key policy informants. Lack of knowledge, patient’s late presentation, scarcity of calcium tablets and delays in implementing new guidelines were the barriers to use identified.

Conclusion: This study shows that there are health care worker and policy level barriers that affect the implementation of calcium and aspirin use for the prevention of preeclampsia in Malawian women.

A200.A001225. GROUP MODEL BUILDING FOR MANAGEMENT RELATED PRACTICES INFLUENCING THE QUALITY OF CARE FOR NEWBORNS IN MALAWI        

Author(s): Elias R. M. Phiri1, Wanangwa Chimwaza Manda1, Victor Mwapasa1, Alinane Linda Nyondo-Mipando1, Monica Malata1, Charlotte Ward2, Catherine Goodman2, and Timothy Powell-Jackson2

Affiliation(s):

1. School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Global Health and Development, London School of Tropical Medicine and Hygiene, London, United Kingdom

Email:  phirie@kuhes.ac.mw

Introduction: While neonatal mortality remains high in Malawi and other LMICs, there is limited information on the influence of management practices on the quality of care (QOC) in these settings.  The IMPRESS project is examining if enhanced management practices can improve neonatal QOC in Malawi. The formative phase of IMPRESS used in-depth interviews (IDIs) and Group Model Building (GMB) to identify management practices affecting neonatal QOC. GMB is a participatory qualitative approach which engages stakeholders in collectively finding causes of complex problems and how they are connected. This paper describes management-related practices influencing neonatal QOC in Malawi using GMB.

Methods: Between September-2021 and February-2020, three GMB workshops with neonatal unit nurses and hospital attendants were conducted, separately, for a district, a central, and a CHAM hospital using purposive sampling. Each workshop involved participant orientation on QOC, management, IMPRESS, and GMB process; elicitation and prioritisation of causes of poor neonatal QOC; clarification of causes of the causes; and identifying the management-related causes. Data was summarised using a causal loop diagram after building group consensus.  The three causal loop diagrams were merged using Vensim PLE 9.2.4 software, through an iterative process among study investigators.

Results: The GMBs highlighted management-related origins of challenges affecting newborn QOC. These include human resource factors such as  low staff motivation from lack of staff appraisals, rewards, and unfair allocation of training opportunities, shortage of staff resulting in high workload, inadequate supervision resulting in staff negligence; shortage of supplies resulting from de-prioritization of the neonatal medicine and supply orders compared to other units; lack of enforcement, clear guidelines, or training on Vitamin K administration; poor coordination during referrals resulting in delayed care and poor health outcomes.

Conclusion: GMB provided a triangulated approach in contextualising hospital management practices and neonatal QOC in Malawi. It also showed interrelations between different practices.   

P201.001241. PREGNANCY OUTCOMES AMONG ADOLESCENT GIRLS AND YOUNG WOMEN AT BWAILA MATERNITY HOSPITAL, LILONGWE, MALAWI          

Author(s): Mtisunge Chang’ombe1, Lameck Chinula 1,2, Jennifer Tang3, and Friday Saidi1,2

Affiliation(s): 

1. Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi
2. University of North Carolina Project, Kamuzu Central Hospital
3. University of North Carolina at Chapel Hill

Email: nelliechangombe@gmail.com

Introduction: Adolescent pregnancy is a major public health problem. The rate of pregnancy in Malawi among adolescent girls rose from 25% in 2010 to 29% in 2015-16. The study was conducted to provide preliminary data on adverse pregnancy outcomes among adolescent girls and young women.

Objective: To compare adverse pregnancy outcomes and maternal complications among adolescent girls (<19 years) and young women (20-24 years) who delivered at Bwaila Maternity Hospital, Lilongwe, Malawi.

Methods: A cross-sectional descriptive study was conducted. From October to December 2020, 429 adolescents and 694 young women were enrolled. Data on demographic, socioeconomic, antenatal care, delivery, postnatal and neonatal outcomes were collected from the participants’ health records using a questionnaire.

Results: Adolescents were significantly more likely than young women to be primigravida, single, unemployed, and HIV negative. Also more likely to reside in a rural setting (p=0.013), have only primary school education (p<0.001), attend their first antenatal visit in the 2nd trimester (p=0.027), and have a planned pregnancy (p<0.001). Adolescents who had a vaginal delivery were more likely to have an episiotomy and perineal tears (64%) than young women (50%, p=0.001), although there was no difference in the proportion of adolescents and young women who underwent caesarean section. No statistical differences were found for adverse pregnancy outcomes, such as neonatal death or stillbirth, or for antepartum and peripartum maternal complications, which generally occurred in less than 10% of our study population.

Conclusion: We found no significant differences in adverse pregnancy outcomes and maternal complications between adolescent girls and young women in our population, all of which were uncommon. Our study findings may be related to the fact that Bwaila is a secondary level hospital that refers women for high-risk complications to a nearby tertiary level hospital, and therefore may not be generalizable to other populations.

P202.A001081. USABILITY EVALUATION TO SELECT THE MOST APPROPRIATE NEWBORN DEVICES IN MALAWI          

Author(s): Lucky Mangwiro1,  Jake Johnson2. Elizabeth Asma2, and Kondwani Kawaza     

1. Kamuzu University of Health Sciences, Blantyre, Malawi
2. Rice 360 Institute for Global Health Technologies

Email:  lmangwiro@medcol.mw

Introduction: Medical devices are used in clinical diagnosis and delivery of life-saving treatments. Devices that are difficult to use can lead to critical errors and cause harm to patients; worsening the already high neonatal morbidity and mortality in low-resource settings [1]. Devices in these settings need to be appropriate for the needs of end users, in order to reduce device errors and adverse consequences [2]. We performed usability evaluations to select the most appropriate device models for inclusion in a bundle of technologies for Malawian neonatal intensive care units (NICUs).

Objective:  To select the most user-friendly models of commonly used newborn devices

Methods:  Nurses and clinicians at Central and District Hospitals in Malawi completed usability evaluations of different models of commonly used newborn medical devices. Brief demonstration videos were shown to the participants before being asked to perform the demonstrated tasks in a simulated scenario. Researchers observed the tasks and recorded assessment scores on pre-designed forms. Participants provided feedback and selected the most preferred model within each device category. Effectiveness, efficiency, and satisfaction, were measured using the System Usability Scale (SUS) [3].

Results: Fifty participants participated in the study (n=50). Users demonstrated both high effectiveness and satisfaction on phototherapy (91.5%, SUS 90), suction pumps (81.3%, SUS 84.8) and pulse oximeters (SUS 71 vs 74.6%). Average satisfaction and lower effectiveness scores were demonstrated with radiant warmers (SUS 63.3 vs 50%) and CPAP (SUS 58 vs 33.3%). 

Conclusion: Usability evaluations did not show consistent patterns across device categories. The results suggest that users may mis-judge their own competence to safely use medical devices. Usability data can guide device selection, user training and future designs of medical devices.

P203.A001207. FACTORS INFLUENCING FATHERS’ INVOLVEMENT IN THE CARE OF HOSPITALISED PRETERM NEWBORNS IN BALAKA, MALAWI           

Author(s): Patani Mhango1, 2, and Alinane Linda Nyondo-Mipando1

Affiliation(s):

1. Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS) Private Bag 360, Blantyre, Malawi.
2. Centre for Reproductive Health, Kamuzu University of Health Sciences (KUHeS) Private Bag 360, Blantyre, Malawi   

Email: pmhango@kuhes.ac.mw

Introduction: Preterm birth is one of the dominant risks in neonatal mortality and it accounts for three million annual deaths globally. Malawi has one of the highest incidences projected at 18.1 percent. Male involvement has been advocated as a key to improving maternal, neonatal, and child health and it is associated with positive outcomes in the care of newborns. Fathers’ involvement could come in the form of accessibility, engagement, and responsibility.

Objectives: The objectives were to assess fathers’ perceptions of the activities they were involved in and explore barriers and facilitators to male involvement in the care of preterm infants.

Methods: A phenomenological study was conducted at Balaka District Hospital guided by the components of the model proposed by Lamb on male involvement and the Theory of Planned Behaviour. In-depth interviews were conducted with fathers of hospitalised preterm infants purposively sampled in June 2021, at a private place, in the language of the participant’s choice after the participant had provided written informed consent. Interviews were digitally recorded, transcribed verbatim, and data were analysed using a thematic analysis approach.

Results: We conducted 16 interviews. At a personal level, perceived difficulty with care activities and perceived benefits of involvement influenced fathers’ involvement. Gender roles and socio-cultural beliefs, work and other family responsibilities, and support from health providers and relatives were found as interpersonal factors that either facilitated or impeded fathers’ involvement. Infant factors such as baby’s physical appearance/nature, baby’s health status, feedback from the baby, multiple births; hospital’s physical environment and ability to provide baby’s basic needs were also reported as barriers and facilitators to fathers’ involvement.

Conclusion: Fathers’ involvement in the care of hospitalised preterm newborns can be improved by finding ways of resolving the barriers. Fathers’ involvement can serve as the catalyst needed to rapidly reduce infant mortality in Malawi.

P204.A001108.  Dietary Patterns and Gestational Weight Gain in the Third Trimester of Women Attending Antenatal Clinic at Bwaila Hospital in Lilongwe City   

Author(s): Stella Phiri1, Lloyd Chauwa1, and Alexander A. Kalimbira1           

Affiliations:

1. Department of Human Nutrition and Health

Email: phiristella@hotmail.com

Introduction: Healthy pregnancy weight gain has a number of benefits, whereas too little or too much gestational weight gain (GWG) are risk factors of various poor pregnancy outcomes.

Objectives: To determine the association between maternal dietary patterns and gestational weight gain in the third trimester among pregnant women attending antenatal clinics at Bwaila Hospital in Lilongwe city.

Methods: This was a combined retrospective and cross-sectional study in which 285 consenting healthy pregnant women of all ages who were in their nineth month of pregnancy were recruited. As primary data, weight and dietary patterns at 9 months gestation were collected using structured questionnaires. Weight at seventh and eight months, and pre-pregnancy height and weight (for pregravid body mass index – BMI computation) were retrospectively obtained from health passports. Dietary patterns were established using Principal Components Analysis with Varimax rotation. Pearson correlation was used to determine the relationship between dietary patterns and GWG.

Results: Thirty-nine percent of the subjects were overweight and obese. Two main dietary patterns, namely “Vegetarian” and “Mixed” were identified. Only the mixed dietary pattern had a significant but small and weak correlation with GWG (r=0.261, p<0.01). Regardless of pregravid BMI category, 41.8% of the women had insufficient GWG particularly those who were underweight or had normal weight. Excessive weight gain was observed in 20.4% of the women, especially those who were overweight and obese.

Conclusion: Women who were consuming a mixed dietary pattern were likely to gain weight than those whose diet was vegetarian. Insufficient GWG was widespread, particularly among those who had normal to low pregravid BMI. Counselling on dietary choices during pregnancy should be intensified.

P205.001372. ACQUISITION OF COMPETENCE: AN ANALYSIS OF CLINICAL TEACHING AND LEARNING OF MIDWIFERY AT KAMUZU COLLEGE OF NURSING

Author(s):  Chrissie Phiri1

Affiliation(s):

1.  Kamuzu University Health Science, Blantyre Malawi

Email: phiric@kuhes.ac.mw

Introduction: Malawi has one of the highest maternal and neonatal mortality rates globally. In response, a competence-based approach to midwifery education was introduced at Kamuzu University of Health Sciences to produce competent midwives capable of taking lead in the provision of quality maternal and neonatal health services. The college adopted the International Confederation of Midwives’ seven essential competencies for basic midwifery practice to produce professional midwives. But there are reports that the graduates perform below the expected standards. This study explored the clinical teaching and learning practices utilized by midwifery lecturers and students in preparation for effective midwifery practice.

Methods: A sequential qualitative study was conducted at KUHeS. Data were collected from multiple sources for triangulation. Using purposive sampling a sample of six senior midwives and six lecturers were selected in the first phase. 26 student midwives, five graduates from the college, and four graduate midwives from Mzuzu University in the second phase. Face-to-face semi-structured interviews were conducted in the first phase. Focus group discussions were conducted to collect data from KUHeS students and graduates in the second phase.  Face-to-face interviews were used for Mzuzu university graduates. Old timetables, the curriculum, and students’ clinical assessment forms were checked to verify data from respondents. Using the NVivo software, a thematic analysis approach was used to analyse data.

Results: Reveal that although the curriculum document indicates that the program is competence-based, the teaching and learning methods and students’ assessments are inconsistent with CBE and learning theories. Educators prefer the traditional lecture to finish the content. There is grade inflation and halo effect during students’ clinical assessments. Students lack good role models. Gross lack of resources, poor infrastructure, and poor relationships at health facilities compromise students’ learning.

Conclusion: The study portrays the impact of introducing change using top management as a change agent.

MEDICAL STATISTICS ABSTRACTS – POSTERS

P207.A001192. COMPETING EVENTS MODELLING OF TIME TO DISCHARGE: APPLICATION TO LENGTH OF HOSPITAL STAY AMONG UNDER-FIVE CHILDREN HOSPITALIZED IN MALAWI 

Author(s): Christopher C. Stanley,1* Madalitso Zulu,2 Harrison Msuku,1 Vincent S. Phiri,3 Lawrence N. Kazembe,4 Jobiba Chinkhumba,1,3 Tisungane Mvalo,2,5 and  Don P. Mathanga1,3   

Affiliations:

1. Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
2. UNC Project—Malawi, Lilongwe, Malawi
3. School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
4. Department of Computing, Mathematical and Statistical Sciences, University of Namibia, Windhoek, Namibia
5. Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.         

Email: cstanley@mac.kuhes.ac.mw

Introduction: Length of hospital stay (LOS) defined as time from inpatient admission to discharge is one of key indicators of quality in patient care and management. Reduced LOS lowers health care expenditure and minimizes chances of in-hospital acquired infections. Conventional time-to-event methods such as Kaplan-Meier curves and the Cox proportional hazards models cannot account for competing risks such as death, referral and abscondment.

Objective: This study applied competing-risk methods to investigate factors important for risk-stratifying patients on LOS in order to enhance patient care and management.

Methods: This study analysed data from an ongoing malaria vaccine implementation program (MVIP) safety surveillance in Malawi’s four district hospitals of Balaka, Machinga, Mchinji and Ntchisi. Children aged 1-59 months who were hospitalized (> night in hospital) with a medical illness were consecutively enrolled between 1 November 2019 – 31 July 2021. Sub-distribution-hazard (SDH) ratios for cumulative incidence of discharge were estimated with a Fine-Gray competing risk model.

Results: Among the 15,463 children hospitalized, 8,607 (55.7%) were male and 6,856 (44.3%) were female and the median age was 22 months (interquartile range [IQR]: 12-33 moths). The cumulative incidence of discharge was 40% lower among children who were HIV-positive compared to HIV-negative (sub-distribution-hazard ratio [SDHR]: 0.60; [95% CI: 0.46–0.76]); with severe and cerebral malaria (SDHR: 0.94; [95% CI: 0.86–0.97]), severe anemia malaria (SDHR: 0.54; [95% CI: 0.48–0.61]) and meningitis (SDHR: 0.18; [95% CI: 0.09–0.37]) when compared to non-severe or cerebral malaria; and also 39% lower among malnourished than non-malnourished children (SDHR: 0.61; [95% CI: 0.55–0.68]).

Conclusion: This study applied a Fine-Gray competing risk approach to more accurately model LOS as time to discharge accounting for in-hospital mortality, referrals and abscondment. Patient care and management can be enhanced by risk-stratifying on LOS based children age, HIV status, diagnosis and nutritional status.

MENTAL HEALTH ABSTRACTS – POSTERS

P208.A001152. PSYCHOSIS RECOVERY ORIENTATION IN MALAWI BY IMPROVING SERVICES AND ENGAGEMENT (PROMISE)

Author(s): Lucinda Manda-Taylor1, Stephen Lawrie2, Olive Liwimbi1, 3, Martyn Pickersgill2, Judith Allardyce2, Charlotte Hanlon4, Kazione Kulisewa1, Angus MacBeth2, Anthony Sefasi1, Robert Stewart2, Kirsty Forsyth5, Martin Knapp6, Sumeet Jain2, Thandiwe Mkandawire1, 2, Michael Udedi3, Jones Masiye3, Eric Umar1

Affiliation(s):

1. Kamuzu University of Health Sciences
2. University of Edinburgh
3. Ministry of Health, Malawi
4. King’s College London
5. Queen Margret University, Edinburgh
6. London School of Economics and Political Science

Email: mandal@kuhes.ac.mw

Introduction:  Most people with mental health problems in Malawi tend to consult traditional or religious healers. Knowledge and understanding of psychosis remain limited, and services have limited capacity.  PROMISE is a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.

Objectives: (1) To understand perspectives of ‘psychosis’ among PWLE, caregivers and health-worker ‘stakeholders’ in Malawi and how these influence help-seeking. (2) To develop and validate a screening tool as part of a psychosis detection system that is acceptable to stakeholders. (3) To formalise a simple psychosis management plan, emphasising community-level psychosocial interventions that are acceptable to stakeholders. (4) To evaluate the effectiveness and cost-effectiveness of psychosis detection and management system in improving outcomes prioritised by stakeholders.

Methods: The study is divided into four work packages. Work package 1: Engages with stakeholders, including the participatory research method of photovoice, to investigate perspectives on psychosis qualitatively and quantitatively. Work package 2: Using the theory of change and implementation science approaches, we will develop a manual for intervention and recruit and train HSAs to use and refine the manual. Work package 3: We will pilot the resulting psychosis detection and management system to screen for psychosis, support engagement in care, and deliver community-based psychosocial interventions in two districts of Malawi. Work package 4: A two-year evaluation of the psychosis detection and management system and completion of a cost-effectiveness analysis.

Anticipated Results: We hope to develop a cost-effective, validated psychosis detection and management approach for scale-up in Malawi and possibly beyond.

Conclusion: This ambitious multidisciplinary implementation research will improve users’ and carers’ knowledge and understanding and strengthen Malawi’s health services’ capacity to provide care for a disabling group of conditions.

P209.A001090. THE EFFECTIVE MANAGEMENT OF COMMON PSYCHO-SOCIAL PROBLEMS AMONG ADOLESCENT LEARNERS IN MALAWI.     

Author(s): John Kuyokwa1,2, Dixie Maluwa Banda2, Symon Chiziwa2, Bob Chulu2 and Nertha Semphere Mgala2         

Affiliation(s):

1. Malawi College of Health Sciences, Faculty of Clinical Sciences, Private bag 396, Blantyre, Malawi
2. University of Malawi, Chancellor College, School of Education, P.O. Box 80, Zomba, Malawi

Email: johnkuyokwa@gmail.com

Introduction and objective: The purpose of this study was to explore an effective way of managing common psycho-social problems among adolescent learners in Zomba, Malawi.

Methods: Mixed-methods sequential explanatory study design guided the study. First phase utilised a qualitative method, where 18 Key Informants were targeted. The second phase was a quantitative method and utilised a Non-equivalent groups quasi-experimental study design which targeted 317 adolescent learners from two secondary schools.  

Results: Adolescent learners had psycho-social problems and prevalence was as follows: depression (87%); suicidal thoughts (26.4%); substance use (31.3%); positive attitudes towards mental health problems (26.4%) and knowledge of mental health problems (23.3%). Being male was associated with depression, substance use, knowledge about mental health problems, positive attitudes towards mental health problems; Younger adolescent (10-15 years) was associated with depression, knowledge of mental health problems, positive attitudes towards mental health problems; being from rural area was associated with suicidal thoughts before intervention. The study observed psycho-social service deficiencies within the Malawian secondary schools. Combined psycho-education and group counselling intervention were able to reduce the prevalence of psycho-social problems among adolescents. Suicidal thoughts: 2% [26%-24%], attitudes 29% [26%-55%], knowledge 47% [23%-70%], Substance use 5% [31% -25.9%] & depression% [87% -88.0%].  However, the impact of the intervention was not statistically significant in some tested variables.

Conclusion: Findings will help relevant stakeholders to be aware of the adolescent psycho-social challenges and how to manage them.

P210.A001273. YOUTHS MENTAL HEALTH, MENTAL ILLNESS AND MENTAL HEALTH CARE HINDER SUSTAINABLE DEVELOPMENT IN MALAWI: THE NEED FOR CLERGY IN MENTAL HEALTH CARE TO ERADICATE POVERTY     

Author(s): Garnet Mpangashala Kibombwe1

Affiliation(s)

1. Malawi Assemblies of God University     

Email: garnetkibombwe@gmail.com

Introduction: Mental illness is a universal phenomenon such that above 25% of people worldwide suffer from mental disorder in their lifetime. Malawi is not exempted from mental illness. Youths in Malawi are affected by mental illness that hinders sustainable development. Malawi does not have enough mental health care takers and mental health facilities. Clergy could compliment mental health experts in caring for youth with mental illness.

Objective: The objective of this study was to explore the extent of clergy’s involvement in youths’ mental health care in Malawi. The research was guided by three questions. First, does clergy take part in youth mental health care? Second, to what extent does clergy take part in youth mental health care? Third, is it necessary for clergy to take part in youth mental health care and why?

Method: Qualitative method of research was used in this study through focus groups discussion, key informants’ interview and literature.

Results: There were three major findings in this study. First, little is done on mental health care on the part of clergy. Second, theological institutions have not integrated mental health, mental illness and mental health care with theology in their curriculum. Third, clergy lacks expertise in handling people with mental illness. 

Conclusion: In view of the above findings, the study gives three recommendations. First, clergy should do more in youth’s mental health care because most youth go to church and interact with clergy. More so, some of the causes of mental illness among youths identified in literature review can be dwelt better by clergy. Second, theological institutions should integrate mental health, mental illness and mental health care with theology in their curriculum and programs. Last, clergy should equip themselves with the knowledge on mental health, mental illness and mental health care through taking courses, attending training and reading.

NON COMMUNICABLE DISEASES ABSTRACTS – POSTERS

P212.001288. PREVALENCE OF HYPERTENSION AMONG PATIENTS RECEIVING ART TREATMENT, AT LIGHTHOUSE CENTRES OF EXCELLENCES, IN MALAWI: A CROSS-SECTIONAL STUDY

Author(s): Petros Tembo1, Danneck Kathumba1, Rebecca Banda1, Margaret Chirwa1, Micrina Mwandeti1, and Aubrey Kudzala1

Affiliation(s):

1. Lighthouse Trust, Lilongwe, Malawi        

Email: ptembo@lighthouse.org.mw

Introduction: Hypertension (HTN) is more common in the general Malawian population and causes increased morbidity and mortality despite being easy to diagnose, to treat, and to control.

Objectives: to examine the burden and factors associated with HTN amongst ART patients.

Methods: This was a cross-sectional study that analyzed routine ART program data from five tertiary HIV/ART referral hospitals in Malawi. Descriptive statistical analysis (median, IQR, and frequencies), and multivariate ordinal logistic regression analysis using odds ratio were conducted. Hypertension was defined, either a systolic blood pressure (SBP) >139 and diastolic blood pressure (DBP) >89. Isolated diastolic hypertension (IDH):(SBP) < 140 and (DBP) ≥90 and Isolated systolic hypertension (ISH): SBP ≥ 140 and DBP < 90.   

Results: The analysis used data from 1175 patients receiving ART, between January 2020 to December 2021 of which 677(57.6%) were females. Clinics distribution; 782(66.6%) MPC, 237(20.2%) Lighthouse, 100(8.5%) Tisungane, 27(2.3%) UFC and 29(2.5%) Rainbow.  About 1123 (95.6 %) were first time initiations and 1085 (92.6%) were started on DTG based (13A, 15A) regimens. The participants’ median age was 36 years (IQR 28-43) and median BMI was 21.5 (IQR 19.6 – 24.0). The prevalence of hypertension was 14.3% (n =168) disaggregated as mild 35(3.0%), moderate 5(0.4%), severe 7(0.6%), isolated systolic 40(3.4%) and isolated diastolic 81(6,9%). In multivariate ordinal logistic regression analysis showed age[>=50years] (OR: 3.8, 95% CI 2.2-6.6, p-value =0.0001), BMI [25-29.9] (OR: 1.5, 95% CI 1.004-2.35, p-value =0.048), HTN management (lifestyle advice] (OR:4.6, 95% CI 3.2-6.8, p-value= 0001) were significant risk factors associated with hypertension.

Conclusions: The prevalence of hypertension was 14% and Isolated diastolic hypertension (IDH) was 7%.  Age, overweight, lifestyle advice were possible risk factors associated with hypertension. IDH was common among (30-49)-aged patients, hence the need to reconsider the management of isolated hypertension rather than ignored. We recommend a holistic approach to management of all types of hypertensions among ART clients.

P213.001475.  BARRIERS AND FACILITATORS TO SCREENING FOR DIABETES, HYPERTENSION AND DYSLIPIDAEMIA AMONG PEOPLE LIVING WITH HIV AGED 40 YEARS AND ABOVE AT ART CLINICS IN SOUTHERN MALAWI  

Kondwani Katundu1,2, Victoria Mukhula3, Myness Ndambo4, Grace Momba5, Monalisa Malenje6, Mwapatsa Mipando1,7, Linda Mipando8, Johnstone Kumwenda9, and Mina Hosseinipour10       

Affiliation(s):

1. Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Malawi HIV Implementation Research Scientist Training
3. Malawi-Liverpool Wellcome Trust Research Project, Blantyre, Malawi
4. Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
5. Neno District Hospital, Neno, Malawi
6. Zomba Central Hospital, Zomba
7. Central Hospital, Lilongwe, Malawi
8. Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
9. Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
10. Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
11. 10 University of North Carolina Project, Lilongwe, Malawi.        

Email: kkatundu@medcol.mw

Introduction: Malawi is among the countries with the highest burden of atherosclerotic cardiovascular diseases (ASCD) among people living with HIV (PLWH). Dyslipidemia, Hypertension, and diabetes mellitus (DM) are major risk factors for ASCD which lead to debilitating consequences such as stroke. There is a gap in the effective integration of screening and managing hypertension, DM and dyslipidemia at ART clinics across Malawi. This study aimed to investigate the barriers and facilitators to integrated screening and management of hypertension, DM and dyslipidemia among PLWH in Southern Malawi.

Methods: A mixed-methods (convergence) approach was used to collect the study data. Retrospective quantitative data were collected from five randomly selected district hospitals (n=875) on screening for hypertension, dyslipidemia and DM in routine care. Qualitative data was then collected from 3 purposefully selected clinics based on hypertension screening performance. The qualitative study was guided by the Consolidated Framework for Implementation Research (CFIR), and three major domains namely, the intervention, the inner setting and the characteristics of individuals were collected.

Results: The screening for hypertension, diabetes and dyslipidemia from the study date were 8%, 1.8% and 0%, as well as 7.9%, 1% and 0% on commencing of ART and in the previous 12 months respectively. On the intervention domain, both healthcare workers (HCW) and PLWH perceived that the integration intervention has a positive relative advantage in terms of time efficiency, early diagnosis and management, and overall cost-effectiveness. Nonetheless, the HCW expressed a perceived additional workload on the ready-strained personnel and that screening of non-communicable diseases (NCDs) was not prioritised at the clinics. Infrastructural challenges linked to poor resource allocation to implement the intervention were also stated as a barrier.  On the Inner setting domain, facilitators included joint support from government and nongovernmental organisations (NGOs) and the use of existing structures. Clinics not fully implementing the intervention expressed interest in its trial. Moreover, institutional incentives were named facilitators for the sustainability of the intervention. In the Individual domain, facilitators included the interest and acceptance of the intervention by both the PLWH and the HCW and the confidence of the HCW with training and experience. However, fear by the PLWH of being diagnosed with an NCD in the face of unavailability of medication and HCW demotivation due to uncertainty of resource availability to support implementation of the intervention were expressed as barriers.

Conclusion: There were low rates of screening for hypertension, DM and dyslipidemia in Southern Malawi ART clinics.  Despite the expressed barriers to the intervention, there was an expressed willingness by the PLWH and HCW to adopt the integration of screening and management of NCDs, using the existing structures and modifying the system to accommodate the integration, given the provision of the required resources.  

P214.001094. QUALITY OF LIFE AMONG TYPE II DIABETES MELLITUS PATIENTS AT KAMUZU CENTRAL HOSPITAL IN LILONGWE, MALAWI: A MIXED-METHOD STUDY

Authors:  Alinafe Chisalunda1, 2, Wingston Ng’ambi2, Nesto Tarimo3, Ndaziona Peter Kwanjo Banda4, Adamson Sinjani Muula5, Johnstone Kumwenda4,6 and Alinane Linda Nyondo-Mipando2

Affiliation(s):

1. Department of Physiotherapy, Mangochi District Hospital, Mangochi, Malawi
2. Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
3. Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
4. Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
5. Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
6. Johns Hopkins Project, Blantyre, Malawi

Email: achisalunda@gmail.com        

Introduction: Type II diabetes mellitus (T2DM) significantly impacts quality of life (QoL). Unfortunately, Majority of guidelines on diabetes care focus on medical aspects of management without addressing other needs e.g. psychological well-being. Studies have found that health related quality of life is instrumental in care delivery and it is recognized as an inclusive term that assesses both self-reported mental and physical functioning of an individual.  Despite the significance, data on quality of life among diabetes patients in Malawi are lacking. This study was conducted to assess QoL among patients with T2DM.

Methods: A mixed-method cross-section study was conducted at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. A systematic sampling method was used for quantitative data and purposive sampling was used for qualitative data. A modified diabetes quality of life (MDQoL)-17 questionnaire was used for quantitative data while in-depth interviews and diary methods were used for qualitative data. Demographic data were summarised using descriptive statistics and inferential statistics using t-test and ANOVA. Thematic analysis was utilised to analyse qualitative data. Ethical approval was obtained from the College of Medicine Research and Ethics Committee (CoMREC) reference number P.09.20.3122.

Results: A sample of 339 participants (mean age 50.3±15.5) was recruited. Overall, the mean QoL score was moderate (63.91±19.54). Those with tertiary education and those on health insurance had better QoL (QoL 73.8, C.I. 68.56-79.04, p-value 0.005), (QoL 76.71, C.I. 69.22-84.19, p-value 0.005) respectively compared to those with lower education and those without health insurance.  Furthermore, absence of comorbidities was associated with having better QoL (QoL 71.18, C.I. 66.69-75.67, p-value < 0.0001). T2DM was associated with patients’ health status, increased stress levels and loss of independence. There were QoL-promoting factors among T2DM patients such as diabetes health talks, having a supportive family and following hospital advice. Inhibiting factors include drug shortages, societal perceptions, sedentary lifestyle, stress, and despising hospital advice.

Conclusions: Overall QoL in patients with T2DM receiving treatment at KCH is moderate. QoL of patients with T2DM is influenced by interrelated factors and requires multidisciplinary team care. Health workers need to adopt a holistic approach when treating patients with T2DM.

P215.A001322. GLUCOSE DYSREGULATION IN ILL CHILDREN HOSPITALISED WITH SEVERE ACUTE MALNUTRITION           

Author(s): Harawa PP1, Afroze F2, Bwanali M3, Khoshnevisan F4, Khoswe S3, Chimwezi E3, Mbale E 1,3, Voskuijl W1,5, Walson JL3,6, Berkley JA3,7,8, and Bandsma RHJ 3,4

1. Department of Paediatrics, Kamuzu university of health sciences, Chichiri Blantyre 3, Blantyre, Malawi
2. Nutrition and clinical services division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
3. The Childhood Acute Illness & Nutrition Network (CHAIN) http://chainnetwork.org/
4. The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario    M5G1X8, Canada
5. Global Child Health Group, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands University of Washington, Seattle, USA
6. KEMRI CGMR-C/Wellcome Research Programme, Kilifi, Kenya
7. Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK

Email: pharawa@kuhes.ac.mw

Introduction: Mortality in children with severe acute malnutrition (SAM) remains unacceptably high despite treatment protocols becoming more available. Metabolic disturbances including hypoglycaemia and hyperglycaemia (i.e. dysglycaemia) are considered important risk factors for death in the early phase of hospitalization. The incidence of this dysglycaemia is, however, not well known.

Objective: This study explored the incidence of dysglycaemia, and glucose variability in children with SAM, moderate malnutrition (MAM) and without malnutrition (NAM) during the initial 48 hours of admission.

Methods: We enrolled 87 children aged 2 to 24 months on admission in Bangladesh and Malawi: 47 with SAM, 24 MAM and 16 with NAM. We continuously monitored their glucose with Dexcom G4 system for 48 hours.

Results: The incidence of hypoglycaemia was 63% in children with oedematous malnutrition, 52% in severe wasting, 50% in MAM and 19% in NAM. Malnourished children had a higher risk of developing hypoglycaemia compared to NAM children, IRR 2.65 (95% CI: 1.99-3.54) in severe wasting, 2.02 (95% CI: 1.47-2.76) in MAM and 1.88 (95% CI: 1.38-2.55) in oedematous children. Children with oedematous malnutrition had a hyperglycaemia incidence of 50%, while those with severe wasting, MAM and NAM had an incidence of 29%, 21% and 31% respectively. The risk of hyperglycaemia was significantly higher in severely malnourished children; IRR 8.88 (95% CI: 6.24-12.63) and 7.62 (95% CI: 5.33-10.90) in oedematous malnutrition, and severe wasting respectively. Glucose variability was the highest in malnourished children with oedema and was significantly higher compared to NAM; (CV p=0.002, CONGA p<0.001, MAGE p=0.012, MODD p=0.019)

Conclusion: Incidence of dysglycaemia is high in hospitalised children especially those with SAM. Children with oedematous malnutrition have high glucose variability and this could possibly be linked to increased mortality in this patient group. We recommend routine glucose monitoring in SAM children during the initial 48 hours of admission.

P216.A001301. HARMFUL ALCOHOL CONSUMPTION AND LIVER DISEASE IN MALAWI: PRELIMINARY RESULTS FROM A COMMUNITY-BASED STUDY IN KARONGA, MALAWI   

Author(s): Riches N1, Thom, N 1, Njawala T1, Mkandawire C1, Banda, L1, Nkoka O1, Udedi M2, Nyanjagha I1, Crampin A1, Stanley A3, and MacPherson P4

Affiliation(s):

1. Malawi Epidemiology and Intervention Research Unit
2. Non-Communicable Diseases & Mental Health Unit, Ministry of Health, Lilongwe, Malawi
3. Gastroenterology & Liver unit, Glasgow Royal Infirmary
4. Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.

Email: nriches@liverpool.ac.uk

Introduction: Alcohol consumption has been rapidly increasing in recent decades in Malawi, particularly among men. To date, limited research in Malawi has investigated physical morbidity associated with hazardous alcohol consumption (HAC), including in relation to liver health.

Objectives:

1. To characterise drinking behaviours in urban and rural sites in Malawi
2. To estimate the prevalence and predictors of liver disease in a cohort of high-risk drinkers.

Methods: The HLM and Chiwindi studies will be delivered at two health demographic surveillance sites (HDSS) in rural Southern Karonga District and urban Area 25, Lilongwe. Residents aged 15+ years in both HDSSs are asked about alcohol consumption using the AUDIT questionnaire. A random sample of male participants with HAC (AUDIT ≥8), stratified by AUDIT score (8-15 and ≥16), and all females reporting HAC are invited for clinical assessment, blood sampling and transient elastography (TE), with linkage. Here we present interim data from Karonga.

Results:  Amongst the first 1977 sampled participants, the prevalence of HAC is 13.1% (95% CI: 11.6-14.6%). HAC prevalence is significantly higher in men (29.5%; 95% CI: 26.5-32.6%) than women (0.8%, 95% CI: 0.4-1.5%; p-value<0.01). Clinic reviews for 101 participants (99 men, 2 women) with HAC have been completed, of whom 11 (10.9%; 95% CI: 5.9-18.1%) have liver fibrosis (TE ≥7.9kPA). Significantly higher levels of GGT (p = 0.02), AST (p = 0.05) and GPR (GGT to platelet ratio; p = 0.01) were observed in the fibrosis group, compared to the group without fibrosis.

Conclusion: In the next phase, additional data (including from the Lilongwe site) will be analysed, to propose screening markers for liver disease in this cohort. These could be used to identify those at highest risk of liver disease to allow physical and psychosocial interventions to be more appropriately targeted.

P218.001321. ASSESMENT OF MEDICAL DOCUMENTATION ON LONG BONES OPEN FRACTURE MANAGEMENT BEFORE AND IMMEDIATELY AFTER IMPLEMENTATING OPEN FRACTURE GUIDELINES IN LOW SETTING COUNTRY          

Author(s): Sabawo MF1, Jaffry Z2, Chokotho L3, and Schade AT4,5           

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Bart’s Health NHS Trust
3. Malawi University of Science and Technology
4. Malawi-Liverpool-Wellcome Trust
5. Liverpool School of Tropical Medicine

Email: msabawo@gmail.com

Introduction: Medical documentation refers to an ongoing process that enables the health care staff to record all information about patient’s health status and the procedures provided by the medical staff. Open fracture management involves initial assessment, infection prevention, bone and soft tissue care and rehabilitation.  The Malawi Orthopaedic Association/Arbeitsgemeinschaft Fur Osteosynthesefragen Alliance (MOA/AOA) guidelines and standards for open fracture management recommends documentation of the open fracture treatment process from initial evaluation to definitive treatment, including complications. One of the most effective ways to obtain quality in medical documentation is through regular audits and reviews of practice. The Surgical Tool for Auditing Records (STAR) assesses documentation on surgical cases and give a guidance in regards to medical notes. The study’s aim was to describe the medical documentation of open fracture treatment before the guidelines and compare it to after the implementation of MOA/AOA guidelines.

Methods: This is a descriptive quantitative ambidirectional study, which reviewed patient’s medical files with open fractures of long bones presenting to Zomba central hospital, Mulanje, Salima, and Mangochi district hospitals for over a 6 months’ period. The following key variables were audited using the adapted STAR documentation scoring system; patient basic demographic details, injury details, treatment modalities, complications and referral details for severe open fractures to central hospitals

Results: Out of 88 open fracture case files reviewed, 57 files were eligible for the audit according to STAR. Poor documentation was reduced from 67% (n=16) to 33%(n=8) (P <0.5) after the guidelines. Good documentation on different variables improved from 39% (n=13) to 61% (n=16) after the guidelines. Missing data on date of injury improved from 28% (n=12) before the guidelines to 0% (n=0) after the guidelines, antibiotic date improved from 26%(n=11) before the guidelines to 2%( n=1) and assessment date improved from 21%(n=9) to 4% (n=2). Before the guideline; 67% (n=14) missed documentation on location of debridement and 33% (n=7) missed data on location of debridement after the guidelines, 70% (n=15) missed documentation on definitive treatment before the guidelines and 30% (n=5) missed data on definitive treatment after the guidelines.

Conclusion: This study demonstrates that training in the MOA/AOA guideline and standard for open fracture management combined with the Audit of these evidence-based guidelines using adapted STAR documentation scoring system can lead to improvements in documentation and patient care. Therefore, there is a need for training on good medical documentation and record keeping in line with MOA/AO guidelines to all concern carders in hospitals of Malawi.

P219.001140. PREVALENCE OF MUSCULOSKELETAL DISORDERS AND ASSOCIATED RISK FACTORS AMONG SELECTED HEALTH CARE PROFESSIONALS AT QUEEN ELIZABETH CENTRAL HOSPITAL, BLANTYRE. 

Author(s): Benson Mbenje1, Japhet Mtolongo1, Omega Mzama1, Ernest Muhaniwa1, and Patience Mwenyekonde1

Affiliation(s)

1. School of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre Malawi

Email: m201750023802@stud.medcol.mw

Introduction: Musculoskeletal disorders (MSDs) are inflammatory or degenerative injuries of anatomical structures like muscles, tendons, bones, ligaments, nerves etc. According to World Health Organization (WHO) and Global Burden for Disease, MSDs are the leading contributor of disability, approximately 1.71 billion people having musculoskeletal conditions worldwide. Studies have indicated that health care workers (HCWs) like nurses, physiotherapist and rehabilitation technicians are at a higher risk of developing these MSDs especially in low and middle income countries, simply because the nature of their work involves manual handling of patients and inadequate resources. This being true, but in Malawi there was paucity of information on actual prevalence of MSDs among these cadres. Therefore, this study was done to highlight the existing knowledge gap regarding prevalence of MSDs among these cadres which may help in developing interventions to curb for the occurrence of these MSDs and help in reinforcing safe workplace ergonomics.

Methods: It was a quantitative descriptive cross-sectional design and we used proportional to size sampling method to recruit 190 HCWs (n=176 nurses, n=10 physiotherapists and n=5 rehabilitation technicians) with at least one-year working experience. Data was collected using Modified Standard Musculoskeletal Questionnaire.

Results: In our study, we found the prevalence of MSDs to be high in Malawi here as well in these cadres with a general prevalence of 86.7% for nurses, physiotherapists and rehabilitation technicians. For cadre specific prevalence was 87.9%, 70% and 80% respectively with gender, time spent per patient, working in the same positions for long periods, treating excessive number of patients among others being the most associated risk factors.

Conclusion: Our study revealed a high prevalence of MSDs among Nurses, Physiotherapists and Rehabilitation Technicians in Malawi (86.7%) with low back pain the most common. This is mostly associated with the nature of their work and individual factors.

P220.001310. EPIDEMIOLOGY OF OPEN LONG BONE FRACTURES AND THEIR MANAGEMENT IN MALAWI

Epidemiology of open long bone fractures and their management in malawi

Author(s): Sabawo MF1, Jaffry Z2, Chokotho L3 and Schade AT4,5

Affilitiation(s):

1. Kamuzu University of Health Sciences
2. Bart’s Health NHS Trust
3. Malawi University of Science and Technology
4. Malawi-Liverpool-Wellcome Trust
5. Liverpool School of Tropical Medicine

Email: richsabawo@gmail.com

Introduction: Open fractures are a common consequence of road traffic collision (RTC) and falls and are associated with high risk of complications such as infection, amputation and nonunion. Open fracture management involves initial assessment, infection prevention, bone and soft tissue care and rehabilitation.

Objective: The study aimed to assess the epidemiology of open long bone fractures and their management in hospitals of Malawi.

Methods: This is a descriptive quantitative ambidirectional study, which reviewed patient’s medical files with open fractures of long bones presenting to Zomba central hospital, Mulanje, Salima, and Mangochi district hospitals for over a 6 months’ period. The study variables were patient’s demographics, mechanism of injury, bone fractured, soft tissue wound classification, type of treatment and immediate complications in hospital.

Results: A total of 88 open fracture case files were reviewed with an overall median age of 36years (interquartile Range [IQR]: 27-45) and 90% (n=80) were male. The most common cause of open fractures was road traffic collisions (RTCs) 60% (n=53) with motorcycles being the leading cause among all RTCs 49% (n=26). Tibia/fibula was the commonest bone fractured 58% (n=59). Gustilo-Anderson wound grading type I was the most common with 26% (n=23), however Zomba central hospital treated the most severe Gustilo-Anderson type IIIs. The majority of cases had debridement 74% (n=67); out of these 58% (n=39) had their debridement done in theater under general anaesthesia or spinal anaesthesia while 42% (n= 28) debridement was done in casualty. More cases were treated with plaster of Paris (POP) 44% (n=31). Majority 88% (n=60) were treated by orthopaedic clinical officers. Out of 88 cases, 19% (n=17) developed wound infection, 7%(n=6) amputation. Overall 25% missed documentation.

Conclusion: Open fracture of long bones mostly affects male productive age group and motorcycle are the most common cause among RTCs. A number of these injuries debridement is done in casualty and are treated non operatively with plaster of Paris. Open fractures are severe injuries with a third of participants developing complications. Further study is needed to understand long term patient outcomes of these complications.

P221.001201. An Audit of Heart Failure Management Among Ambulatory Adult Patients at Queen Elizabeth Central Hospital (QECH), Malawi        

Author(s): Emmanuel S. Mwabutwa1, Steve Kateta2, Louis Kinley2, Tadala Ulemu2, Patrick Goodson2, Adamson S. Muula3, and Johnstone Kumwenda1

Affiliation(s):

1. Department of Medicine, School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
2. Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
3. Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi          

Email: emwabutwa@kuhes.ac.mw

Introduction: There are limited data on the clinical characteristics and use of guideline-directed medical therapy among patients with heart failure in Malawi.  We conducted a study to assess patient characteristics and associated clinical management given to heart failure patients at Queen Elizabeth Central hospital (QECH) in Malawi.

Methods:  In a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their socio-demographic and clinical characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities. Descriptive statistics are presented.

Results: A total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5-70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodelling. Most patients were on at least a single neuro-hormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively.

Conclusions: Hypertension was the commonest comorbidity in patients with heart failure, who were mostly females with NYHA class I or II symptoms. Most had LV remodelling changes and are on at least one neuro-hormonal antagonist but most remain sub-optimally treated.           

NEGLACTED TROPICAL DISEASES ABSTRACTS – POSTERS

P222.A001121.  PREVALENCE, FORMS, RISK FACTORS, AND IMPACT OF VIOLENCE TOWARDS HEALTHCARE WORKERS DURING THE COVID – 19 PANDEMIC IN MALAWI          

Author(s): Wongani Nyangulu1, Christina Sadimba1, Joyce Nyirenda1, Angella Masano1, Elizabeth Chilinda1, Linda Mipando Nyondo2

Affiliation(s):

1. Public Health and Nutrition Research Group, Kamuzu University of Health Sciences, Mangochi, Malawi
2. Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi

Email: wnyangulu@gmail.com

Introduction: The COVID–19 pandemic overwhelmed health systems with poor infrastructure and limited workforces. Healthcare workers faced increased workload, burnout, stress, and violence as a result. If not effectively dealt with, this violence could derail the pandemic response.

Objectives: We aimed to estimate prevalence of violence toward healthcare workers during the pandemic and to describe the forms and perpetrators, evaluate predictors, and determine impact on healthcare workers.

Methods: We conducted a multicenter, cross-sectional study in six health facilities across three districts in Malawi. We recruited doctors, COs, nurses, ambulance drivers, HSAs, and patient attendants present on recruitment day. Standardised questionnaires were used to collect data on sociodemographic and professional characteristics of healthcare workers. Main outcome measures were personal experiences of physical violence, verbal abuse, and bullying or mobbing during the pandemic.

Results: We recruited 200 study participants and 70.5% were female. The age range was 20 – 59. The most common age category was the 25 – 29 group (24.5%). Overall prevalence of violence was 93% (95% CI: 88.5 – 96.1). Prevalence of physical attacks was 5.5% (95% CI: 2.8 – 9.6%), verbal abuse was 91.5% (95% CI: 86.7 – 95.0), and bullying/mobbing was 79.2% (95% CI: 72.8 – 84.6). Being married (OR: 19, 95% CI: 1.9 – 185.3) and having 6 – 10 staff members working concurrently (OR: 13.8, 95% CI: 1.8 – 107.6) were significantly associated with a physical attack. Being married (OR: 4.7, 95% CI: 1.2 – 18.2), a regular member of staff (OR: 22.6, 95% CI: 1.4 – 410.4), and working with over 15 people concurrently (OR: 25.2, 95% CI: 5.2 – 122.7) were significantly associated with verbal abuse.

Conclusions: Prevalence of violence against healthcare workers was extremely high during the pandemic. Levels of violence were higher than pre-pandemic levels in the country and higher than levels in other countries during the same period.

P223.A001196. INVESTIGATIONS OF SCHISTOSOMIASIS ON THE NAMWERA PLATEAU (ISNAP)      

Author(s): Oscar Herrera1, Lyson Samikwa2, Stefan Witek-McManus1, James Simwanza3, Stella Kepha6, Elliott Rogers1, Khumbo Kalua2,3, Peter Makaula5, J. Russell Stothard4 and Robin L. Bailey1           

Affiliation(s):

1. LSHTM
2. Kamuzu University of Health Sciences
3. Blantyre Institute of Community Outreach
4. Liverpool School of Tropical Medicine
5. RHED Malawi
6.  Kenya Medical Research Institute

Email: lysamikwa1983@gmail.com

Introduction: Schistosomiasis is a highly focalised neglected tropical disease caused by flatworms of the Schistosoma genus. In Namwera, Malawi annual mass drug administration of praziquantel has been utilised to control schistosomiasis for over 10 years with high reported coverage at the district level.

Methods: This study was nested within the DeWorm3 study. In the summer of 2022, we conducted a community based cross-sectional study of 10–15-year-old boys in Namwera, Malawi. Kato-Katz was performed on 310 stool samples collected as part of the DeWorm3 trial. 247 Urine samples were collected and analysed using urine filtration, dipstick and CCA. All those who provided urine samples completed a short symptom, water exposure and school attendance questionnaire. A malacological survey of 8 sites was also conducted.

Results: The overall prevalence of S. haematobium as detected on urine filtration was 48.2% (95% CI 41.8-54.6). Of these detected infections 63.9% were of light intensity and 36.1% were of heavy intensity. S. mansoni demonstrated a prevalence of 6.6% (95% CI 4.1-9.9) on Kato-Katz and a prevalence of 29.6% (95%CI 22.5-37.5) on CCA. Microscopic haematuria on dipstick demonstrated a sensitivity of 89.9% and a specificity of 81.3% when compared to urine filtration. There was strong evidence of association between detected Schistosoma infection and answering yes to having “red urine” (p<0.0001) or “bilharzia” (p=0.01) on questionnaire. Of the risk factors examined, only reported bathing in a body of water in the past week showed weak evidence of association with Schistosoma infection (OR 3.35, 95% CI 1.09-10.27, p=0.03). Biomphalaria spp. were found in two sites and Bulinus spp. were found in five of eight sites explored. None of the 74 captured snails shed cercariae.

Conclusion: We observed moderate prevalence of S. haematobium despite multiple rounds of mass drug administration.  This community may benefit from biannual community-based MDA, with less emphasis placed on school attending children.

P224.A001151. MALE GENITAL SCHISTOSOMIASIS (MGS) AMONG LOCAL FISHERMEN ALONG THE SOUTH SHORELINE OF LAKE MALAWI IN MANGOCHI DISTRICT.      

Author(s): S. Kayuni1,2,3,4, M. Al-Harbi3, P. Makaula1, F. Lampiao5, L. Juziwelo6, E.J. LaCourse3, and J.R. Stothard3         

Affiliations:

1. Malawi Liverpool Wellcome (MLW) Clinical Research Programme, NTD group, Blantyre, Malawi
2. MASM Medi Clinics Limited, Clinical, Lilongwe, Malawi
3. Liverpool School of Tropical Medicine, Tropical Disease Biology, Liverpool, United Kingdom
4. Kamuzu University of Health Sciences (KUHeS), Pathology, Blantyre, Malawi.
5. Kamuzu University of Health Sciences (KUHeS), Physiology, Blantyre, Malawi.
6. Ministry of Health, Preventive Health, Lilongwe, Malawi

Email: skayuni@mlw.mw

Introduction: Male genital schistosomiasis (MGS) is an ignored chronic consequence of urogenital schistosomiasis (UGS) associated with schistosome eggs and pathologies in male genital system. Despite being first described in 1911, its epidemiology, diagnosis and management are not well described in endemic areas.

Objective: A longitudinal cohort study was conducted among fishermen along southern Lake Malawi shoreline to investigate prevalence and morbidity of MGS.

Methods: Fishermen aged 18+ years were recruited and underwent questionnaire interviews. The participants submitted urine and semen for point-of-care (POC) field and laboratory parasitological and molecular diagnostic tests. Transabdominal pelvic and scrotal ultrasonography were conducted, assessing pathologies in the prostate, seminal vesicles, epididymis and testes. Standard praziquantel (PZQ) therapy (40mg/kg) and follow-up invitations at 1, 3, 6 and 12 months were offered to all participants.

Results: 376 fishermen (median age: 30 years, range: 18-70) were recruited and interviewed. Below 10% participants reported having experienced MGS symptoms, like genital or coital pain, haemospermia. Baseline MGS prevalence by semen microscopy was 10.4% (n = 114, median: 5.0) while real-time PCR was 26.6% (n = 64). UGS prevalence was 17.1% (n = 210, median: 2.3/10 ml). None of the MGS positive participants experienced symptoms associated with MGS. 130 participants underwent ultrasonography at baseline of which 9 (6.9%) had abnormalities, with 2 having prostatic and testicular nodules.

Conclusion and recommendations: MGS is prevalent among local fishermen living along southern Lake Malawi. There’s need for improved availability and accessibility of parasitological and molecular diagnostics, ultrasonography, PZQ treatment and control interventions to reduce prevalence and better manage MGS cases.

P225.001463.  IDENTIFYING HYBRID INFECTIONS IN COMMUNITIES ALONG SOUTH LAKE MALAWI

Author(s): Priscilla Chammudzi1, David Lally1, Donales Kapira1, Gladys Namacha 1, Alexandra Juhasz 2, Sam Jones 2, Sekeleghe Kayuni 1,2, Peter Makaula 1, Janelisa Musaya 1,3, and Russell Stothard 2      

1. Malawi Liverpool Wellcome Clinical Research Programme
2. Liverpool School of Tropical Medicine
3. Kamuzu University of Health Sciences

Email: dkapira@mlw.mw

Introduction: Schistosomiasis is a parasitic neglected tropical disease caused by trematodes of genus Schistosoma. Efforts to eliminate schistosomiasis as a public health problem are ongoing with reinforced annual Mass drug administration targeting humans. However, for the first time in Malawi a high number of hybrids between bovine schistosomes and human schistosomes has been observed. This observation presents a gap in the 2030 WHO-NTD strategy. We therefore embarked on a study to investigate the prevalence of schistosomiasis in animals and intermediate hosts and to isolate parasites of medical importance.

Objective(s): Conduct active surveillance in livestock and snail populations to determine prevalence of schistosomiasis

Methods:  We carried out systematic surveys in definitive hosts (cows and goats) and snail intermediate hosts in two districts, Mangochi and Nsanje. Faecal material (15g) was collected from 240 cattle from 6 locations for miracidial hatching, as well as post-mortem samples from local abattoirs. Further DNA tests will be done on harvested adult worms and miracidia stored on FTA cards. Malacological surveys of snail intermediate hosts are being carried out at several sites in each district, (Mangochi 7 sites, Nsanje 5 sites) in open water sources used by the communities and their animals. The occurrence and distribution of Schistosoma species will be assessed by molecular analyses of parasitological and malacological specimens collected.

Results: Overall prevalence of bovine schistosomiasis in Mangochi was ~67%(n=120) and Chikhwawa/Nsanje was ~28%(n=120). Preliminary findings from DNA tests show that 2 of 403 samples from 102 cattle show likely hybrids.

Conclusions: Our preliminary findings suggest that hybrids originate in humans from zoonotic spillover from livestock populations, where schistosomiasis is co-endemic. This complicates the epidemiology of schistosomiasis in Malawi. Further work is being carried out in livestock and snail populations to unravel these observations.

P226.001191. CORRELATES OF PRIOR HIV TESTING AND SCHISTOSOMIASIS TREATMENT: BASELINE SURVEY FINDINGS FROM THE “CREATING DEMAND FOR FISHERMEN’S SCHISTOSOMIASIS AND HIV SERVICES” (FISH) TRIAL IN MANGOCHI   

Author(s): Augustine Talumba Choko1*, Sekeleghe Kayuni2, Peter MacPherson1,3,4,, Anthony Butterworth1, and Elizabeth L. Corbett4

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
2. Medical Aid Society of Malawi (MASM), Blantyre, Malawi
3. Department of Clinical Sciences, Liverpool School of Tropical Medicine
4. Clinical Research Department, London School of Hygiene and Tropical Medicine

Email: achoko@mlw.mw

Introduction: Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently to risky sexual behaviour. We characterised the knowledge of HIV and schistosomiasis to inform the design of cluster randomised trial in Mangochi.

Methods: A baseline survey of fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. Fishermen reported their knowledge, attitudes, and practices in the uptake of HIV and schistosomiasis services. Willingness to attend a beach clinic was assessed with outcomes modelled using random effects logistic regression, accounting for clustering.

Results: A total of 6,297 fishermen were surveyed from 45 clusters with harmonic mean number per cluster of 112 (95% CI: 97; 134). Mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) were illiterate. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) tested in the last 12 months, 5.9% (373/6290) taking ART. Being able to read and write (adjusted risk ratio [aRR: 1.91, 95% CI: 1.59-2.29, p<0.001); previous use of Praziquantel (aRR: 2.00, 95% CI: 1.73-2.30, p<0.001); knowing a relative or friend who died of HIV (aRR: 1.54,95% CI: 1.33-1.79, p<0.001); and being on ART (aRR: 12.93, 95% CI: 6.25-32.93, p<0.001) were associated with increased likelihood of ever testing for HIV. Only 40% (1,733/4,465) had recently (<12m) received Praziquantel. Every additional year of age was associated with 1% decreased likelihood of having recently taken Praziquantel (aRR: 0.99, 95% CI: 0.98-0.99, p<0.001). Recent HIV testing increased the likelihood of taking Praziquantel by over 2-fold (aRR 2.24, 95% CI: 1.93-2.62, p<0.001). 99.0% (6,224/6,284) were willing to attend a beach clinic.

Conclusion: In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilisation of free schistosomiasis treatment. Beach clinics were hypothetically highly acceptable.

P227.001182. CO-INFECTION OF TOXOPLASMA GONDII AND HIV INFECTIONS IN PREGNANCY IN BAMAKO – A CASE REPORT

Author(s): Mazo Kone1,2, Henrietta Oluwatoyin Awobode1           

1. Department of Zoology, University of Ibadan, Ibadan, Nigeria
2. PA&KA Medical Laboratory, Bamako, Mali

Email: mzoalger@yahoo.fr

Introduction: Toxoplasma gondii infections cause serious complications in HIV-infected pregnant women, leading to miscarriages, stillbirths, birth defects such as mental retardation, blindness, epilepsy, and could favour or enhance the mother-to-child transmission of HIV. Worldwide, 30% of the population have antibodies to the intracellular protozoan parasite Toxoplasma gondii and about 36.7 million people are infected with HIV, however little is known about the prevalence of co-infection of Toxoplasma gondii and HIV in pregnancy.

Objective of the report: To report the co-infection of Toxoplasma gondii and HIV in pregnant women in Mali.

Methods: Toxoplasma gondii anti- IgG, IgM and HIV Combi PT serology were performed in sera from pregnant women using the Elecsys system. Methods: HIV genotyping was performed using the Tri-DOT technique.

Results: One pregnant woman out of 247 screened was anti-Toxoplasma IgM positive and HIV type I positive. An anti-Toxoplasma gondii IgM positive reading is an indication of an acute/current infection.

Conclusion and recommendation: This suggests there is active toxoplasmosis transmission and therefore a possible risk for congenital infections in Bamako. HIV infection being endemic in Mali may accentuate toxoplasmosis pathology in this region. Toxoplasmosis surveillance and awareness are therefore necessary in Bamako to stem the scourge of this neglected infection.

P229.001466. PEOPLE’S SLEEPING AND WAKING UP TIMES IN RELATION TO BITING PROFILES OF MALARIA VECTORS IN MACHINGA AND BALAKA DISTRICTS     

Author(s): J. Kumala1, C. Mangani2, T. Mzilahowa1, and D. Mathanga1     

Affiliation(s):

1. Malaria Alert Centre-Communicable Diseases Action Centre, Kamuzu University of Health Science, Blantyre Campus, Malawi.
2. Kamuzu University of Health Science, Blantyre Campus, Malawi    

Email: jkumala@mac.kuhes.ac.mw

Introduction: Malaria vector mosquitoes traditionally bite people at night while they sleep. Insecticide-treated bednets and indoor residual spraying exploit therefore have typically exploited this behavior to protect individuals while indoors and at night. However, there is still a proportion of vectors that bite outdoors when people are not yet under the protection of ITNs and IRS.

Objectives: We conducted this study to assess people’s sleeping and waking up times in relation to mosquito biting profiles.

Methods:  Human-biting mosquitoes were sampled using the human landing catch technique. Mosquitoes were collected every hour from 6pm to 10am both indoors and outdoors in study sites in Machinga and Balaka districts. In addition, a questionnaire was also administered to household/community members where self-reported sleeping and waking up times were recorded.

Results: Between September 2020 and February 2021, a total of 1501 Anopheles mosquitoes were collected consisting of An. gambaie s.l, An. funestus s.l and other Anopheline species such as An. coustani. Of these, 194 were An. gambiae collected biting indoors while 1007 were An. gambaie s.l collected outdoors, 156 An. funestus s.l were collected indoors while 58 An. funestus s.l were sampled outdoors, 6 other Anophelines were sampled indoors while 80 other Anophelines were sampled outdoors. The majority of people interviewed (84%, n=26672) reported to sleep within an hour or two after sunset. Likewise, 49% (n=26674) of respondents woke up at sunrise or within an hour after sunrise (5-6AM), followed by 44% (n=26674) who woke up one to three hours after sunrise (6-8AM).

Conclusion: We concluded that although a good proportion of study participants reported being indoors when the peak of mosquito biting took place, there was still a significant proportion of potentially infectious bites that took place outside that window of protection.

NUTRITION ABSTRACTS – POSTERS

P230.A001110. Malnutrition According to the Global Leadership Initiative on Malnutrition Criteria in Adult Out-patients with Cancer Undergoing Chemotherapy in Malawi     

Author(s): Chipiliro Dannayo1,2, Aaron Chikakuda1, Richard Nyasosela3, and Getrude Mphwanthe1

Affiliation(s):

1. Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Bunda College, Lilongwe, Malawi
2. Clinical Dietetics, Queen Elizabeth Central Hospital, Blantyre, Malawi
3. Department of Medicine, National Cancer Center, Kamuzu Central Hospital, Lilongwe.

Email: chipidannayo@gmail.com

Introduction: Early screening and assessment for malnutrition are fundamental for appropriate nutrition recommendations in cancer management. The scarcity of cancer-related malnutrition data in Malawi limits the provision of nutrition and dietetic services during treatment.

Objectives: To assess malnutrition prevalence and its determinants in adult outpatients with cancer undergoing chemotherapy.

Methods: We conducted a hospital-based cross-sectional study (protocol # 21/06/2728) among 114 adult outpatients receiving chemotherapy at the National Cancer Center in Lilongwe, Malawi. Parameters collected included demographics, inflammatory biomarkers (albumin and c-reactive protein [CRP]), and health-related and anthropometrics. We screened and assessed for malnutrition using the malnutrition screening tool and the Global Leadership Initiative on Malnutrition (GLIM) criteria, respectively. Using IBM SPSS v.25.0, descriptive statistics such as percentages and frequencies were generated. The determinants of nutritional risk and malnutrition were determined using adjusted multivariate logistic regression.

Results: The overall mean age of the patients was 47.1 ± 14.3 years, 62.3% were females, and 57.9% were married. About 45.6% and 23.7% of the patients had hypoalbuminemia, and high CRP levels, respectively. Over 35% of the patients experienced unintentional weight loss of greater than five percent in six months, 21% were underweight, and 65.8% indicated reduced hand grip strength. Gastrointestinal symptoms such as nausea (72.6%), vomiting (53.7%), and diarrhoea (23.2%) were common among the patients. Forty-six percent of the patients were at nutritional risk, and 27.2 % were moderate-to-severe malnourished according to GLIM criteria. The odds of being malnourished increased significantly (p<0.05) with gastroesophageal cancer, reduced hand grip strength, and high CRP levels.

Conclusion: Gastrointestinal symptoms prevalently exacerbated nutritional risk and malnutrition among Malawian patients with cancer. Hence, early screening and assessment of malnutrition in cancer care services in Malawi are needed to provide appropriate nutrition interventions.  

P231.A001324. DETERMINANTS OF ACCURACY IN CLASSIFYING NUTRITIONAL STATUS OF CHILDREN USING MID-UPPER ARM CIRCUMFERENCE TAPE AND BILATERAL PITTING OEDEMA AMONG RURAL-RESIDENT CAREGIVERS          

Author(s): Benson C. Singano1, 4, Collina A.A. Tchongwe 1, 4, Numeri N. Geresomo1, Tinna A.N. Manani2, Aaron T. Chikakuda1, Alfred B. Ngwira3, Emma Budalla4, and Alexander A. Kalimbira1,4

Affiliation(s):

1. Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
2. Department of Food Science and Technology, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
3. Department of Basic Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
4. Screening and Referral by Caregivers, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi funded by Unicef

Email: bensonsingano01@gmail.com

Introduction: Caregivers have capacity to correctly screen nutritional status of children in a rural setting, however, little is known about the determinants of accuracy.

Objective: To identify determinants of accuracy among caregivers when classifying the nutritional status of their children

Methods: Health surveillance assistants trained caregivers to classify nutritional status of children using colour-coded MUAC tapes. Nutritional screening and socio-demographic characteristics data were collected using a structured questionnaire.  Binary dependent variable was accuracy, and caregivers’ age, marital status, education, district, occupation and age of the child formed predictor variables. Binary logistic regression was performed to determine the effect of each predictor on accuracy of caregivers.

Results: A total of 12057 caregivers were trained and majority were within the age range of 25-39 (49.6%). One third of caregivers (31%) had attained primary education, 86% were farmers, and about 87% were married. Formally employed caregivers were three times less likely to be accurate (AOR 0.303; 95% CI: 0.122, 0.751) than farmers, caregivers from Phalombe district were almost five times more likely to be accurate than caregivers from Nsanje district (AOR 4.926; 95% CI: 3.305, 7.347).  The odds of accuracy among caregivers were twice and almost thrice higher when screening children aged 31-42 months (AOR 2.443; 95% CI: 1.429, 4.174) and 43-54 months (AOR 2.831; 95% CI: 1.446, 5.542) than odds of accuracy among caregivers screening children aged 6-18 months, respectively.

Conclusion: Location, occupation and age of children are significant determinants of caregivers’ accuracy when screening children. Therefore, caregiver trainings should be designed to address specific needs in different districts. Nutrition education should be an integral part of training in order to make all caregivers aware that their children are vulnerable to malnutrition.

P232.001179.  HANDGRIP STRENGTH AND ITS RELATIONSHIP TO ANTHROPOMETRIC MEASUREMENTS OF VARIOUS AGE GROUPS AMONG RURAL RESIDENTS OF LILONGWE, MALAWI           

Author(s): Esther Gunsalu1, Samuel Phiri1, Dalitso Banda1, Loyce Mtima-jere1, Christopher Lazaro1 and Alexander A. Kalimbira1

Affiliation(s):

1. Department of Human Nutrition and Health, Bunda College, Lilongwe University of Agriculture and Natural Resources, P.O. Box 219, Lilongwe, Malawi

Email: mphatsogunsalu@gmail.com

Introduction: Handgrip strength (HGS), a measure of muscular strength or the maximal force generated by one’s forearm muscles, is rarely used to assess nutritional and functional status. The study aimed to profile HGS and its relationship to anthropometric measurements of various age groups in a rural area of Lilongwe, the capital of Malawi.

Methods: A descriptive cross-sectional study (n=270) of school-aged children (SACs) (10–14 years), adolescents (15–19 years) and adults (20–39 years) was carried out in which weight, height, mid-upper arm circumferences (MUAC) and triceps skinfold thickness (TST) were measured using standard protocols. HGS (kg/f) was measured using a dynamometer. Body mass index (BMI) was calculated as weight (kg) divided by height in metres squared. One-way ANOVA was used to determine differences in measurements between men and women, while Pearson correlation was used to determine the relationship between HGS and anthropometric measurements and BMI by gender and age.

Results: HGS significantly increased with age in males and females (p<0.01). Males had significantly higher HGS values than females (p<0.001) except in SACs where females had higher left HGS values than males (14.13±4.60 vs 11.83±4.12, p=0.42) but not right HGS. Among SACs, HGS significantly correlated with height, weight, MUAC and BMI (p<0.001) but not TST. In adolescents, HGS significantly correlated with height, weight and MUAC (p<0.001) but not BMI and TST. Among adults, weight and height significantly correlated with HGS (p<0.001) but not BMI, MUAC and TST.

Conclusion: In a rural Malawian population, HGS varies according to gender and age. In all age groups assessed, there was a strong positive correlation between HGS and weight and height. The number of anthropometric variables that significantly correlated with HGS decreased with increasing age. A national-wide study to profile normative HGS values of Malawians in various settings is warranted.

P233.001064.  Underweight and bodyweight prediction equations using neck, calf and mid-upper arm circumferences in Malawian adult patients

Author(s): Limbikira Wasambo1, Alexander Kalimbira1, and Takondwa Kakota1

Affiliation(s):

1. Lilongwe University of Agriculture and Natural Resources, Lilongwe Malawi

Email: li.wasambo@gmail.com

Introduction: Bodyweight is an important parameter in clinical practice as it is part of patient admission records, and it is used for prescription of some drugs and delivery of nutrition support. In dietetic practice, patient body weight is critical in all the four steps of the nutrition care process: assessing patient’s weight status; diagnosing malnutrition; prescribing nutrients, fluids and calories; and monitoring and evaluating nutrition interventions. Problem statement: It presents a handicap in Malawian public hospitals where bed-scales that can be used to obtain weight in non-ambulatory patients are not available. As such, it was necessary to develop cutoffs points and equations from measurements of body parameters that can be used to predict underweight and bodyweight in these patients.

Objectives: 1) to establish a cut-off point of MUAC equivalent to BMI <18.5 kg/m2 in Malawian adult patients; 2) to develop body weight prediction equations using neck, calf and mid-upper arm circumferences in Malawian adult patients.

Methods: Anthropometric data of patients were collected using non stretchable tapes and weighing scales at Kamuzu Central and Mzuzu Central Hospitals from May to July in 2021. Correlations were conducted among weight, height, BMI, sex age and neck, calf and mid-upper arm circumferences using SPSS. Receiver operating curve in MedCalc was used to develop MUAC cutoffs for predicting underweight, and multilinear regression analysis was used to develop the equations.

Results: 513 subjects (56.1% females) participated. MUAC <22.4 cm correlated well with a BMI of <18.5 kg/m2 in both gender, and simplified formulas of weight = (0.9*MUAC [cm] – height [m]) x height (m) x height (m) (for males) and (0.925*MUAC [cm] – height [m]) x height (m) x height (m) (for females) were developed.

Conclusion: MUAC cutoff of <24.4 cm should be used in Malawian adult patients to predict underweight than the current 22 cm for females and 23 cm for males. A height and MUAC based weight estimation equation is proposed for non-ambulatory Malawian adult population where chair-scales are not available.

P234.001383. PERSONAL FOOD ENVIRONMENT FACTORS THAT INFLUENCE PURCHASE OF DAIRY AND FISH BY MOTHERS WITH YOUNG CHILDREN IN RURAL LILONGWE DISTRICT      

Author(s): Beverly Laher1, John Phuka1, Valerie Flax2, Tracy Slaybaugh-Mitchell2  

Affiliation(s):

1. Kamuzu University of Health Sciences
2. Research Triangle Institute International 

Email: laherbeverly@gmail.com

Introduction: Understanding the individual level or personal food environment factors that influence the purchase and consumption of animal source foods may be useful for designing interventions to increase their consumption by women and young children. This study designed and tested tools for measuring the personal food environment factors (i.e., accessibility, affordability, convenience, and desirability) that influence consumption of dairy and fish among women with young children in Malawi. 

Methods: This was a mixed methods cross-sectional study conducted in Chadza and Khongoni Traditional Authorities, in rural areas of Lilongwe District, Malawi. We conducted 4 focus group discussions (FGDs, N=41) and a quantitative survey (N=200) with mothers of children <5 years. The results of the FGDs were used to refine the survey questionnaire.

Results: Dairy products were purchased by 72% of respondents, including yoghurt drinks (52%), UHT milk (46%), powdered milk (44%), fresh milk (17%), and yoghurt (7%). The top factors in order of prevalence that influenced purchase were: yoghurt drinks (make children happy, taste good, healthy/nutritious), UHT milk (healthy/nutritious, tastes good, makes children happy), and powdered milk and fresh milk (tastes good, healthy/nutritious, makes children happy). The main barrier to purchase of dairy was cost for all items plus availability for fresh milk and yoghurt.  Fish was purchased by 99% of respondents, including small dried fish (87%), large dried fish (64%), small fresh fish (58%), large fresh fish (45%), and farmed fish (21%). The top factors that influenced purchase were: small dried fish (tastes good, healthy/nutritious, can buy in quantity needed) and all other types of fish (tastes good, healthy/nutritious, makes children happy). The main barrier to purchase was cost for all fish types plus availability for fresh fish.

Conclusions: Mothers’ purchases of ASFs are driven by taste, perceived nutritiousness, and children’s enjoyment, but limited by cost and availability.

P235.001138.  UTILISATION OF COWPEA IN CHILD FEEDING USING INDIGENOUSLY TREATED COWPEA FLOUR     

Author(s): Tinna A. Ng’ong’ola- Manani1, Mwayi E. Kaliwo1, Maxwell January1, and Madalitso Nankapa1

Affiliation(s):

1. Lilongwe University of Agriculture and Natural Resources, Bunda College Campus, Department of Food Science and Technology, P.O. Box 219, Lilongwe, Malawi.

Email: mwayikaliwo101@gmail.com

Introduction: A major public health concern and development challenge in Malawi still remains to be malnutrition, with a high prevalence rate in children especially under-fives. This is majorly caused by multiple factors such as suboptimal child feeding practices and inadequate dietary intakes. Cowpea legumes are rich with great potential to contribute towards alleviating malnutrition especially in under-five children. Cowpeas have high resilience to harsh conditions, including hot and dry environments as well as poor soil conditions making it a better candidate in climate change mitigation. However, its utilisation is limited to incorporation into adult diets, hence does not contribute much to child nutrition even in cowpea growing areas such as in Salima district. Therefore, development of cowpea complementary food for under-five will try to solve the challenge of malnutrition in under-fives in the country while adding value and increasing market potential of cowpea.

Methods: In this study, we compared the effectiveness of 4 common domestic processing methods (germination, roasting, fermentation, and soaking) in reducing phytic acid concentrations in cowpea.

Results: The results showed fermentation and roasting cowpeas reduced the antinutritional compound phytic acid, which affects the bioavailability of minerals like calcium, zinc, and iron, by percentage levels ranging from 0.4 to 1.6% and 2.6 to 4.2%, respectively, while retaining high-value nutrients in the majority of landrace varieties of cowpeas.

Conclusion: As a result, fermented and roasted cowpea are the best combinations to employ in creating various complimentary dishes. In order to select the supplemental meal made with cowpeas that consumers under the age of five like the best and create the ideal mix for them, sensory evaluation will be used.

P236.001271. EFFICACY OF DIETITIAN-LED DIETARY COUNSELLING ON GLYCEMIC STATUS AND DIETARY INTAKE OF ADULTS DIAGNOSED WITH TYPE 2 DIABETES: A RANDOMISED CONTROL TRIAL   

Author(s): Jonathan Misolo1, Alexander Kalimbira2, and Getrude Mphwanthe1  

Affiliation(s):

1. Kamuzu Central Hospital, Lilongwe, Malawi
2. Lilongwe University of Agriculture and Natural Resources, Bunda College Campus, Department of Food Science and Technology, P.O. Box 219, Lilongwe, Malawi

Email: JMisolo@gmail.com   

Introduction: In Malawi, prevalence of diabetes mellitus is estimated at 4.7% among adults (18 to 69 years). Patients with T2DM have little knowledge of portion sizes of locally available foods and how it affects their glycemic status. The objective was to determine the efficacy of dietitian-led dietary counselling on glycemic status and dietary intake among adults with T2DM.

Methods: We conducted a single-blind parallel-RCT at ZCH from July 2021 to January 2022. Participants were randomised into intervention (n=45) and control (n=45) groups. We targeted overweight/obese adults (40-65 years) clinically diagnosed with T2DM for over one year, with HbA1C of ≥7.0%, and on oral antihyperglycemics. The intervention group received dietary counselling from a registered dietitian every two months (3 times). We collected data twice, at baseline (June-July 2021) and endline (January-February 2022); parameters included socio-demographics and economic characteristics, BMI, fasting blood glucose, HbA1C, diabetes knowledge, and dietary intake. Using IBM SPSS v.26, descriptive analysis (percent and frequencies) was performed. T-tested compared the mean of the two groups. The multiple linear regression models determined the key predictors of the dependent variable, HbA1C.

Results: The mean age of participants was 50.7±7.3 years, dominated by females (58.9%) than males (41.1%). The mean BMI at baseline in the intervention group was 29.7±5.3kg/m² and reduced to 28.0±4.6kg/m² at the endline. HbA1C of the intervention group significantly improved from 18.6±6.7% to 8.8±1.6%, while the control group 18.1±7.8% to 11.1±3.2% respectively. We observed significantly (P&lt;0.05) higher energy intake in the intervention group (2989±634.8 kcal) than the control group (2680.3±512 kcal) at baseline. Total energy intake and FBS had a positive significant association with HbA1C (P&lt;0.05), which implies that when total energy intake and FBS increased, HbA1C also increased.

Conclusion: Dietitian’s dietary counselling efficacy has proven to reduce mean HbA1C, mean FBS, mean BMI, mean total energy intake in this study.   

P237.A001156. DEVELOPMENT OF A PICTORIAL FOOD AND FLUID INTAKE TOOL FOR ESTIMATING PERCENT MEAL CONSUMPTION OF HOSPITALISED PATIENTS AT KAMUZU CENTRAL HOSPITAL, MALAWI: USER-CENTRED APPROACH

Author(s): Mercy Navaka1,2, Robin Dolman 3, Sanele Nkomani1, and Getrude Mphwanthe1

Affiliation(s)  

1. Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi 
2. Zomba Central Hospital, Zomba Malawi
3. North-West University-South Africa

Email: navakamercy@gmail.com

Introduction: Reduced food intake is the major cause of malnutrition among hospitalised patients. The lack of a simple, reliable, and user-friendly tool to assess food and fluid intake in Malawian hospital settings limits dietetic service delivery.

Objectives: To qualitatively assess needs and barriers to food and fluid intake monitoring, develop a pictorial prototype, and test usability.

Methods: We conducted an exploratory sequential (three phases) mixed methods study at Kamuzu Central Hospital. Firstly, we interviewed key informants (KI); four dietitians, eight nurses, and seven kitchen staff to identify needs and barriers to monitoring food and fluid intake among in-hospital patients. Then, developed a pictorial food and fluid estimation tool (PFFET). Lastly, three focus group discussions (FGDs) were done with KI to elucidate the usability and challenges of the PFFET after two weeks of utilisation in practice. The System Usability Scale (SUS) measured the usability of the PFFET. We analysed the qualitative and quantitative data using thematic and descriptive analysis, respectively.   

Results: Three major themes emerged, including a lack of hospital policy on monitoring food and fluid intake, limited time to monitor food and fluid intake due to a high patient-to-health worker ratio, and poor dietary recall among patients/guardians. Hence the PFFET prototype was developed to address the barriers. The PFFET comprises Malawi food groups and macronutrient content at different consumption rates of 0%, 25%, 50%, 75%, and 100%. Overall, the PFFET was rated to be easily adopted as 79% of participants indicated easiness, had an average task completion time of three minutes, and had a SUS score of above 68.

Conclusions: A user-friendly prototype PFFET was developed to address barriers in assessing food and fluid intakes in hospital settings in Malawi. Hence the need to assess the validity and reliability of the developed tool.

P238.A001292. BODY COMPOSITION OF SURVIVORS OF ACUTE MALNUTRITION: RETROSPECTIVE COHORT STUDY

Author(s): Madalitso Makawa Phiri1, Oscar Divala2, Queen Mwakhwawa2, Keneth Maleta2, and Efrat Monsonego-Ornan1

Affiliation(s):

1. The Hebrew University of Jerusalem;
2.  Kamuzu University of Health sciences

Email: mmakawaphiri@medcol.mw

Introduction: Currently, Ready to use therapeutic foods (RUFT) is used to treat severe acute malnutrition (SAM). But little is known about long term effects of RUFT on body composition.

Objectives: To assess the impact of exposure to SAM treatment on body composition.

Methods: The study participants included exposed group (children aged 21.5 months) who were treated for SAM at QECH Blantyre while unexposed included age and sex matched peers and /or siblings from the same community. Participants had anthropometric assessment and body composition assessment.

Results: Data from a total of 93 exposed and 38 unexposed was used for analysis. In the exposed group, mean anthropometric characteristics at 12 years post exposure; weight 23.18(±4.0); height 123.43(±8.2); MUAC 169.58(±16.1); waist circumference 55.54(±3.5); hip circumference 61.49(±4.4). Mean body composition characteristics fat mass 3.33(±1.4); fat free mass 19.87±3.2); total body water 15.16(±2.4); fat mass percentage 14.06(±4.9). Two sample t tests showed no significance difference between the two groups in all variables. Incidence (95%CI) of excess fat was 24(14.38 – 41.00) for the whole population. In the unexposed group 54(28.37 to 104.80) compared to the exposed group 12(5.06 – 29.19) per 1000 person-years which did not differ statistically. Risk factor for having excess fat, in unadjusted Cox regression modelling showed previous exposure to treatment for SAM as a significant risk factor (p=0.004). In the adjusted analysis no significant difference was recorded. Adjusted mean change using Linear mixed model showed body composition variables were minimal in the exposed group.

Conclusion: Results revealed no difference on the risk of having excess fat between the exposed and non-exposed group. Previous treatment of SAM using therapeutic milk and homogeneity of the study population could partly explain the lack of significant difference between the study groups. Further research is recommended to discover if RUTF does not negatively impact body composition.

P239.A001269. ENABLERS AND HINDRANCES OF SELF-REFERRALS AMONG CAREGIVERS TRAINED TO HOME-SCREEN AND REFER CHILDREN WITH ACUTE MALNUTRITION IN SOUTHERN MALAWI      

Author(s): Collina A. A. Tchongwe1, 4, Benson C. Singano1, 4, Numeri N. Geresomo 1, Tinna A.N. Manani2, Aaron T. Chikakuda1, Alfred Ngwira3, Emma Budalla4, and Alexander A. Kalimbira1,4.   

Affiliation(s)

1. Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
2. Department of Food Science and Technology, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
3. Department of Basic Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
4. Screening and Referral by Caregivers (SCRECA), Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi

Email: collinatchongwe@gmail.com

Introduction: Caregivers trained in nutrition screening are able to self-refer children detected with acute malnutrition for treatment, but there is lack of information regarding factors that facilitate and obstruct self-referrals.

Objective: To identify enablers and hindrances of self-referrals among caregivers who home screened and detected acute malnutrition in children.

Methods:  A cross-sectional qualitative study was conducted in Phalombe (n = 57) and Nsanje (n = 61) districts. Caregivers (n= 64) and health surveillance assistants (HSAs) (n = 40) were randomly selected, while district nutritionists (n = 2) were purposely selected. Data were collected through eleven focus group discussions (Caregivers = 7; HSAs = 4), four in-depth interviews with caregivers who correctly identified acute malnutrition and self-referred for treatment and two key informant interviews with district nutritionists. Data were audio-taped, transcribed, translated, coded and analysed using thematic analysis to identify themes.

Results:  Three themes were identified as enablers of self-referrals which included proper growth and development of children, prevention of child mortality and benefits of therapeutic foods, while other three themes were identified as hindrances which included unprofessional conduct of HSAs, MUAC measurement disparities between HSAs and care group promoters, and stock out of therapeutic foods.

Conclusion: Caregivers realise the importance of seeking treatment for acute malnutrition to safeguard the health of their children. However, self-referrals by caregivers are likely to be negatively affected by absence of treatment and unprofessional conduct of health workers.

P240.001195.  ADHERENCE TO THE FEEDING OF SEVERELY MALNOURISHED CHILDREN AT KAMUZU CENTRAL HOSPITAL, MALAWI        

Author(s): Wilfred Gaven1, Beverly Laher1, and John Phuka1      

Affiliation(s):

1. Kamuzu University of Health Sciences, Blantyre Malawi 

Email: gavenwilfred1@gmail.com

Introduction: Severe acute malnutrition (SAM) in Malawi affects 9.7% of 6 to 36 months old children with a 10.1% death rate. Despite Malawi having done a lot to review community-based management of acute malnutrition guidelines and training of health workers on the same, there were still increased deaths in children with SAM. Again, data on adherence to SAM treatment were inadequate, hence the need to do the study.

Objectives: To assess factors associated with adherence to the feeding of under-five-old SAM children at Kamuzu Central Hospital. Specific objectives: to determine adherence level to feeding in stabilisation phase, establish association between shift times, weekdays, admission wards, outcome, and adherence.

Methods: A retrospective cohort study focused on the systematic sampling technique was used to select 459 SAM children aged 6 to 59 months from 2017 to 2021 in the hospital paediatric ward. A data extraction tool was used to collect data from SAM case files. Descriptive statistics were used to summarise the socio-demographics, patients’ clinical characteristics, and level of adherence to feeding protocol. Association between independent factors and adherence was determined by logistic regression and Chi-square tests.

Results: The study had more female (53.2%) than male participants, the lowest and highest children’s weight in kilograms was 3 and 14.4, respectively and the median weight was 7kg. The study found 12.6% total adherence to feeding. Adherence rates were: 12.4% and 13.7% during day and night, 12.1% and 15.4% during working days and weekends, 8.5% and 13.7% in NRU and other wards, respectively.

Conclusion: There was limited knowledge of health workers on feeding guidelines.

P241.001359.  THE ROLE OF THE GASTROINTESTINAL TRACT MICROBIOTA IN COLONISATION RESISTANCE AGAINST COMMON ENTERIC PATHOGENS IN MALAWIAN CHILDREN   

Author(s): Angeziwa Chunga1,2,3, Happy Chimphako Banda2, Tonney S. Nyirenda1, Arox Kamngona1, Benjamin Kumwenda1, Philip Ashton2,3+, Anmol Kiran2, Miren Iturizza-Gomara3, Lindsay Hall4, Melita A. Gordon2,3   

Affiliation(s):

1. Kamuzu University of Science and Technology, Blantyre, Malawi
2. Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, Malawi
3. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
4. Gut Microbes and Health, Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, United Kingdom

Email: achunga@kuhes.ac.mw

Introduction: Gut microbiota disruption during early life has an immediate and long-term impact on host health. Early feeding habits and pathogen exposure are important factors that can cause gut microbiota disruption. This study aimed to describe the role of gut microbiota in controlling enteric pathogens that Malawian children are exposed to and to characterise and explore the anti-infective properties of Bifidobacterium isolated from Malawian infants against Salmonella Typhimurium.

Objectives:

1. To describe and quantify enteric pathogen exposure events among Malawian children
2. To describe the relationships between gut microbiota composition and asymptomatic exposure to enteric pathogens among healthy Malawian children
3. To isolate and describe Bifidobacterium isolated from healthy exclusively breastfed Malawian infants
4. To investigate anti-Salmonella properties of Bifidobacterium strains isolated from Malawian children

Methods: The study used an enteric Taqman Array Card to detect pathogens that Malawian children aged 6 to 18 months are exposed to, 16S rRNA sequencing for microbiota profiling, whole-genome sequencing to characterize Bifidobacterium and in vitro competitive assay to explore anti-infective properties of the Malawi Bifidobacterium against an invasive Salmonella Typhimurium strain. 

Results: The study has demonstrated that healthy Malawian children are exposed to multiple enteric pathogens that are mostly not associated with clinical symptoms. Apart from Giardia, EAEC and B. fragilis, most of these pathogens do not affect gut microbiota composition. In addition, the data demonstrate that Bifidobacterium is predominant in Malawian children, especially those that are exclusively breastfeeding. Malawian breastfeeding infants are predominantly colonised by Bifidobacterium longum, possessing a wide range of human milk oligosaccharide digesting genes. Exploratory data show that Malawian Bifidobacterium strains possess anti-infective properties against Salmonella Typhimurium. 

Conclusion: Malawian children are asymptomatically exposed to multiple enteric pathogens that may affect gut microbiota composition. Bifidobacterium from Malawian breastfeeding infants possess HMOs that may be important for colonisation resistance against important enteric pathogens.

SOCIAL SCIENCE IN HEALTH ABSTRACTS  – POSTERS

P242.001471. HEALTH WORKER ATTITUDES AND PERCEPTIONS TOWARDS WOMEN ACCESSING POST-ABORTION CARE FOLLOWING INDUCED ABORTION IN MALAWI: A QUALITATIVE STUDY

Author(s): Wezzie Dunda1,2, Mallory Michallak2, Agatha Bula2, Annie Thom2, Lameck Chinula2,45, Irving Hoffman2,4, Mina Housseinpour2,3, and Friday Saidi2,5          

1. Kamuzu University of Health Sciences
2. UNC Project-Malawi, Lilongwe, Malawi.
3. Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
4. Division of Infectious Disease, Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
5. Malawi Ministry of Health, Kamuzu Central Hospital    

Email: wdunda@unclilongwe.org

Introduction: Unsafe abortion is one of the leading causes of pregnancy-related mortality in Malawi. While most health systems provide post-abortion care as part of emergency obstetric care, induced abortion is often legally restricted. In contexts in which abortions laws are restrictive, most induced abortions are often underreported.

Objectives: To determine the perceptions of healthcare professionals in providing post-abortion care and counseling to patients after induced abortion.

Method: We used Snowball sampling to identify and recruit 16 healthcare professionals and stakeholders who participated in in-depth interviews. All interviews were audio-recorded and transcribed verbatim. Data was coded using Nvivo12 and analysed using thematic analysis approach. Memos were used to report summaries of findings.

Results: Heath care workers (HCWs) consider induced abortion as act of promiscuity and sinful leading to delay in seeking post-abortal care and non-disclosure of the type of abortion. Even if they report early, most HCWs often are not willing to provide post-abortal care as this is considered illegal and increasing unnecessary work to them, making patients vulnerable to complications. HCWs noted that that they provide post abortion contraception but highlightened lack of psychosocial counseling. However, even though women who had induced abortion rarely get psychosocial counseling as part of their post abortion care, participants agreed that they still need to be counseled, where issues that led to the abortion can be addressed and offer psychological support. HCWs also reported that sometimes psycho-social counselling is not offered because facilities are understaffed and do not have trained psychosocial counsellors to offer such services.

Conclusion: HCWs in Malawi perceive induced abortion patients as promiscuous and sinful and, consequently, affects the quality of care and counselling provided to women who have induced abortion leading to unnecessary complication. There is a need for interventions and resources to improve post-abortal care and counselling services.

P243.A001083. WOMEN’S PERCEPTIONS AND EXPERIENCES ON MEDICAL TREATMENT OF INCOMPLETE ABORTION IN MALAWI: A MIXED METHODS STUDY     

Author(s): Bertha Magreta Chakhame1,2*, Elisabeth Darj1, Mphatso Mwapasa1,2, Ursula Kalimembe Kafulafula2, Alfred Maluwa3, Jon Øyvind Odland1, Maria Lisa Odland1.          

1. Norwegian University of Science and Technology, Trondheim, Norway:
2. Kamuzu University of Health Sciences, Malawi
3. Malawi University of Science and Technology    

Email: bchakhame@kuhes.ac.mw

Introduction:  Abortion related complications are among the leading causes of maternal mortality in Malawi. Post-abortion care is paramount in preventing such deaths hence the need to make the services available and accessible to all. Medical management with misoprostol is the recommended treatment for incomplete abortions in the first trimester but is still seldomly used in many low-income countries like Malawi.

Objective:  To explore the perceptions and experiences of women who received medical treatment for the management of incomplete abortion in Malawi.

Methods:  A descriptive cross-sectional study that used mixed methods was conducted in 3 hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for the quantitative part and thematic analysis for the qualitative aspect. Data are presented in tables and narratives.

Results: Three themes emerged around the following areas: experienced effects of misoprostol, the support offered to women by health care workers, and perceptions of women after taking misoprostol. Almost all participants reported having received drugs and counselling as support from health care workers. The majority of participants, 94%, reported satisfaction with the support and described misoprostol as helpful and effective in expelling retained products of conception. Misoprostol was preferred and regarded as the most reliable treatment and beneficial to women by most participants. The majority of the women reported tolerable effects of the drug and 91% would recommend misoprostol to friends.

Conclusions: The use of misoprostol for first trimester incomplete abortion in Malawi is acceptable and is regarded as helpful, and satisfactory to women receiving post-abortion care. Medical management is a potential mode of treating women with incomplete abortions in Malawi.

P245.001198. PARENTAL PERCEPTIONS ON OVER-NOURISHED SCHOOL-AGED CHILDREN’S WEIGHT STATUS AND THEIR WILLINGNESS TO MODIFY LIFESTYLE PREFERENCES OF THEIR CHILDREN

Author(s): Lustia Mndoliro1, Numeri Geresomo, and Alexander A. Kalimbira1

Affiliation(s):

1. Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi      

Email: chatengalustia@gmail.com

Introduction: Globally the rate of overweight and obesity (OW/OB) among school-aged children (6 to 10 years) has increased from 18% in 2016 to 20.6% in 2019. In Sub-Saharan Africa, the prevalence increased from 4.8% in 2000 to 11.5% in 2016. In Malawi, there is paucity of data on prevalence of OW/OB in school-aged children. A recent localised study showed that 56.3% of school-aged children in urban Lilongwe were OW/OB. Most literature indicates that most parents give unhealthy diets and under-estimate the weight status of their children, and such data is scarce in Malawi.

Objective: Study assessed parental perceptions on over-nourished school-aged children’s weight status and their willingness to modify diet quality and physical activity level to improve their weight status.

Methods: Data was collected on demographics of parents, children weight status, readiness to change, and dietary quality and patterns through a cross-section study. Prime dietary quality score and principal component analysis were used to derive the dietary quality and patterns respectively. We used IBM SPSS 26 to analyse the data and statistical significance was set at p value< 0.05.

Results: Majority of parents (69%) gave unhealthy diets to their children, 83% of caregivers underestimated the prevalence and 46 % of the caregivers were ready to modify diet patterns and 31.6% were ready to change the physical activity level of their children.

Conclusion and Recommendation: Results reveal that there was high consumption of unhealthy foods, high prevalence of parental under-estimation of children’s weight status and low parental readiness to modify lifestyle preferences of their OW/OB children. This suggests an urgent need to step up policy by the ministries of education and health to enforce healthy eating among learners and to include diet modification programmes in the form of nutrition counselling and education during outreach visits in communities.

P247.001128. ACCEPTABILITY OF INTEGRATING SCREENING FOR SEXUAL AND GENDER-BASED VIOLENCE INTO ROUTINE HEALTH CARE SERVICES IN NENO, MALAWI: A QUALITATIVE STUDY

Author(s): Rachel Mwanza1, Vera Kabanda1, Manuel Mulwafu1, Kingsley Kanzoole1, Willy Chisindo2, Haules Zaniko2, Jimmy Tamani1, Grace Momba2, Chiyembekezo Kachimanga1, Emilia Connolly1

Affiliation(s):

1. Partners in Health
2. Ministry of Health

Email: rakelo.mk@gmail.com

Introduction: Sexual and gender-based violence (SGBV) is widespread in Malawi. Consistent prevalence and high level of non-disclosure or non-reporting of incidences of SGBV with particular reference to women and children remains a major concern. On the other hand, COVID-19 pandemic has significantly increased the prevalence. The 2015/16 Malawi Demographic and Health Survey found that 34% of the women aged 15-49 reported experiencing physical violence, 14% experienced sexual violence while 23% experienced emotional violence within the 12 months’ period prior to the survey (National Statistical Office, 2017). The Government of Malawi (GoM) has established some structures and policies to address and provide comprehensive SGBV care and response, however, a good proportion of survivors of violence do not systematically utilise them.

Objective: To conduct a process evaluation on the acceptability of integrating screening for SGBV into routine health care services.

Methods: We conducted in-depth interviews among purposively selected twenty female clients and seven health care providers in four primary health care facilities. Perceptions, satisfaction, facilitators and barriers of integrating SGBV screening into routine health care services were identified using a grounded theory approach.

Results: Clients and providers expressed satisfaction with the integration. They both perceived it as an avenue of providing support, care and referral to SGBV survivors. Facilitators had a safe and warm environment, comprehensive care and support for clients while providers mentioned availability of clinical mentors, protocols and job aids, positive case outcomes and trained personnel. Barriers were few trained personnel, workload and poor coordination with other stakeholders for providers while clients mentioned their unwillingness to disclose.

Conclusions: Our findings can inform efforts to scale up integration of SGBV screening into routine health care services. Implementation initiatives should focus on increasing comprehensive GBV training, mentorship and supervision, strong coordination among stakeholders, community awareness and engagement, male involvement, expanding referral structures and building patient-provider relationships.         

P248.A001459. ACCEPTABILITY OF FOUR HIV PREVENTION METHODS: PERSPECTIVES OF WOMEN AT RISK OF HIV IN MALAWI

Authors: Agatha K Bula1, Mercy Tsidya1, Jennifer Tang1,2 and Mina Hosseinipour 1,3        

1. UNC Project-Malawi, Lilongwe, Malawi.
2. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
3. Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA

Email: abula@unclilongwe.org

Introduction: Women at risk of HIV need HIV-prevention methods they can control and incorporate easily in their lives. We used qualitative methods to explore attitudes and acceptability of four HIV prevention methods: Dapivirine Ring (MTN-025), injectable versus oral PrEP (HPTN-084), an HIV monoclonal antibody (HPTN-081 “AMP”), and HIV vaccine (HVTN-705) among women at risk of HIV in Lilongwe, Malawi.

Methods: We purposively recruited and conducted 30 in-depth interviews (IDIs) with women who participated in the above studies from March 2019-February 2020 at UNC Project-Malawi. Study participants included women continuing, refused to join or withdrew from the studies. IDIs were audio-recorded, transcribed and translated to English. Data were analysed using framework analysis with NVivo 12.

Results: Most participants reported little knowledge about the other on-going studies during the time of enrollment. However, they mentioned willingness to protect themselves and the feeling of “being protected” from HIV by study products as motivating factors to continue with their current study. Product attributes were frequently mentioned as facilitators and barriers to acceptability of different HIV methods. Injectable PrEP and HIV vaccine were preferred most due to the privacy from sexual partners and the 2-3 months’ interval. Most women were concerned about the vaginal ring, fearing that their sexual partners could feel it during sex and fear of developing vaginal infections or cervical cancer. For the antibodies, many women associated administration through an intravenous line with sickness. Oral pills were least liked due to fear of being labelled as “HIV-infected” and fear of forgetting to take pills. Others raised concerns about vaccine-related side effects and fear of failure to conceive.

Conclusions: Product characteristics, specifically route of admiration, were the most commonly reported barriers and facilitators to acceptability of HIV prevention products. Women may require additional counselling to ease product concerns regarding specific HIV prevention methods.  

P249.A001332. ASSESSMENT OF KNOWLEDGE AND PERSPECTIVES ON THE CORRECT USE AND MAINTENANCE OF CLOTH FACE MASKS DURING THE COVID-19 OUTBREAK IN SOUTH AFRICA

Authors: Polo-Ma-Abiele H Mfengwana1, Mutshidzi A Mulondo2  

1. Faculty of Health & Environmental Sciences, Central University of Technology, Bloemfontein (SA)
2. Faculty of Health Sciences, University of the Free State, Bloemfontein (SA)

Email: pntsoeli@cut.ac.za

Introduction: A novel coronavirus disease impacted the globe in 2019 and was soon declared a global health crisis/pandemic by WHO in 2020. Since then, people have been encouraged to follow some non-pharmaceutical preventative measures such as the wearing of cloth face masks, maintenance of social distancing, and frequent washing of hands.

Objectives: This study reviewed the correct use and maintenance of cloth face masks during the COVID-19 pandemic in South Africa.

Methods: Participants were recruited to complete an anonymous self-administered online questionnaire. It was conducted with adults, over the age of 18 years, with access to social media network platforms and who were residing in South Africa during the study.

Results: The questionnaire was fully completed by 117 participants from a total of 152 that took part in the study. Although 77% indicated that they knew how to correctly wear a cloth face mask, 30% of them indicated uncertainty of how many layers the cloth face mask needed to be. Furthermore, about 20.42% of respondents did not show an understanding of the forbidden use of damaged or wet cloth face masks, with 61.54% of respondents lacking knowledge on how frequently a cloth mask should be washed.

Conclusion: Due to the neutrality and uncertainty indicated by some of the participants in this study, re-examining information exchange on public health subjects are crucial. More awareness campaigns are recommended to ensure there is an understanding from the younger age demographic on topics that bear public health significance. This study helped to identify existing gaps in knowledge on the particular topic of maintaining cloth face masks and the need for more awareness/educational campaigns as part of the public health initiatives on curbing the increasing communicable diseases.

SEXUAL & REPRODUCTIVE HEALTH ABSTRACTS  – POSTERS

P250.A001268. EXPERIENCES OF SECONDARY SCHOOL STUDENTS IN MULANJE DISTRICT ON PARENT – ADOLESCENT COMMUNICATION ABOUT SEXUAL AND REPRODUCTIVE HEALTH ISSUES      

Author(s): Esnat Likoya Kampondeni1 and Masauko Msiska2

Affiliation(s):

1. Phalombe District Hospital

2. Kamuzu University of Health Sciences

Email: likoya2016vanessa@kcn.unima.mw

Introduction: The study explored the experiences of secondary school students in Mulanje district on factors that affect parent-adolescent communication about Sexual and Reproductive Health Issues. Communication on SRH issues between parents and children rarely occurs despite the fact that parents live and spend most of the time with their children. Lack of openness when discussing SRH issues between parents and children negatively impacts on the lives of adolescents.

Objective(s): (1) To explore the views of adolescents towards parents-adolescent SRH communication (2). To understand the circumstances when parent-adolescent SRH communication occurs (3). To describe the SRH issues discussed between adolescents and their parents

Methods: The study employed a descriptive explorative qualitative research. The study was done at Mulanje mission secondary School and involved 22 adolescents aged 12-19 years. Purposive sampling was used to recruit the participants. Data were collected through in-depth interviews from 5th July to 17th August 2017. Data analysis was done using a conventional approach.

Results (2): The study found that the majority of adolescents perceive SRH communication with parents as important. However, the study established that communication between parents and their children does not occur and if it does, parents give inadequate information. The parent-adolescent relationship was perceived by adolescents to be foundational for healthy parent-adolescent communication, a good relationship promotes openness between parents and adolescents. Socio-cultural factors were found to be the main barrier as it is considered taboo for parents to talk openly about SRH issues in their cultures.

Conclusion: It is evident that communication between parents and adolescents on SRH matters is less and inadequate as such, adolescents are prone to risky sexual behaviors. It is therefore important to empower parents with the necessary knowledge and skills so that they can ably and effectively communicate SRH information to their children.

P251.001275. INVESTIGATING THE ROLE OF SOCIAL MEDIA IN SEX WORK IN URBAN BLANTYRE, MALAWI: AN ETHNOGRAPHIC STUDY    

Author(s): Doren Sakala1,2, Wezzie Lora1,2, Moses Kumwenda1,2, and Nicola Desmond2

Affiliation(s):

1. Malawi Liverpool Wellcome Trust Clinical Research Programme
2. Liverpool School of Tropical Medicine    

Email: dsakala@mlw.mw

Introduction:  Social capital has been found to mitigate some risks faced by female sex workers (FSWs) including abuse, inconsistent condom use, alcoholism, legal constraints, and male-female power dynamics. There is a lack of literature regarding the role of social media as a form of social capital, in engagement with sex work in sub-Saharan Africa (SSA). Anecdotal evidence suggests increasing use of social media for sex work transactions.

Objective: To understand how social media as a form of social capital is being used in the context of sex work engagements and transitions to identify potential social media-based health interventions.

Methods: A qualitative study using traditional and digital ethnography, In-depth interviews (IDI) and Key Informant Interviews (KI) with preliminary social mapping of sex workers and physical risk hotspots. Participants will include FSWs, bar owners and bartenders. Digital ethnography will involve monitoring online interactions and engagement in sex work. IDIs and KIs will complement ethnography and collect data from FSWs and other players who have knowledge on the topic.

Results: There are currently 2,700 FSWs in Blantyre. Three typologies exist but most FSWs are predominantly venue based, followed by street-based and home-based. There is considerable smart phone coverage among FSWs with 50% having a working smart phone. Working settings for FSWs vary by township with varying degrees of risks. Next we will characterize the forms of social media used by FSWs and establish how these are used to engage with clients as well as their role in promoting trust and reciprocity in social and sexual networks. Current observations indicate that FSWs use social media to find and retain clients as well as manage risks.

Conclusion: Understanding social media as a form of social capital in the context of FSW has potential to influence transitions in- and -out of sex work.

P252.A001353. DETERMINANTS OF INTENTION ON PARTNER NOTIFICATION AMONG PATIENTS AGED 18 YEARS AND ABOVE WITH SEXUALLY TRANSMITTED INFECTIONS IN MZUZU          

Authors: Pauline Nkhata1, Lignet Chepuka2, and Lucy Kululanga3

Affiliations:

1. Mzuzu Central Hospital, Mzuzu Malawi

2. Kamuzu University of Health Sciences, Blantyre Malawi

Email: pmnkhata@gmail.com

Introduction: Partner notification is cornerstone in management of sexually transmitted infections (STI). It helps to identify asymptomatic cases of STI, prevents reinfection and interrupts chain of transmission. Several factors have been known to influence one’s intention towards partner notification. Therefore, this study aimed at investigating the determinants of intention to notify partner among patients with curable sexually transmitted infections.

Objectives: (1) To assess socio-demographic factors associated with intention on partner notification. (2) To determine the association between sexual practice and intention on partner notification (3) To assess psychosocial (attitude, social influence, self-efficacy) factors associated with intention on PN.

Methods: This was a quantitative, facility based cross-sectional study conducted at two main public health facilities in Mzuzu among 236 STI patients aged ≥18 years. Data was collected using an interviewer-administered questionnaire. Ethical approval was obtained from COMREC. Data was entered into the SPSS version 20, and then analysed using regression analysis and Pearson’s Chi-square test at a P-value of 0.05.  

Results:  Overall intention of participants on partner notification was 87%. Marital status, level of education, attitude and self-efficacy were significantly associated with intention to notify a partner. Thus, the odds of intention to notify partners were high among married participants (OR, 3.66; 95% CI: 1.10-12.13), and those with high self-efficacy (OR, 4.53; 95% CI: 1.41-14.59). However, the odds of intention to notify a partner were low among participants who had not attended any formal education (OR, 0.16; 95% CI: 0.02-1.57), and those with a negative attitude towards partner notification (OR, 0.03; 95% CI: 0.01-0.17).

Conclusion: The study has revealed that partner notification is influenced by marital status, level of education, attitude and self-efficacy; therefore, interventions regarding partner notification in STI management should take into consideration these factors in order to maximise partner notification.

P253.A001517. INVOLVING FEMALE SEX WORKERS IN DEMAND CREATION FOR VMMC SERVICES IN CHIKWAWA DISTRICT, MALAWI 

Author(s): Stefano Mjuweni1, Oscar Kuboma1, Misheck Chiwanda1, Tiwonge Kayira1, Daniel Pindani1, Sarah Sakanda1 James Odek2, Jeroen van ’t Pad Bosch1, Fidelis Sindani1, and William Twahirwa1           

Affiliation(s):  

1. Jhpiego Malawi  
2. USAID mission Malawi    

Email: Stefano.Mjuweni@jhpiego.org

Introduction: Jhpiego implements a USAID-funded EMPOWER Voluntary Medical Male Circumcision (VMMC) project in Chikwawa district, collaborating with and strengthening the Catholic Health Commission (CHC). Jhpiego’s CDC-funded Getaway project works with seven female sex workers (FSWs) support groups and over 640 registered FSWs in the Nchalo trading center. FSWs were identified in a unique collaboration between EMPOWER and Gateway, and they subsequently created demand for VMMC among their clients and other men in the Chikwawa district. Two FSWs formed parallel groups to drive demand for VMMC services. Using a referral card or a phone call, FSWs referred their clients to the Montfort VMMC clinic.

Methods: The project had 113 community mobilizers (CMs) 44 (40%) were females assigned to VMMC clinics/sites in their catchment areas. CMs contributed 51% of the 23,667 male circumcisions (MCs) performed between October 2021 and August 2022. Among the 44 female CMs, 35 (85%) were FSWs. The project used a two-day MOH-Health Education Unit (HEU) training curriculum for CMs to train the FSWs on VMMC demand creation. FSWs were given Interpersonal Communication (IPC) tools that contained structured VMMC messages, including HIV risk reduction, better hygiene for men, and cervical cancer risk reduction for women. FSWs created demand for VMMC services as they interacted with men and other women. Every two weeks, FSWs received a group pay and airtime based on the number of clients they brought to the site.

Results: The two groups of FSWs at Montfort VMMC site contributed 1044 (29.9%) clients at St Montfort (Nchalo) between October 2021 and August 2022. The two groups of FSWs contributed 4.5% of VMMCs achieved in August 2022. 

Conclusion: The use of FSWs to generate demand for VMMC is both feasible and effective. MOH and VMMC implementing partners (IPs) should increase women’s awareness and participation in VMMC demand generation, including FSWs.           

P254.A001077. EVALUATING ADOLESCENT-FOCUSED COMMUNITY OUTREACH PROGRAM IN RURAL MALAWI: A MIXED METHODS EVALUATION STUDY  

Author(s): Vera Kabanda1, Manuel Mulwafu1, Justice Kachitsa1, George C. Talama1, Moses Banda Aron 1, Anthony Musandiyang’ane2, Jimmy Tamani1, Fabien Munyaneza1, Grace Momba2, Beatrice Matanje1, Lothiar Ngulube1, Chiyembekezo Kachimanga1, and Emilia Connolly1

Affiliations:   

1. Partners in Health
2. Ministry of Health

Email: shabavera@gmail.com          

Introduction: Uptake of sexual reproductive health (SRH) services among adolescents in Malawi is low. To improve health service delivery and to address the gaps in access and uptake of SRH services among adolescents, Abwenzi Pa Za Umoyo and the Ministry of Health implemented adolescent Screening for Health and Referral in the Community (aSHARC) program. The program involves mobilising adolescents in a community and providing them with SRHR services.

Objective:  To conduct a process evaluation of the implementation of an adolescent-focused community screening intervention in Neno district, Malawi.

Methods: We utilised a cross sectional convergent mixed method design. Quantitative data was routinely collected using a Commcare application during aSHARC events in June 2021 and analysed using STATA 15. For qualitative data, we used interview guides to conduct 4 focus group discussions (a total of 32 participants) with adolescents aged 10-19 years and 8 key informant interviews (KIIs) with health service providers. Purposive sampling method was used to recruit study participants. Interviews were transcribed verbatim and analysed using a grounded theory approach.

Results: aSHARC received appropriate clients, out of 890 client records, 82% were adolescents aged 10-14 years and 15% were adolescents aged 15-19 years while 3% were above 20 years and not the target population. Overall percentage of adolescents who were screened for all the services that they were eligible for was 97%. Family planning had low service uptake, only 8% of adolescents accepted and received family planning services. Outreach and adolescent- centred services were commonly mentioned by both adolescents and providers as facilitators to attending aSHARC. Barriers were lack of information and lack of communication. Suggestions for improvement were increasing frequency of conducting aSHARC and establishing effective linkage to care and follow-up system.

Conclusion: aSHARC has the potential to increase uptake of SRHR services and might be scaled up.

TB EPIDEMIOLOGY PREVENTION &  TREATMENT ABSTRACTS – POSTERS

P256.A001391. PREDICTORS OF ISONIAZID PREVENTIVE THERAPY UPTAKE AND COMPLETION IN UNDER-FIVE CHILDREN IN CONTACT WITH ADULT TUBERCULOSIS PATIENTS IN BLANTYRE, MALAWI          

Author(s): Symon Chiumia1,2, Dr. Atupele Kapito-Tembo1, and Kruger Kaswaswa3    

1. School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre Malawi
2. Mwaiwathu Private Hospital, Blantyre Malawi
3. Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre Malawi

Email: symbrownv@gmail.com         

Introduction: Tuberculosis (TB), a leading cause of avoidable death in high TB burden countries among under-five children, can be prevented in TB-exposed children by taking Isoniazid Preventive Therapy (IPT). But IPT is poorly accessed. Among the causes, individual patient factors for IPT uptake among household (HH) children remain speculative.  We conducted a cross-sectional secondary analysis of medical data from 14 TB-burdened facilities in the Blantyre district to determine individual predictors of IPT uptake and completion in under-five children in contact with adult pulmonary TB patients and define the characteristics of those registered for tracing, initiated, and completed IPT.

Methods: We abstracted medical data of the enrolled under-five children from TB contacts registers of 14 facilities in the district from January to December 2019. The records extracted were sociodemographic and medical data for index cases and contacts plus LTBI screening and treatment for the contacts. Logistic regression analyses were conducted to identify predictors of IPT uptake and completion.

Results: A total of 243 contacts were enrolled, 233/243(96%) screened for TB and 13/233(7%) had active TB. After screening, 12/233(5%) contacts were lost to follow-up (LTFU) and 208/233(89%) were eligible for IPT. Only 193/208(93%) contacts started IPT. Only 187/193(97%) contacts completed 6 months of IPT. A total of 37(15%) contacts were LTFU.  The mean delay for IPT initiation was 17 days (sd 41 days). Child contact age was negatively associated with IPT initiation (OR 0.92 (95% CI 0.86, 0.98) P-value 0.006) in univariate analysis. No individual factors, including high ART adherence among our index cases, were associated with IPT completion in univariate and multivariate logistic regression.

Conclusion: Older children were less likely to be started on IPT. No patient factors were associated with IPT completion. IPT initiation delays may risk TB progression.

CANCER ABSTRACTS  – POSTERS

P257.A001280. EXPLORING THE FEASIBILITY AND FINDINGS OF A SURVEILLANCE SYSTEM TO TRACK POST-TB MORBIDITY IN BLANTYRE URBAN 

Author(s): Elizabeth Mkutumula1, Deborah Phiri1, Wezi Msukwa Panje 1, Nora Engel 2, Peter MacPherson 1, 2, and Jamilah Meghji 2

1. Malawi-Liverpool-Wellcome Programme, Malawi
2. Maastricht University, Netherlands
3. Liverpool School of Tropical Medicine, United Kingdom

Email: ecmbamba@gmail.com

Introduction: In Africa, significant gains have been realised in the diagnosis and treatment of tuberculosis (TB). However, some TB survivors continue to experience morbidity post-treatment, and the mortality rate among TB survivors is 2.91 times higher than the general population. Data on residual morbidity at TB treatment completion is not routinely collected in Sub-Saharan Africa. This leaves a gap in understanding the severity, and distribution of disability amongst TB survivors making the design and implementation of programmes to care for this population challenging.

Objectives: To design, implement, and optimise a pilot surveillance questionnaire to capture routine data on residual physical and psychosocial morbidity amongst TB survivors at the point of TB treatment completion.

Methods: This ongoing study piloted a surveillance questionnaire in 5 health centres in Blantyre urban. The data capture tool was built into an existing digital TB surveillance platform used by TB officers (TBOs). During the study, TBOs will capture residual morbidity data from 500 TB survivors aged 8 years and above at the final TB treatment visit. We use feedback from TB officers and regular data reviews to refine the questionnaire.

Results: TB officers reported good acceptance of the questionnaire by patients, with completion taking approximately 10 minutes. Between February – September 2022, 296 patients were screened, and 288 (97%) eligible patients enrolled in the study. Guardians rather than patients attending the final TB treatment visit has been a major challenge to data capture.

Conclusion: TBOs report TB survivor’s eager to share their experiences. Frequent communication with TBOs has been key to collection of quality data. Initial findings suggest that routine capture of morbidity data by TBOs at treatment completion visits could be a simple, low-cost measure that works within health system structures to generate data on the burden and distribution of post-TB morbidity.

P258.001237.  CLINICAL CHARACTERISTICS OF DOXORUBICIN-INDUCED CARDIOTOXICITY IN BLACK ZIMBABWEAN AND MALAWIAN BREAST CANCER PATIENTS          

Author(s): Vincent Aketch Nyangwara1, Adrian Tinashe Mazhindu1, Zedias Chikwambi1,2, Collen, Masimirembwa1, Ntokozo Ndlovu3, Margaret Borok4

Affiliation(s):

1. African Institute of Biomedical Science and Technology, Harare, Zimbabwe
2. Department of Biotechnology, Chinhoyi University of Technology, Zimbabwe
3. Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe
4. Unit of Internal Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe

Email: vinakech@gmail.com

Introduction: Doxorubicin induced cardiotoxicity (DIC) is a common nonmalignant treatment-related cause of death in cancer patients. Doxorubicin is well established as an efficacious drug for the treatment of a variety of cancers including breast cancer. Breast cancer is the leading cause of cancer-related deaths in women globally. Doxorubicin is administered as a single agent or more commonly in combination for breast cancer patients. Identifying patients at risk of developing DIC is therefore important in improving treatment outcomes. The risk of DIC in patients undergoing doxorubicin treatment is multifactorial and includes hereditary and non-hereditary factors. Several DIC risk factors have been identified including: cumulative anthracycline doses, female gender, age, diabetes, hypertension, African ancestry, concomitant exposure to radiation and genetic factors. The objective of this study was to demonstrate the clinical and demographic characteristics of DIC as part of a feasibility study of breast cancer treatment complications in low-resource African settings.

Methods: Sixty-five breast cancer patients (50 Zimbabwean and 15 Malawian) treated with doxorubicin were recruited to participate in this study. The patients were enrolled from January to December 2019. All the participants were women aged ≥ 18 years with breast cancer who were on doxorubicin. Non-black women and those with prior chest wall radiotherapy were excluded.  To determine DIC, cardiologists performed echocardiographic examinations and echocardiographic recordings. The patients were evaluated for cardiovascular disease at entry (baseline), 3, 6 and 12 months during the study. Additional information, such as BMI, cumulative dose of doxorubicin, co-medications and physical performance of the patients were recorded using a questionnaire. To evaluate the impact of the clinical factors on left ventricular ejection fraction (LVEF) and cardiac failure, a uni- and multivariable logistic regression analysis was carried out.

Results: Out of the 65 patients who were recruited into the study only 35 (54%) completed the study. The median age was 48 years (IQR 44.5 – 59.0). Of the 35 patients, 28 (80%) had advanced stage breast cancer (stage III/IV) with Karnofsky performance status between 80-90%. The prevalence of HIV, diabetes and hypertension were 3%, 11% and 46% respectively. The median LVEF before treatment was 64.7%. The median cumulative doxorubicin dose was 238.89 mg/m2. Five (Zimbabwe=3 and Malawi=2) (14%) of the patients experienced acute DCI associated with LVEF reduction of ≥ 10% from baseline (<60%). The three patients who developed cardiotoxicity from Zimbabwe were hypertensive in contrast to the two patients who developed cardiotoxicity from Malawi. One of the three patients from Zimbabwe who developed cardiotoxicity was diabetic. The final LVEF measurements of the seven patients after the 12-month follow up ranged from 18.2% to 39%.  There was no significant association between the clinical risk factors with DIC.

Conclusion: There is a high incidence (14%) of DIC in the two these two cohorts which is concerning as non-communicable diseases increase in Africa. DIC may lead to cardiovascular disease resulting in heart failure and death. There is a need for incorporation of both clinical and genetic determinants to refine toxicity risk assessment of DIC.

P259.A001408.  A QUALITATIVE EXPLORATION OF A SUPPORT GROUP INTERVENTION AMONG WOMEN WITH CERVICAL CANCER AT TIYANJANE CLINIC FOR PALLIATIVE CARE, QUEEN ELIZABETH CENTRAL HOSPITAL, BLANTYRE, MALAWI.           

Author(s): Mwandida Nkhoma 1, Liz Gwyther 2, and Jane Bates1

1. Kamuzu University of Health Sciences, Blantyre Malawi
2. University of Cape Town, Cape Town South Africa

Email: mmnkhoma@kuhes.ac.mw

Introduction: Cancer of the cervix is a common malignancy among women and is one of the leading causes of cancer morbidity and mortality in Malawi. The majority of women with cervical cancer present with advanced disease where cure is not possible. These women face many challenges that affect their lives holistically. In particular, the psycho-social impact is common for women living with cervical cancer and psychosocial care does not have sufficient attention as the focus is management of the disease and physical symptoms. However, research shows that support groups are associated with improvements in intimacy, emotional support and becoming better informed for women living with cancer of the cervix. 

Objectives: To explore the psychosocial impact of support group intervention among women with cervical cancer, to explore the impact support group intervention on cervical cancer women’s experiences on intimacy and to evaluate the outcomes of attending the support groups among women with cervical cancer

Methods: This was a qualitative research study. Semi structured interviews were used to collect data and were audio-taped. A purposive sampling technique was used in selection of participants. One to one interviews were conducted in eight (8) women diagnosed with cervical cancer because data saturation was reached at that number. Thematic analysis was undertaken where four phases of organisation, familiarisation, reduction and analysis were used.

Results: The following themes were identified: intimacy, emotional support, becoming informed and drawbacks of support groups.

Conclusion: A support group intervention is found to reduce psychosocial and intimacy distress associated with cervical cancer diagnosis. This leads to improved quality of life for these women and their families. Thus, a support group intervention has the potential to enhance appropriate holistic management plans for women with cervical cancer.

P260.A001096. INVESTIGATION OF GENETIC VARIANTS ASSOCIATED WITH CERVICAL CANCER IN MALAWIAN WOMEN

Author(s): Samuel Duncan Gwayi1, Tamiwe Tomok2, Lameck Chinula2, George Fedoriw3, Emile R. Chimusa4, and Benjamin Kumwenda1   

1. Department of Biomedical sciences, Bioinformatics Unit, Kamuzu University of Health sciences, Malawi
2. University of North Carolina(UNC), Lilongwe project
3. University of North Carolina (UNC, Chapel Hill, USA, Malawi
4. University of Cape town, South Africa    

Email: sgwayi@kuhes.ac.mw

Introduction: Globally, Malawi has the second highest cervical cancer mortality rate, estimated at 51.5 deaths per 100,000 women per year. Cervical cancer prevalence is largely attributed to Human Papilloma Viruses (HPV) as causative agent; however, studies have shown that genetic factors influence the disease. Population specific genetic variants and Single Nucleotide Polymorphisms (SNPs) have been identified in different genes including SHKBP1, ERBB3 and TGFBR2 associated with the disease. However, the genetic variants that predispose women to the disease and are unique to the Malawian population have not been investigated. Hence, the aim of this study is to investigate genetic features associated with cervical cancer that are unique to Malawi women and could help in efficiently screening the disease.

Methods: This is a case control study comprising 100 Malawian cases and the 1000 public genomes as control. Whole genome sequencing will be done, followed by SNPs and variants identification using Genome Analysis Toolkit (GATK). Association tests will be done on the variants and SNPs followed by protein structures modelling and integrative polygenic risk scores (PRS) calculation which will enable risk stratification through identification of SNPs unique to Malawian women.                                                                    

Expected Results: This study will effectively identify unique variants and SNPs associated with cervical cancer in Malawian women. It will reveal the impact of each significant variant or SNP on protein structure and consequently function. A catalogue of SNPs will be developed that will form a basis for a genetic based cervical cancer screening among Malawian women.

Conclusion: The high number of cases of cervical cancer in Malawi demands for more robust and cost-effective techniques of screening, diagnosis and management of the disease. Thus, this study will facilitate the development of a genetic based approach to cervical cancer screening, diagnosis and management, which are robust and efficient in combating the disease.