Abstracts for the 2023 Kamuzu University of Health Sciences Research Dissemination Conference

INFECTIOUS DISEASES (Antimicrobial Resistance)

O1_001805. AETIOLOGICAL AND ANTIMICROBIAL RESISTANCE PROFILE OF MATERNAL INFECTIONS IN BLANTYRE, MALAWI; ANALYSIS OF DATA FROM A MATERNAL INFECTION SURVEILLANCE PROJECT
Author(S): Hussein H.Twabi1, Charlotte van Der Veer2, Margaret Khonga1, David Kulapani2, Tonney Nyirenda3, Chisomo Msefula3, Jon Odland4, Victoria Nnensa-Bobe5, Yankho Zolowere5, David Lissauer6, Luis Gadama3, Samuel Meja3 and Marriott Nliwasa1
Affiliation(s):
1.Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences
2.Malawi Liverpool Wellcome Trust Clinical Research Programme
3.Kamuzu University of Health Sciences
4.Norwegian University of Science and Technology
5.Queen Elizabeth Central Hospital, Ministry of Health
6.University of Liverpool
Email: htwabi@kuhes.ac.mw

Introduction: There is a high prevalence of infections and sepsis in pregnancy in low resource settings, with evidence of a rising incidence of antimicrobial resistance in these settings. Additionally, there is a paucity of data to inform the organism-specific therapy of maternal infections, highlighting the need to clearly evaluate the epidemiology of infections in the maternal population in such settings.
Objectives: To describe the prevalence and aetiology of maternal infections in a tertiary hospital in Blantyre, Malawi; to describe the occurrence of antimicrobial resistance in organisms identified in samples from a tertiary hospital in Malawi; to describe the impact of a maternal infections surveillance platform on pregnancy outcomes in a tertiary hospital in Malawi.
Methods: We established a maternal infection and antimicrobial resistance surveillance project serving a tertiary hospital in Blantyre, Malawi. Data on pregnant women from this project from 1 February 2021 to 30 March 2023 was used for the analysis. Descriptive statistics were used to describe the prevalence of infection and antimicrobial resistance. A composite outcome was created through theory-driven grouping of a priori defined variables to test the association between infection from different samples and adverse delivery outcomes.
Results: Preliminary analysis on urine sample ata for 347 patients shows the prevalence of infections in urine in this population was 41.2% (95% CI of 36.0% to 46.4%). 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. Infection in urine was associated with adverse delivery outcomes 1.95 (95% CI 1.24 to 3.10, p=0.004).
Conclusion: The results suggest that having UTIs 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.

O2_002288. PATTERN OF ANTIMICROBIAL RESISTANCE TO UROPATHOGENS OVER A 5-YEAR PERIOD (2018-2022) AT LARGE PRIVATE HOSPITALS IN BLANTYRE, MALAWI
Author(s): Anastanzia Nancy Chisambio1,2, Pauline Katundu3, David Kulapani1 and Tonney S. Nyirenda1
Affiliation(s):
1.Pathology Department, Kamuzu University of Health Sciences, Blantyre Malawi
2.Blantyre Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre Malawi
3.Medical Laboratory Sciences Department, Kamuzu University of Health Sciences, Blantyre Malawi
Email: achisambo@kuhes.ac.mw

Introduction: Urinary tract infections (UTIs) are among the most prevalent bacterial infections with an annual global estimate of 150 million cases. One of the major contributing factors to treatment failure of uropathogens is antimicrobial resistance (AMR).
Objective: The aim of the study was to assess antimicrobial resistance patterns of uropathogens in large private hospitals in Blantyre, Malawi. Prevalence and resistance patterns of commonly isolated aetiological agents was evaluated over a five-year period; January 2018 – December 2022.
Methods: The cross-sectional retrospective study was conducted at Mwaiwathu Private Hospital (MPH) and Blantyre Adventist Hospital (BAH). Data on all laboratory urine culture results, which included organism identification and antibiotic susceptibility testing (AST) was analysed. Resistance percentage was calculated for uropathogens against several antimicrobial agents that included; ciprofloxacin, nitrofurantoin, gentamicin, amoxicillin, trimethoprim-sulfamethoxazole, augmentin and ceftriaxone, these seven are the antimicrobial agents listed in the Malawi standard for treatment guidelines (MSTG) as empirical therapy for UTIs.
Results: A total of 384 culture results were included in this study, of which 76.83% and 23.17% belonged to female and male populations respectively. Frequencies of aetiological agents of UTI were; Escherichia coli (62.50%), Klebsiella species (12.24%), Proteus species (11.98%), Staphylococcus species (6.77%), Enterococcus species (3.65%) and Pseudomonas aeruginosa (2.86%). Overall Imipenem and Meropenem had the lowest resistance rates at 2.7% and 2.9% respectively, while ampicillin, trimethoprim-sulfamethoxazole and erythromycin had the highest resistance rates at 80.5%, 86.4% and 91.4% respectively.
Conclusion: The study revealed that UTI remains an important problem in this population. The results showed that most of the isolates had a high level of resistance to commonly prescribed antibiotics. AMR increased over the five-year period. We recommend continuous surveillance of the antimicrobial resistance patterns to inform health care providers on better treatment options in timely fashion.

CANCER
06_001798. FACTORS ASSOCIATED WITH DELAYED PRESENTATION AMONG PATIENTS WITH ORAL CANCER IN MALAWI CENTRAL HOSPITALS
Author(s): N. Lungu1,2, M.Turton1 and M.G Sekhoto1
Affiliation(s):
1.University of Witwatersrand
2.Kamuzu University of Health Sciences, Malawi
Email: nathanlungu82@gmail.com
Introduction: Many patients in developing countries delay in presenting to healthcare facilities for treatment. Oral cancer patients are
prone to delays in visiting healthcare facilities resulting in delayed diagnosis, poor prognosis, disfigurement of patients, and an increase in management costs. Hence this study determined the reasons for the delayed presentation in Malawi Central Hospitals. Objectives: The aim was to assess factors related to health-seeking delay among patients with oral cancer in Malawi’s central hospitals. The objectives were to determine the proportion of oral cancer patients associated with delayed presentation; the socio-economic factors associated with delayed presentation and to assess the site, type, and stage of oral cancer associated with delayed presentation.
Methods: A descriptive cross-sectional study was undertaken of 68 patients presenting with oral cancer in all the dental clinics in Malawi referral hospitals from April 2023 to June 2023. A closed-ended, structured questionnaire was utilised to collect the data. Ethical clearance was obtained from the Witwatersrand University, Human Research Ethics Committee and College of Medicine Research Ethics Committee Malawi.
Results: Thirty-six (52%) were females, fifty-one 75% were illiterate and forty (59%) participants delayed from 3 weeks to six months for treatment. Thiry-six 52.94% participants visited the hospital when in pain and 66.18% (n=45) were not aware of oral cancer. The association in delays and the distance to the nearest HCF (p= 0.000), as well as delay and disclosure of symptoms, was statistically significant (p= 0.000). The most prevalent type of oral cancer was squamous cell carcinoma (SCC) (n=49.72.06%), which primarily affected the buccal mucosa (n=26, 38.24%).
Conclusion: Absence of pain, lack of awareness and distance to the nearest health facility were associated with delay. Education and awareness in primary health care can help prevent treatment delays.

O7_002036. ASSESSING DETERMINANTS CONTRIBUTING TO THE DELAY IN DIAGNOSING PAEDIATRIC CANCER AMONG PRIMARY CARE HEALTH WORKERS IN BLANTYRE
Author(s): Akonda Sulumba, Matthews Jalifu, Kondwani Mponda, and Diana Howse
Affiliation(s):
1.Kamuzu University of Health Sciences;
2.Malawi University of Business and Applied Sciences
Email: Sulumba2019akonda@kcn.unima.mw

Introduction: Cancer is one of the major causes of pediatric mortality globally. Malawi like any other sub-Saharan African country experiences a high burden of paediatric cancer with a mortality rate of about 23%. Some of the contributing factors to this mortality rate are delay in diagnosis and treatment abandonment.
Objectives: This study aimed to assess determinants contributing to the delay in diagnosing paediatric cancer among primary care health workers (PCHW) at Mpemba and Chileka health centers. We assessed PCHW knowledge for paediatric cancer diagnosis, factors associated to knowledge of paediatric cancer, and challenges associated with delayed diagnosis.
Methods: The study followed a quantitative approach. 33 PCHW were randomly selected and interviewed using a questionnaire designed as a quiz. Data analysis was done using Statistical Package for Social Scientists (SPSS) version 13.0.
Results: The results revealed that around 82% of PCHW had little knowledge on paediatric cancer. This was based on little knowledge on definition of different types of paediatric cancers, common causes, risk factors and early warning signs and symptoms of paediatric cancer. The results have also indicated that age, profession, gender, and education background are the common significant determinants relating to PCHW knowledge for paediatric cancer. The study has further revealed that the most common challenges associated with delayed diagnosis were inadequate knowledge of paediatric cancer among PCHW and delay of patients in seeking medical attention.
Conclusion: The study findings have highlighted the need to improve PCHW knowledge for both pre-service and in-service education and community sensitization to promote early diagnosis and treatment of paediatric cancer.

O8_002182. CERVICAL CANCER SCREENING UPTAKE, BEST PRACTICES AND CHALLENGES IN MACRO CLINICS FROM 2021 TO 2023; RETROSPECTIVE COHORT STUDY
Author(s): L. Phiri1, L. Mkandawire1, P. Damiano1, C. Crusoe1, N. Kaunda1, A. Rambiki1, P. Mbulaje1 and C. Udedi1
Affiliation(s):
1.Malawi AIDS Counselling and Resource Organization
Email: lphiri@macromw.org

Introduction: Globally, Malawi has the second-highest age-standardized cervical cancer incidence rate. Cervical cancer screening rates are low in Malawi, despite the country’s reproductive-age women having an HIV prevalence of 11.7%. To address this issue, MACRO integrated cervical cancer screening using Visual Inspection with Acetic Acid (VIA) in ART, HTS, Family Planning and STI clinics.
Objectives: This study aims to analyze the uptake, challenges, and best practices associated with this program from 2021 to 2023 and to analyze uptake of cervical cancer screening in MACRO clinics
Methods: A six-prolonged approach developed by MACRO in October 2021 to improve cervical cancer screening in its clinics across Malawi was used. This included: Specialized Care; Integrated Services; Health Education; Early Detection and Referral; counseling and support and Data-Driven Approach. Program routine data captured in registers and reports over a three-year period (2021-2023) was entered using MS Excel. Data analysis was performed in STATA 17.0 using proportion z-test. The uptake, best practices and challenges of screening services by age, HIV serostatus, and trends were evaluated.
Results: We reviewed 7917 HIV positive women screened for cervical cancer in the period of October 2020 to September 2023. The annual cervical cancer coverage increased (P < 0.0001) from 1810, 59% in 2021 to 3363, 87% in 2022 and further increased (P < 0.0001) to 2744, 91% in 2023. The proportion of VIA positive increased (P < 0.01) from 36 in 2022 to 392 in 2023. VIA positivity rate was higher in women aged 30-45 years than women aged 29 years below (8.8% vs 7.0%). Over the three-year period, only 428 (88%) out of 484 VIA positive were treated in the clinics, 12 % were referred to other facilities. The main challenge of the program was failure to treat VIA positive eligible for thermocoagulation in some facilities due to unavailability of the thermocoagulator and power outage.
Conclusion: The study underscores the success of MACRO’s VIA screening program, demonstrating notable improvements in uptake despite challenges. To sustain these gains, it is crucial to address logistical challenges. Healthcare workers should continue implementing the six-prolonged approach, in improving cervical cancer screening rates and ultimately, women’s health in Malawi.

O9_001850. ACCEPTABILITY, FEASIBILITY AND APPROPRIATENESS OF INTEGRATING HPV SELF-SAMPLING FOR CERVICAL CANCER SCREENING INTO VOLUNTARY FAMILY PLANNING SERVICES IN MALAWI
Author(s): Patani Mhango1, Bianca Kandeya1, Lameck Chinula2,3, Jennifer Tang2,3, Andrew Kumitawa4, Wanangwa Chimwaza1, Princess Kayira1, Razak Mussa1, Agatha Bula2, Effie Chipeta1, Mitch Matoga2, Jennifer Smith5, Victor Mwapasa4 and Luis Gadama6

Affiliation(s):
1.Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
2.UNC Project-Malawi, Lilongwe, Malawi
3.Department of Obstetrics and Gynaecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
4.Kamuzu University of Health Sciences, Department of Public Health, Blantyre, Malawi
5.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
6.Kamuzu University of Health Sciences, Department of Obstetrics and Gynaecology, Blantyre, Malawi
Email: pmhango@kuhes.ac.mw

Introduction and Objective: Despite cervical cancer being preventable through screening and preventive therapy, it remains a burden for Malawi and other low-income countries. The World Health Organization recommends the use of human papillomavirus (HPV) testing for cervical cancer screening (CCS). We assessed the acceptability, feasibility and appropriateness of 2 models for integrating HPV self-sampling for CCS into family planning (FP) services in Malawi.
Methods: We randomised 16 health facilities to two models: Model 1 involved only clinic-based HPV self-sampling, whereas Model 2 included both clinic-based and community-based HPV self-sampling. We conducted a mixed-methods study through in-depth interviews (IDI), focus group discussions (FGD) and a Likert-scale questionnaire. We purposely sampled 193 healthcare providers (nurses and clinicians), laboratory staff, clinic managers and community health workers (CHWs) at early, midline and final trial implementation phases. We audio-recorded IDIs and FGDs and then transcribed and analysed data using Nvivo 12 software and thematic content analysis. Quantitative data were entered directly into tablets using ODK software and analysed using Stata Version 16.
Results: We completed 171 IDIs, 22 FGDs and 272 questionnaires. Providers found both models acceptable because integrating CCS and VFP saved time. Model 2 was acceptable due to trust the community had in CHWs. Availability of equipment and supplies, well-trained personnel, mentorship, staff commitment and teamwork made both models feasible. Workload was reduced for clinicians and nurses, but increased for CHWs and lab personnel. The models were also appropriate because HPV self-sampling was simple and ensured client privacy for those hesitant to undergo a speculum examination for screening. The integration also mitigated fears that women had about speculum exams and dispelled myths and misconceptions around family planning methods.
Conclusion: Both models of the integration of CCS into VFP were acceptable, feasible and appropriate, and provide a platform to rapidly increase the CCS uptake in Malawi.

HEALTH SYSTEMS AND POLICY
O11_002206. REVOLUTIONIZING DISEASE SURVEILLANCE FOR RURAL HEALTH FACILITIES IN LOW-INCOME COUNTRY: MOBILE HEALTH SOLUTIONS IN HOSPITALS
Author(s): Alfred Matengeni1, Ernest Matola1, Paulo Filimone2, Peter Ntenda1, Christopher Chikhosi Stanley1, Samson Gowa1, Harrison Msuku1, Wangisani Kumalakwaanthu1, Charles Mangani3, Lauren Cohee4, Karl Sydel5, Terrie Taylor5, Don P. Mathanga1,3, and Clarissa Valim3,7
Affiliation(s):
1.MAC- Communicable Disease Action Center (MAC-CDAC),
2.Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
3.Philimone’s Group, 25 de Junho, 299, Maputo, Mozambique. 3School of Global and Public
4.Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
5.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
6.Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
7.Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Email: amatengeni@mac.kuhes.ac.mw

Introduction: Traditional hospital systems with networked screens at treatment points are expensive and power-hungry. While effective, they are often unaffordable for low-income and rural institutions. On the other hand, mobile apps like ODK provide a cost-effective solution for data collection in remote areas, needing just a mobile device. These apps work offline and require internet access only for data synchronization. This paper examines the viability of mobile technology for disease surveillance in hospitals in remote, low-income areas of Malawi.
Objectives: To assess effectiveness of mobile technology for hospital surveillance data collection. To evaluate adaptability of mobile technology for managing patients’ hospital visits. To assess Impact of Mobile Technology on Healthcare Resource Utilization.
Methods: We evaluated effectiveness of using mobile technology solution to collect surveillance data in a hospital setting where patients come for sick visits. We implemented mobile system of integration of HDSS using HDS-Explorer and study-specific questionnaires with ODK. The system operated offline on Android devices to collect patient visit data ranging from vitals, diagnosis, and treatment. The data was collected longitudinally for 4 years. Participants visited the clinic voluntarily when unwell.
Results: Out of the total 10,000 clients who were registered in the study, 250 had at least a sick visit. These 250 participants contributed 940 hospital visits. Collected data provided valuable insights into disease trends, their distribution by villages, and supported targeted interventions. The mobile application’s adaptability facilitated seamless movement for the study nurse across treatment rooms, ensuring comprehensive data coverage without gaps.
Conclusion: This effective, streamlined approach has the potential to replace the need for on-site servers and complex network infrastructure, using just a tablet and an internet-connected server for data synchronization. This innovative approach in low-income country healthcare, seen in Malawi, underscores the transformative impact of mobile health solutions on healthcare and patient outcomes.

O12_002276. LEVERAGING DASHBOARDS IN RESEARCH FOR EAGLE-EYEING OF NATIONWIDE PROJECT MONITORING AND QUALITY ASSURANCE IN REAL-TIME FIELD ACTIVITIES
Author(s): Harrison Msuku1, Alfred Matengeni1, Ernest Matola1, Peter Ntenda1, Samson Gowa1, Wangisani Kumalakwaanthu1, Vincent Samuel Phiri2, Alfred Chimala1, Christopher Chikhosi Stanley1, Charles Mangani2, Madalitso Zulu3, Tisungane Mvalo3, Victor Mwapasa2, and 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.University of North Carolina Project – Malawi, Private Bag A 104, Lilongwe, Malawi
Email: hmsuku@gmail.com

Introduction: The extensive scope of nationwide field research diverts the focus of supervisors and investigators from their primary responsibilities to project progress monitoring requiring frequent travel and phone calls. Online dashboards have emerged as a solution to this issue, offering improved oversight. This paper evaluates the dashboard’s role in eagle-eyed monitoring of nationwide project activities for real-time quality assurance.
Objectives: We aimed to (1) evaluate the effectiveness of online dashboards. (2) assess improvements in transparency and accountability and measure the cost-effectiveness of implementing online dashboards.
Methods: We deployed 60 research assistants across 10,947 villages and 181 health facilities in 9 districts to collect data using ODK forms on tablets every 30 days for 4 years (2019-2023). We implemented an online dashboard of PHP and highcharts platform interfaced with MySQL database hosting ODK Aggregate. This system enabled us to calculate statistics and generate visual representations of visited and unvisited villages and health facilities within the prior 30-day period. Villages with missing data were flagged in red on another section of the dashboard. Supervisors from district offices daily accessed the dashboard to see field progress by accessing data uploaded to the server by field workers. Each district had a dedicated supervisor who retrieved daily data uploads summaries.
Results: During the 4 years, the system tracked 17,556 facility death notifications, 16,4459 verbal autopsies, 10,692 facility visits, and 293,161 community visits. Clusters failing to report data were flagged in red, signifying the need for intervention. Based on insights from summary progress statistics on the dashboard, senior researchers promptly contacted district supervisors for quick intervention where needed. Supervisors followed up with research assistants using the flagged list of villages and health centers with missing monthly data.
Conclusion: Online dashboards have potential to enhance nationwide project oversight, ensuring quality assurance through improved transparency, accountability, and cost-effectiveness.

O15_002005. IMPROVING MINERS’ ACCESS AND DIAGNOSTIC CAPACITY OF TUBERCULOSIS AND OCCUPATIONAL LUNG DISEASE SERVICES THROUGH MOBILE DIAGNOSTIC UNITS
Author(s): Yotam Moyo1, Madalitso M’manga2, Tisungane Mwenyenkulu2, Levi Lwanda1, Kuzani Mbendera2, and James Mpunga2
Affiliations:

1. Southern Africa Tuberculosis and Health Systems Support Project, Malawi
2. National Tuberculosis and Leprosy Elimination Program, Malawi
   Email: mgonjetsi@gmail.com

Introduction: The Southern Africa Tuberculosis and Health Systems Support Project implemented a piloted initiative on integrated primary care mobile occupational health services into an existing community mobile diagnostic unit (MDU), with the aim of increasing the access to tuberculosis and occupational lung disease (OLD) screening to improve the disease management services in Malawi.
Methods: The intervention used one of the existing MDUs to offer an integrated screening and management of Tuberculosis and pneumoconiosis among mine workers. We explored the impact of a training conducted in December, 2022 based on the modified version of the International Labour Organization (ILO) guidelines for International Classification of Radiographs for Pneumoconiosis (ICRP) which was offered to local staff working in that MDU and referral health care facilities. The impact was specifically assessed on the access, diagnosis and management of occupational diseases among mine workers between the years 2022 (before the intervention) and 2023 (after the intervention).
Results: Implementation of the intervention resulted in an increase of more than two folds in the number of mine workers screened in the same implementation area from 379 in 2022 to 925 in 2023 after the intervention. Tuberculosis cases detection rate increased from 0.05% to 1% while pneumoconiosis detection increased from 0% to 7% in the same comparison periods following the intervention. However, there was no observed differences in the medical management of tuberculosis between the two periods. Furthermore, there was no improvement in the workplace management for both tuberculosis and pneumoconiosis despite the high yield of cases detected.
Conclusion: Integration of primary occupational health services in mobile diagnostic units can markedly increase access as well as the diagnostic capacity of Tuberculosis and occupational lung diseases among at risk populations in Malawi.

INFECTIOUS DISEASES (MALARIA)
O17_002138. ASSESSING THE IMPACT OF INDOOR RESIDUAL SPRAYING (IRS) ON MALARIA VECTORS IN SALIMA AND NKHATA BAY DISTRICTS: INSIGHTS FROM THE HUMAN BLOOD INDEX AND LONGEVITY
Author(s): Sande F1, Chiumia M1, Uzalili V 1, Banda C 1, Chamdimba L 1, Kapito G 1, Kamwana M 1, Dandalo L 2, Mathanga D 1, and Mzilahowa T 1
Affiliation(s):
1.Malaria Alert Centre-Communicable Disease Action Centre
2.Abt Associates, U.S President’s Malaria Initiative – Evolve Project, Malawi
Email: fsande@mac.kuhes.ac.mw

Introduction: Indoor residual spraying (IRS) aims to reduce malaria transmission by either deterring or killing mosquitoes that enter treated houses to rest before or after feeding and hence reducing their longevity as well as their contact with humans.
Objective: This paper investigates the effects of IRS on Anopheles arabiensis and Anopheles funestus sensu stricto, two primary vectors in Malawi.
Methods: Mosquito samples were collected in two districts namely Nkhata Bay (treatment arm where IRS was implemented) and Salima (Control arm without IRS). Samples were collected using human landing catches, pyrethrum spray catches and CDC light traps for total of 54 sampling days in each district from July 2022 to June 2023. A sub-sample of mosquitoes was dissected to determine their parity status which was used to estimate longevity. Blood meal analysis was conducted using conventional polymerase chain reaction (PCR) on engorged mosquitoes to ascertain the source of their blood meals.
Results: In Nkhata Bay, an IRS district, the longevity in both species declined after the spraying. For An. arabiensis, the lifespan dropped from 3.8 to 3 days, and for An. funestus s.s., it decreased from 7.2 to 4.5 days. In contrast, in Salima, a non-IRS district, the lifespan showed an increase for both An. arabiensis (from 2.6 to 6.1 days) and An. funestus s.s. (from 1.9 to 4.3 days) during the same period. The human blood index (HBI) in Nkhata Bay decreased from 0.67 to 0.5 after the IRS intervention, indicating a reduced preference for human blood by the Anopheles mosquitoes. Conversely, in Salima, the HBI increased from 0.5 to 0.73.
Conclusion: The results unequivocally demonstrate that IRS has significantly diminished the lifespan and impeded the blood-feeding habits of both An. arabiensis and An. funestus s.s. Therefore, the ongoing implementation of IRS is imperative for the continued effectiveness of malaria control efforts in Malawi.

O18_002257. RTS,S/AS01 MALARIA VACCINE DOES NOT INCREASE MORTALITY RISK IN CHILDREN: A SELF-CONTROLLED CASE-SERIES STUDY
Author(s): Noel Patson1, Patrick Musonda2, Mavuto Mukaka3,5, Christopher Stanley1, Alfred Chimala1, Peter Ntenda1, Harrison Msuku1, Jobiba Chinkhumba1, Tobias Chirwa4, Victor Mwapasa1, and Don Mathanga1
Affiliation(s):
1.Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
3.Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
4.Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
5.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Email: npatson@kuhes.ac.mw

Introduction: Phase III trial of RTS,S/AS01 malaria vaccine detected a safety signal of increased mortality although it was based on insufficient data. In practice, it is challenging to identify the best comparison group to those who received the vaccine. Leveraging the WHO-commissioned population-level malaria vaccine implementation program (MPVIP) in Malawi, we carried out self-controlled case series(SCCS) study that offers a solution by providing an alternative to the conventional epidemiological study designs. SCCS requires no separate controls and fixed confounders are automatically controlled for.
Objective: To investigate the association between RTS,S/AS01 vaccine and death among children who had received at least a single dose of RTS,S/AS01 vaccine, prior to death
Methods: The ascertainment of exposure to RTS,S/AS01 vaccine was based on the documented immunization history found in health passports of the deceased child. The post-vaccination observation time for each dose covered 30 days from the time of any of four doses that were delivered. We assessed the risk of death within two risk time intervals; 1 to 3 days and 8 to 14 days after vaccination such that the control periods were 4 to 30 days and 15 to 30 days respectively.
Results: We analysed 531 cases who had received at least a single RTS,S/AS01 dose of whom 253 (47.7%) were girls. We observed 531, 423, 327 and 49 first, second, third and booster doses respectively.
Conclusion: Overall, there was no evidence of difference in risk of death within risk periods post-vaccination, regardless of gender. For instance, risk of death within 4-14 days post-vaccination compared to the control period risk was 0.81 (95% CI: 0.53, 1.23; p=0.320); the observed relative risks were 0.78 (95% CI: 0.43, 1.39; p=0.396) and 0.86 (95% CI: 0.48, 1.56; p=0.627) for girls and boys respectively. These findings highlight that the earlier observed mortality safety signal, could have risen due to chance.

O19_002193 RTS,S MALARIA VACCINE COMBINED WITH PYRETHROID-PIPERONYL BUTOXIDE-LONG-LASTING INSECTICIDAL NETS (PBO-LLIN) PROVIDES ADDED PROTECTION AGAINST PLASMODIUM FALCIPARUM INFECTION COMPARED WITH PBO-LLIN ALONE
Author(s): Peter A. M. Ntenda1, Alfred M. Matengeni1, Lauren Cohee2, Mark L. Wilson3, Alick Sixpence4, Hillary Katsabola1, Noel Patson1, Karl B. Seydel5, Miriam K. Laufer2, Terrie E. Taylor5, Clarissa Valim6 and Don P. Mathanga1,7

Affiliation(s):
1.Malaria Alert Centre, Kamuzu University of Health Science, Blantyre, Malawi,
2.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA, Baltimore, MD, United States,
3.University of Michigan, Michigan, MI, United States,
4.Department of Epidemiology and Department of Global Health, Boston University, School of Public Health, MA, USA,
5.Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA,
6.Department of Global Health, Boston University, Boston, MA,
7.School of Global and Public Health, Kamuzu University of Health Science, Blantyre, Malawi.
Email: peterantenda@yahoo.com

Introduction: Both PBO nets and RTS,S vaccine have independently demonstrated their effectiveness against malaria.
Objective: To investigate whether the addition of RTS,S vaccine to PBO nets is more effective in preventing Plasmodium falciparum infection compared to the use of PBO nets alone.
Methods: We conducted data analysis on a cohort of 776 children, ranging in age from 7 months to 10 years, as part of a prospective, community-based longitudinal study conducted in rural Malawi. Index children aged 7-18 months received 3 doses of RTS,S and PBO nets, while those aged 19 months to 10 years (siblings) received PBO nets only. Capillary blood samples were collected at enrollment (month 0), and at 2, 4, and 6 months thereafter, for detection and quantification of P. falciparum using qPCR targeting the 18s rRNA gene. The effect of adding RTSS to PBO nets compared to PBO nets alone was estimated using multivariable generalized estimating equation models after adjusting for other predictors including age.
Results: Overall, 66% (401/607) of children received both PBO nets and the RTS,S vaccine, while the remaining 34% (206/607) received only PBO nets. All children were considered, contributing to a combined follow-up time of 325 person-years. Notably, the PBO-alone nets group exhibited 376 infection events per 100 person-years at risk, whereas the RTS,S+PBO group demonstrated 157 events per 100 person-years at risk. The adjusted incidence rate ratio (IRR) for children who exclusively received PBO nets was twice that of children who had also received the PBO+RTS,S vaccine (IRR: 2.11; 95% CI: 1.62-2.75).
Conclusions: Our findings show a significant reduction in the risk of malaria parasitemia in the PBO+RTS,S vaccine group compared to the PBO-alone group. These results suggest that incorporation of RTS,S vaccination alongside PBO nets can effectively reduce P. falciparum transmission and infection.

O20_001837. TOLERABILITY OF 6-DIAZO-5-OXO-L-NORLEUCINE (DON) IN MALAWIAN ADULTS
Author(s): J. Mallewa1, B. Riggle2, N. Nampota-Nkomba1, O. Nyirenda1, M.P. Fay2, M. Gopalakrishna3, S.K. Pierce2, N. F. O’Brien4, L. H. Miller2, Y. Chimalizeni1, A. Liomba1, N Dzabala1, N. Nyoloka1, K. Zuze3, N. Moodley3, M. Lauren5, and D. Postels6.
Affiliation(s):
1.Kamuzu University of Health Sciences
2.National Institute of Allergy and Infectious Diseases, USA
3.University of Maryland School of Pharmacy, USA
4.Nationwide Children’s Hospital, USA
5.University of Maryland School of Medicine, USA
6.The George Washington University/ Children’s National Medical Center, USA”
Email: jmallewa@kuhes.ac.mw
Introduction: The current standard of clinical care for pediatric cerebral malaria (CM) is intravenous antimalarials and supportive care. We identified the glutamine-antagonist, 6-diazo-5-oxo-L-norleucine (DON; NSC-7365), as a potential adjunctive therapy for pediatric CM. Prior to testing in children, we evaluated the tolerability of DON in Malawian healthy adults (HA) and adults with uncomplicated malaria (UM).
Methods: We conducted an open-label prospective dose-escalation Phase I clinical trial of a single dose of intravenous DON from August 2022 to July 2023. Ten participants in each group (HA or UM) were administered DON in sequentially increasing doses: 0.1 mg/kg, 1.0 mg/kg, 5.0 mg/kg, or 10 mg/kg. We collected safety laboratory studies and assessed clinical and laboratory-based adverse events (AEs) for the first 2 weeks after DON administration. Participants were followed for 6 months.
Results: Forty HAs and 38 adults with UM received DON. The most common laboratory-based AE was an asymptomatic transient elevation in creatinine at 12 hours after DON administration. Clinical adverse events, usually gastrointestinal, were uncommon at lower DON doses (0.1 mg/kg or 1.0 mg/kg) but at higher doses (5.0 mg/kg or 10.0 mg/kg) were more frequent. Approximately 50% of participants who received the two higher doses of DON experienced nausea, vomiting, diarrhea, of a combination. There was one severe adverse event, a participant who developed transient bloody diarrhea 36 hours after DON administration. All related AEs resolved rapidly and without sequelae. Types and rates of AEs did not significantly differ between healthy adults and those with uncomplicated malaria.
Conclusions: The tolerability of DON is dose dependent with higher doses (5.0 mg and 10 mg/kg) associated with moderate rates of gastrointestinal AEs, all transient. In future planned clinical trials of children with CM, lower doses of DON (0.1 mg/kg and 1.0 mg/kg) will be administered.

MATERNAL AND CHILD HEALTH 1
O21_002053. MATERNAL DEATH IN MALAWI 2020-2022: CAUSES AND ASSOCIATED FACTORS
Author(s): Jennifer Riches1,2, James Jafali1,2, Marthe Onrust2, Mtisunge Joshua Gondwe2, Owen Musopole3, Linda Nyondo Mipando1,2, and David Lissauer1,2
Affiliation(s):
1.Malawi Liverpool Wellcome programme
2.University of Liverpool
3.Ministry of Health
Email: jenny.m.riches@gmail.com

Introduction: Malawi has a maternal mortality ratio (MMR) of 381 deaths per 100,000 live births(1) and is not expected to meet targets to reduce its MMR to under 140 by 2030(3). To end preventable maternal mortality, its causes must be understood such that interventions to improve maternal health may be implemented effectively. However, no formal analysis of maternal deaths has been conducted since 2015.
Objectives: To describe – (1) Demographic and clinical characteristics of women who died (2) Causes of maternal death (3) Avoidable factors associated with maternal deaths.
Methods: Working with the Ministry of Health, we conducted a secondary analysis of data from a digital maternal health surveillance platform. We extracted and analysed data on deaths occurring from August 2020 to December 2022 from 33 facilities. Deaths reviewed locally were included; those reported but not reviewed were excluded. We used an international classification system (WHO-ICD10-MM) to determine cause of death. Policy recommendations were developed through consultation with key stakeholders.
Results: 1135 maternal deaths were reported during this period, of which 809 were included. The median age of women who died was 27 years (IQR 22, 34). Most deaths occurred in the postnatal period(64.9%); mostly following Caesarean section(51.8%). The leading causes of death were infection(24.8%), postpartum haemorrhage(20.4%) and eclampsia(13.3%). “Healthcare worker” factors were the most common avoidable factors associated with maternal deaths(85%). This included factors such as “inadequate monitoring”, “prolonged abnormal observations without action” and “lack of obstetric emergency skills”.
Conclusion: Maternal deaths in Malawi are primarily caused by infection, postpartum haemorrhage and eclampsia. A disproportionate number of women died following Caesarean section, warranting further investigation. The role of health system factors in maternal deaths was notable. We have compiled a national report on maternal deaths in Malawi together with a comprehensive list of policy recommendations to reduce maternal mortality.

O22_002152. ENDING PREVENTABLE MATERNAL DEATHS: THREE PRIORITIES FOR MATERNAL HEALTH IN MALAWI
Author(s): Mtisunge Joshua Gondwe1, Leonard Mndala1,2, Chifundo Kondoni1, Annie Kuyere1, Bertha Maseko1, Laura Munthali1, Catherine Bamuya3, Rosemary Bilesi4, Henry Phiri4, Fannie Kachale4, Malangizo Mbewe5, Jenny Riches1,2, Maria Lisa Odland1,2, Effie Chipeta6, Elizabeth Chodzaza7, David Lissauer1,2 and Alinane Linda Nyondo-Mipando1,2,8

Affiliation(s):
1.Maternal and Fetal Group, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2.Department of Women’s and Children’s Health, University of Liverpool, UK
3.Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
4.Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
5.Ministry of Health, Quality Management Directorate, Lilongwe, Malawi
6.Department of Sexual and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
7.Department of Midwifery, School of Maternal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
8.Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
Email: mgondwe@mlw.mw

Introduction: The Malawian context poses multifactorial challenges impeding provision of high-quality maternal health services, resulting in high maternal mortality and morbidity rates. Prioritisation of focus areas in health and research is beneficial so that limited resources can be effectively targeted. We conducted a national maternal health prioritisation exercise involving key stakeholders in Salima, Malawi.
Objective: To identify three priority areas for national focus to improve maternal health outcomes/indicators.
Methods: We adapted the Nominal Group Technique (NGT) to reach consensus on priorities following presentation of data and real-life experiences of service users. Four stages were followed: 1) silent individual prioritisation, 2) consolidation of priorities, 3) clarification and discussion at a group level using a prioritisation matrix, and 4) ranking of generated priorities.
Results: Seventy-four stakeholders attended the prioritisation workshop. Individual prioritisation exercise produced 189 priorities. These were then reduced to 40 priorities through a group prioritisation exercise which involved merging of similar priorities and application of a prioritisation matrix. The top two priorities were selected from each group, resulting in 12 priorities. These 12 priorities were reduced to three by the whole group voting (n=57). The top three priorities were: 1) respectful maternity care, 2) information and data management, and 3) strengthening skills of birth attendants. We also captured the rationale why these three were selected. Policy implications and recommendations to effectively support these three priority areas were highlighted.
Conclusion: Achieving national targets for maternal health requires increased focus on respectful maternity care, information and data management, and strengthening skills of birth attendants, that build capacities of staff as agents of change. Stakeholders are encouraged to use these priorities to guide future programme implementation, research investments and to adapt them for country programmes by engaging with national level stakeholders.

O23_002154. IDENTIFYING CRITICALLY ILL CHILDREN IN MALAWI: A MODIFIED QSOFA SCORE FOR LOW-RESOURCE SETTINGS
Author(s): Mercy Kumwenda1,2, Roxanne Assies1,3,4, Ilse Snik3, Gloria Chatima1, Josephine Langton1, Yamikani Chimalizeni 1, Sam T. Romaine5, Job B.M. van Woensel 3,4, Philip Pallmann 6, Enitan D. Carrol 5 , and Job C.J. Calis1,3,4
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Paediatrics and Child Health, Blantyre, Malawi
2.Kamuzu Central Hospital, Department of Paediatrics and Child Health, Lilongwe, Malawi
3.Amsterdam UMC, University of Amsterdam, Department of Global Health and PICU, Amsterdam Institute for Global Health and Development and Emma Children’s Hospital, Amsterdam, the Netherlands
4.Amsterdam Public Health, Global Health and Quality of Care, Amsterdam, the Netherlands
5.Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
6.Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
Email: roxanne.assies@gmail.com

Introduction and Objective: In low-resource settings, a reliable bedside score for timely identification of children at risk of dying, could help focus resources and improve survival. The rapid bedside Liverpool quick Sequential Organ Failure Assessment (LqSOFA) uses clinical parameters only and performed well in United Kingdom cohorts. Our objective was to develop a similarly quick clinical assessment-only score for paediatric populations in sub-Saharan Africa.
Methods: In a development cohort of critically ill children in Malawi, we calculated the LqSOFA scores using age-adjusted heart rate and respiratory rate, capillary refill time and Blantyre Coma Scale, and evaluated its prognostic performance for mortality. An improved score, the Blantyre qSOFA (BqSOFA), was developed (omitting heart rate, adjusting respiratory rate cut-off values and adding pallor), subsequently validated in a second cohort of Malawian children, and compared with an existing score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC).
Results: Mortality was 15.4% in the development (N=493) and 22.0% in the validation cohort (N=377). In the development cohort, discriminative ability (AUC) of the LqSOFA to predict mortality was 0.68 (95%-CI: 0.60-0.76). The BqSOFA and FEAST-PET yielded AUCs of 0.84 (95%-CI:0.79-0.89) and 0.83 (95%-CI:0.77-0.89) in the development cohort, and 0.74 (95%-CI:0.68-0.79) and 0.76 (95%-CI:0.70-0.82) in the validation cohort, respectively.
Conclusion: We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as a more complex score. The BqSOFA might be used to promptly identify critically ill children at risk of dying and prioritize hospital care in low-resource settings.

024_001922. MONITORING CRITICALLY ILL CHILDREN IN MALAWI: A QUALITATIVE STUDY
Author(s): Daniel Mwale1,2,7, Lucinda Manda-Taylor2, Alice Likumbo5, Michael Boele van Hensbroek1,3,7, Job Calis2, 3,7, Wendy Janssens4,7 and Christopher Pell1,6,7
1.Department of Global Health, Amsterdam UMC, University of Amsterdam, the Netherlands.
2.Kamuzu University of Health Sciences, Malawi
3.Amsterdam Centre for Global Child Health, Amsterdam UMC, the Netherlands
4.Vrije Universiteit Amsterdam, the Netherlands.
5.Training Research Unit of Excellence, Malawi, Africa
6.Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
7.Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
Email: dmwale@kuhes.ac.mw

Introduction: Critically ill children require close monitoring to facilitate timely interventions throughout their hospital admission. In low- and middle-income countries, effective monitoring is complicated by a high disease burden yet scarce paediatric critical care resources. Objective: This study describes the monitoring practices for critically ill children and examines factors affecting monitoring in a paediatric high-dependency unit (HDU) in Malawi.
Methods: An exploratory qualitative study based on 21 in-depth interviews with healthcare workers (n=12) working in the high dependency unit and caregivers of critically ill children (n=9), and on structured observation of monitoring. Interviews were transcribed and translated for thematic content analysis.
Results: The ward layout, power outages, a lack of human resources, and limited familiarity with the available monitoring devices affected the monitoring of critically ill children admitted to the high-dependency unit. Monitoring was mostly performed intermittently, through clinical observations. Healthcare workers prioritized the sickest children for more frequent or continuous monitoring using the available devices. Caregivers, who were usually present throughout admission, were involved informally in flagging possible deterioration to the healthcare staff.
Conclusion: Opportunities to improve the monitoring of critically ill children in high dependency unit include ongoing training of healthcare workers to effectively allocate and employ the available devices, and/or supporting caregivers to play a more formal role in escalation. In lower-resource critical care settings, healthcare staff need support to allocate effectively the available resources for monitoring admitted children. In the absence of adequate devices, this includes training and support for prioritisation of the most ill. Staff are also likely to benefit from dedicated training on available devices. Although caregivers are often involved in monitoring critically ill children, they could benefit from a formal induction to the high-dependency unit and instruction on when to call for help.

O25_002199. IMPLEMENTING NEWBORN ESSENTIAL SOLUTIONS AND TECHNOLOGIES TO IMPROVE NEWBORN QUALITY OF CARE IN MALAWI
Author(s): Samuel Ngwala1, Msandeni Chiume1, Mercy Jere2, Evelyn Zimba1 and Kondwani Kawaza1.
Affiliation(s):
1.Kamuzu University of Health Sciences, Malawi.
2.Ministry of Health, Quality Directorate Management
Email: sngwala@medcol.mw

Introduction: Neonatal mortality rate is still high, accounting for 45% of under-five deaths globally, and sub-Saharan Africa contributes about 38%. Despite the major investments by countries in the region through Every Newborn Action Plans, there is little impact shown toward small and sick newborn (SSNC) care. There is a need to invest in scientific quality improvement (QI) programs to ensure quality in service delivery.
Objective: To document evidence-based quality improvement interventions toward small and sick newborn care.
Methods: A quasi–experiment design was used to assess the impact of the Newborn Essential Solutions and Technologies program QI approach on sick newborn quality of care improvement. A team of QI facilitators was trained and facilitated SSNC quality improvement processes in 36 facilities in Malawi, from quarter three in 2021 to quarter four of 2022.
Results: Vital signs measurement improved significantly during the implementation of the quality improvement visits. Glucose measurement increased from 75%[IQR; 60-85] to 85%[IQR; 65-100]. Continuous Positive Airway Pressure usage increased from 21% [IQR; 15-30] to 25%[IQR; 10-30].
Conclusion: Quality Improvement visits have proved to be effective in closing facility-specific gaps for small and sick newborn care. The hospital management teams, and different stakeholders should put their efforts together, to improve small and sick newborn care at the facility, regional, and national levels through quality improvement processes for the countries to achieve Sustainable Development Goal 3.2
Keywords: Newborn Care, Quality Improvement, Newborn Essential Solutions and Technologies.

SOCIAL SCIENCE IN HEALTH
O26_001908. KNOWLEDGE, ATTITUDES AND PERCEPTIONS OF SEXUAL CONSENT AMONG UNIVERSITY STUDENTS IN BLANTYRE, MALAWI: A STUDY IN TWO PUBLIC UNIVERSITIES
Author(s): Kundai Chipo Watambgwa1, Newton Lupwayi1, and Rudo Masendeke1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: rudomasendeke@gmail.com
Introduction: The urgent matter of sexual assault on university campuses worldwide underscores both its physical and non-physical expressions, afflicting a substantial number of victims with a variety of psychological issues. In Malawi, this predicament is also on the rise, particularly among female students. The scarcity of discourse concerning sexual matters within African culture compounds the issue. Sexual consent fundamentally shapes the definition of sexual assault, it becomes absolutely crucial that we gain insight into students’ knowledge, attitudes, and perspectives on this subject.
Objectives: To determine the level of knowledge, attitudes and perceptions of sexual consent among university students enrolled at the Malawi University of Business and Applied Science and Kamuzu University of Health Sciences.
Methods: This research employed a cross-sectional design, utilizing a mixed-methods approach across two Blantyre-based public universities: MUBAS and KUHeS. Our study comprised university students aged 18-25. We obtained a sample size of n=74 for quantitative data and n=15 for qualitative in-depth interviews. The in-depth interview transcripts were analyzed by manually to identify codes, generate categories and themes. Qualitative data used Thematic Content Analysis, while quantitative questionnaire data was entered into SPSS for analysis. Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were utilized to illustrate patterns in the three variables.
Results: Analyzing responses, two themes surfaced: a) the significance of sexual consent and b) the intricate and multifaceted aspects of sexual consent. Furthermore, the quantitative aspect exposed incongruities between students’ attitudes and perceptions and their actual behaviors. Additionally, discontentment emerged regarding the manner in which sexual consent was taught within educational institutions.
Conclusion: This study underscores the necessity for more exact delineations of sexual consent and enhanced instruction on requesting such consent, given its ramifications for both parties. It highlights the paramount importance of addressing this matter within Malawi’s educational institutions.

O27_002143. ‘THEY PICK UP SMALL STICKS SAYING, DEATH REMAIN WITH YOU’: CULTURAL BELIEFS, RITUALS AND PRACTICES OF COMMUNITY LEADERS FOLLOWING PERINATAL DEATHS IN CHIKWAWA DISTRICT.
Author(s): Dalitso Ndaferankhande 1, Chisomo Petross 2, Josephine Tenthani 1, Robert Stewart 3, David Lissauer 1,4 and Moses Kumwenda 1,5

Affiliation(s):
1.Malawi Liverpool Wellcome Trust Clinical Research Programme
2.Kamuzu University of Health Sciences
3.University of Edinburgh
4.University of Liverpool
5.Helse Nord TB Initiative
Email: dndaferankhande@mlw.mw

Introduction: The prevalence rate of perinatal deaths, including stillbirths and early neonatal deaths, are significantly higher in Sub-Saharan countries (19.9%-24.8%) compared to higher-income countries (2.9%-3.0%). Deaths are traumatizing to individuals and may trigger the onset of anxiety, depression, stigma, and self-isolation. Social support is a protective factor but the provision of this may be influenced by contextual cultural beliefs and practices. Few studies have highlighted the impact of contextual traditions on the provision of social support as a form of social capital. Understanding contextual social dynamics and relationships is useful in managing psychosocial needs of bereaved families.
Objective: The study explored the commonly held contextual social beliefs, rituals, and cultural practices associated with perinatal deaths in Chikwawa District.
Methods: A cross-sectional qualitative design was employed to understand beliefs and ritual practices observed and performed when perinatal death occurred. Data was collected through (N=1) focus group and (N=2) in-depth interviews with religious (N=3) and Community leaders (N=9). Study participants from the community were purposefully selected based on their experience and knowledge of the perinatal death phenomena. Data was coded manually using both inductive and deductive approaches and thematic analysis was applied to identify the common patterns within coded data.
Results: We found that the community’s rituals and practices around perinatal deaths differed with adult deaths. Support following perinatal deaths was provided. However, the type and extent of support depended on these three themes: 1) The perceived identity of the baby, 2) cause of death 3) tribal group.
Conclusion: Cultural rituals and practices following perinatal deaths were marked with rushed burials and void of public mourning and condolence practices. The lack of the public recognition of perinatal deaths may affect the mental health of families. There is need to work with communities to address practices to manage the psychosocial needs of families.

O28_002145. UTILIZATION OF SEXUAL REPRODUCTIVE HEALTH SERVICES AMONG YOUNG PEOPLE LIVING WITH HIV IN NAIROBI, KENYA
Author(s): Nomsa Phiri1, Susan Mambo1, and Careena Otieno Odawa2
Affiliations:
1.Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, School of public Health
2.Great Lakes University of Kisumu – Department of Community Health
Email: nphirimd@gmail.com

Introduction: The consequences of poor sexual reproductive health services utilization outcomes are more compounded for young people living with HIV compared to their peers1. Kenya has little evidence to showcase the utilization of the services among adolescents and young people living with HIV. Nairobi County has one of the highest HIV burdens in the country.
Objectives: To assess the determinants of the utilization of sexual reproductive health services among young people living with HIV aged 15-24 years attending HIV clinics.
Methods: A health facility-based cross-sectional study design was used. Purposive sampling with predetermined criteria was used to select six public health facilities in 6 sub-counties of Nairobi. Data collection was conducted using questionnaires. Sociodemographic, sexual behavioural and facility factors were assessed. The outcome variable utilization was coded as low utilization if one used 0-1 service in the last 6 months and average utilization if one used more than 1 service in the last 6 months. Stepwise binary logistic regression was used to measure the associations.
Results: 253 participants were interviewed during June 2023. Out of the participants, 69% were female. The mean age was 20 years. 53% (134) of the participants had low utilization and 47 % had average-high utilization. Collection of condoms (45.7%) was most utilized while treatment of sexually transmitted infections (8.2%) was the least utilized. Female gender (AOR: 3.60 95%Cl: 1.67-6.40), increase in age (AOR: 2.27 95%Cl: 1.11-4.65), HIV status disclosure to a sexual partner (AOR: 2.00 95%Cl: 1.11-3.80) and privacy for sexual reproductive health services at a health facility (AOR: 3.27 95%Cl: 1.42-7.60) were factors significantly associated with average utilization.
Conclusion: Although this vulnerable population has frequent contact with healthcare providers, utilization is low. Stakeholders are recommended to put more emphasis on behavioural interventions to promote male involvement and HIV disclosure to sexual partners.

O29_001909. DISRUPTED TRANSITION TO ADULTHOOD: CAUSES AND EFFECTS OF DIVORCE AT A YOUNG AGE IN RURAL MALAWI
Author(s): Estelle McLean1,2, Albert Dube1, Mia Crampin1,2, Emma Slaymaker2 and Rebecca Sear2
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit
2.London School of Hygiene and Tropical Medicine
Email: estelle.mclean@lshtm.ac.uk

Introduction: Marriage is almost universal in rural Malawi and is a key marker of adulthood. Divorce is also common, particularly if young, and if the marriage was due to a pregnancy. Some research has suggested that divorce at a young age may ‘reset’ the transition to adulthood as it may enable the young person to restart school and improve their prospects. In Malawi, children are expected to stay with the mother following divorce, and the ex-husband is often seen as comparatively unburdened. However, some studies have recognised a more nuanced picture of the effect of young marriage and divorce on men, who also experience effects on their education and well-being. Objective: Data from the Karonga Health and Demographic Surveillance Site in Malawi is used to explore the effects of gender and child-bearing on first marriage, divorce and remarriage and on other adulthood markers following a divorce.
Methods: Data from 2004 to 2017 were included. 5 analyses were carried out: 1. Survival analysis including participants who were never married at the age of 15 examining outcome of first marriage within 10 years; 2. Survival analysis including participants with first marriage before the age of 20 (women) or 22 (men), examining outcome of marital disruption; 3. Survival analysis including participants divorced before the age of 20 (women) or 22 (men), examining outcome of remarriage. The main explanatory variable was time-varying, indicating having or expecting a child [analyses 1 & 3] or indicating the timing of the first birth (pre-marital or within marriage conception) [analysis 2]. 4. Logistic regression including one record per participant at age 20 (women) or 22 (men), with binary outcome of living without parents; 5. Logistic regression as above, with binary outcome of currently in school. For analysis 4 & 5 the interaction between marital status (only never married or divorced) and having children was assessed. Models in all 5 analyses were controlled for age, year, socio-economic status, household composition and information about spouse where relevant.
Results: For men, having or expecting a child was associated with higher chance of first marriage; for women having a child was associated with lower chance and expecting a child with higher chance. Birth within marriage was protective against marital disruption for men; for women pre-marital conception was associated with higher chance of disruption. For divorced men, having a child was associated with lower chance of remarriage; for women, having and expecting a child were associated with lower chance. Divorced men and women were more likely to live without their parents, compared to their never married counterparts. Divorced men and women were much less likely to be in school compared to those who were never married: there was strong evidence that having children made being out of school more likely for divorced women only.
Conclusion: Having children affected marriage and divorce in both men and women. A divorce did not ‘reset’ transition to adulthood for either sex, but women may be more at a disadvantage with respect to returning to school.

030_001961. EXPERIENCES OF LIFE WITH LONG TERM CONDITIONS IN AFRICA: A META-ETHNOGRAPHY
Author(s): Nozgechi Phiri1, Sally Wyke2, Amelia C Crampin1 and Christopher Bunn1
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit, University of Glasgow
2.University of Glasgow
Email: 2717496P@student.gla.ac.uk

Introduction: Long-term conditions are a growing burden for African countries, producing a ‘double burden’ of non-communicable and communicable disease, placing pressure on already strained healthcare services and communities. There is a growing body of research characterizing how long-term conditions are experienced across Africa, but no syntheses have been attempted. Objective: Our study investigates commonalities and differences in experiences of long-term conditions in Africa.
Methods: We conducted a meta-ethnography of qualitative research relating to lived experiences of long-term conditions in Africa, following the eMERGE guideline. We searched Embase, OVID MEDLINE, PsychINFO, Allied Health Literature (CINAHL), SocINDEX and African Index Medicus databases. After screening, full texts were coded in NVivo 14 for first and second order constructwhich were analyzed inductively to generate third order synthesis.
Results: Our search identified a total of 6,311 records. After screening, 56 full texts were included in the review. Research identified experiences of 18 diseases categories in 13 countries. Our preliminary analysis suggests similarities to experiences in other regions. We identified four main themes; a) the search for an explanation for their long-term conditions is central in what has been called ‘a search after meaning, b) long term illness requires a reconstruction of how one thinks of oneself, c) long term illness experience is majorly influenced by poverty and the availability of different forms of healers, d) and these experiences affect how illness is self-managed.
Conclusion: Literature on life with long term conditions across Africa is substantial and there is significant theoretical affinity between this research and research from other regions. However, the diverse contexts covered by the review demand theoretical developments to account for the specificity of chronic illness experiences across African countries.
POSTERS PRESENTATIONS: INFECTIOUS DISEASES (Antimicrobial Resistance)
P1_002219. EFFICACY, EFFECTIVENESS, SAFETY AND ADHERENCE OF SHORT VERSUS LONG DURATION MACROLIDE TREATMENT FOR RESPIRATORY INFECTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Author(s): Maureen Tayamika Ndalama1,2,4, Solomon Mequanente Abay6, Anteneh Belete1, Anthony Emeritus Chirwa4, Laure Ngaunfo5, Katherine L Fielding3, Elizabeth L Corbett2,3 and Titus Divala 2,3,4
Affiliation(s):
1.Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
2.Helse Nord Tuberculosis Initiative (HNTI), Kamuzu University of Health Sciences (KUHES), Malawi
3.TB Centre, London School of Hygiene & Tropical Medicine, London
4.Malawi Liverpool Wellcome Trust Clinical Research Program, Malawi
5.University of Limerick
6.Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University
Email: mndalama@mlw.mw

Introduction: Respiratory tract infections are a cause of death and disability worldwide. Management involves a course of antibiotics for a period of 7-14 days, however prolonged exposure to antibiotics may lead to the development of antimicrobial resistance.
Objectives: We compared the efficacy, safety, and adherence of short-course with long-course macrolide treatment for respiratory tract infections.
Methods: We conducted a systematic review and meta-analysis by searching the Embase, MEDLINE, and Cochrane Central Register of Controlled Trials for randomized controlled trials published from inception to 25 August 2021. Studies that recruited patients with respiratory infections and reported treatment outcomes of at least two macrolide antibiotics given for different durations were eligible. We used Rob 2.0 to assess the quality of studies and a random effects meta-analysis to estimate effects and 95% confidence intervals.
Results: 2695 articles were retrieved. 9 randomized controlled trials published between 1984 and 2005 involving 2900 participants from 27 countries in Africa, America, Asia, Europe, and Oceania were eligible for inclusion. The target respiratory infections were tonsillo-pharyngitis, atypical pneumonia, acute exacerbation of chronic bronchitis, community-acquired pneumonia, sinusitis and upper respiratory tracts infection, community-acquired acute maxillary sinusitis and Group A beta-haemolytic streptococcal tonsillitis/pharyngitis. Short duration treatment did not differ from long duration treatment with respect to efficacy assessed using incidence of treatment failure (RR= 0.88, 95% CI= 0.71-1.09). The proportion of treatment non-adherent participants was also similar between short and long duration macrolide groups (RR= 0.85, 95% CI=0.65, 1.11). The risk of adverse events was lower among patients in the short duration group compared to long duration group (RR =0.88, 95% CI=0.80, 0.96).
Conclusion: We found that short duration treatment is as effective and safe as long duration treatment. This result should inform the design of antibiotic dosages to preserve the lifespan amid the dryness of the product development pipeline.

P2_001923. IDENTIFICATION OF PATHOGENIC MICROORGANISMS IN COSMETIC PRODUCTS FROM MAKE-UP ARTISTS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY
Author(s): Beatrice Mbamba1, Thandizo Kapatsa1, Glory Kadzanja1*, Yohane Kazembe1, Madalitso Kamaliza1, Jeverson Mwale1, Gama Bandawe1, and Petros Chigwechokha1.
Affiliation(s):
1.Biological Sciences Department, Academy of Medical Sciences, Malawi University of Science and Technology
*These authors equally contributed to this work*
Email: beatymbamba@gmail.com

Introduction: Cosmetic products are widely used by women of university-going age. However, these products can be a potential source of infection if contaminated with harmful microorganisms. The objective of this study was to evaluate microbial contamination, in in-use cosmetic products and determine their antimicrobial susceptibility. The study also investigated factors that contribute to microbial contamination of cosmetic products.
Methods: A total of 20 samples were collected from various types of cosmetic products: foundation, concealer, powder, the
beauty blender and brushes, from 4 make-up artists from Malawi University of Science and Technology, Malawi University of Business and Applied Sciences, Catholic University and University of Malawi. Each sample was cultured on 4 types of media making a total of 100 plates. The samples were cultured, and isolated microorganisms were identified by conventional microbiology methods.
Results: From the 20 samples analysed in this study, 19 samples (95%) were positive for various microbial contamination. Seven species of bacteria were identified using biochemical tests with the most isolated bacteria being Salmonella spp. (32.2%) and coagulase-negative Staphylococci (16.4%); and the least isolated bacteria being S. aureus (3.5%) and Pseudomonas spp. (3.5%). Multi-drug resistance was observed in both isolates of S. aureus. 100% of these isolates were resistant to Oxacillin, 50% to Tetracycline, Chloramphenicol and Trimethoprim. 100% of the isolates were susceptible to gentamicin and imipenem.
Conclusion: This study’s results provide vital information on the prevalence and antibiotic resistance patterns of microorganisms in cosmetic products. We show that most of the microbial contamination that occurred was from enteric bacteria, which can be attributed to inadequate disinfection of the hands of the make-up artists and their application tools. We recommend that make-up artists wash their hands before attending to clients, use disinfected cosmetic applicators on each client and usage of latex gloves when applying cosmetic products on clients.

P3_002048. EXPOSURE PATHWAYS TO ANTIMICROBIAL RESISTANT BACTERIA IN SOUTHERN MALAWI: A SANIPATH APPROACH
Author(s): Taonga Mwapasa1, Kondwani Chidziwisano 1,2, Madalitso Mphasa3, Derek Cocker34, Lorenzo Rimella5, Stevie Amos1, Nicholas Feasey3,4 and Tracy Morse6.
Affiliation(s):
1.Centre for Water, Sanitation, Health, and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi
2.Department of Environmental Health, Malawi University of Business and Applied Sciences, Blantyre, Malawi
3.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
4.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
5.Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK.
6.Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK.
Email: tmwapasa@mubas.ac.mw

Introduction: Antimicrobial resistance (AMR) poses severe global health threat, yet the transmission pathways of AMR within communal public environments, where humans and animals interact, remain poorly explored.
Objectives: This study investigates AMR risk pathways, prevalence, and seasonality of extended-spectrum β-lactamase (ESBL) producing E. coli and K. pneumoniae, and observed practices contributing to environmental contamination from urban, peri-urban, and rural Malawi.
Methods: This formative research was conducted in two phases across three study sites. Phase one was conducted in August 2020 using the SaniPath tool, interviews were conducted with community leaders (n=9) to understand community practices that contribute to environmental contamination. Transect walks were also conducted where potential AMR exposure pathways including drains, standing water, soil, and areas of communal hand contact were identified. Subsequently, from September-2020 to August-2021, 1440 samples (n=40/month from each site) underwent culture on chromogenic agar to detect ESBL E. coli and K. pneumoniae in phase two of the study.
Results: Results revealed high ESBL prevalence in urban areas (68.1%, CI: 64.0%,72.3%, p<0.001); mainly in drains (58.8%, CI=55.1%,62.6%, p<0.001) compared to other pathways. Environmental contamination that results in risk pathways was attributed to unavailability and poor conditions of sanitation and hygiene infrastructure based on interviews with community leaders and confirmed by independent observation. ESBL prevalence varied with seasons (p=.004), with the highest in the hot-dry period (55.8% (n=201)). Prevalence of ESBLs also increased with increased urbanisation, high temperatures and increased rainfall (for ESBL E.coli).
Conclusion: Community environments are a crucial component in AMR transmission, evident in the abundance of ESBLs in identified exposure pathways. The poor sanitation infrastructure and practices coupled with the dynamics in seasonality further affect the presence of ESBLs in communal environments, calling for a whole systems approach that tackles infrastructure and behaviour and is driven by context appropriate surveillance and interventions.

P4_002063. ENVIRONMENTAL CONTAMINATION WITH EXTENDED BETA-LACTAMASE PRODUCING BACTERIA FROM WASTEWATER TREATMENT PLANTS IN BLANTYRE, MALAWI
Author(s): Edna Ibrahim1, Charity Mkwanda1, Edward Masoambeta1, Watipaso Kasambala3, Jobiba Chinkhumba1, Rajab Mkakosya1, Janelisa Musaya1, Save Kumwenda2, and Chisomo Msefula1
Affiliation(s):
1.Pathology Department, Kamuzu University of Health Sciences
2.Malawi University of Business and Applied Sciences
3.Public Health Institute of Malawi
Email: ednqibrahim@gmail.com

Introduction: Antimicrobial resistance (AMR) is a significant concern across the human, animal and environmental sectors. One Health solutions to the AMR problem require strategies cutting across the three sectors However, there is little reported on AMR in the environment.
Objectives: This study explored the role of the final discharge from wastewater treatment plants (WWTP) spreading AMR pathogens. Specifically, the study investigated the presence of Extended Spectrum Beta-Lactamase (ESBL) producing E. coli (Ec), Klebsiella pneumoniae (Kp) and Enterobacter cloacae (Enc) from sewage effluent in Blantyre and determined the varied antibiotic sensitivity profiles of the identified bacteria.
Methods: Samples were collected on three consecutive days every week over three months from Soche and Blantyre WWTPs. The samples were filtered through a membrane to concentrate the bacteria, followed by enrichment in BPW. Both selective and non-selective chromogenic agar were used to check for ESBL producing organisms. The presumptive ESBL organisms were confirmed using API 20E biochemical kit. Disc diffusion was used to test for sensitivity of the identified bacteria and antibiotic resistance profiles were interpreted according to the CLSI criteria.
Results: A total of 72 samples were collected of which 68 had ESBL growth providing a total of 122 confirmed ESBL producing organisms. 55 were Ec, 45.1%, 35 were Kp, 28.7% and 32 were Enc 26.2%. Ec and Kp were more significantly identified in samples collected from Soche WWTP (36, 100% and 33, 91.7% respectively) versus Blantyre WWTP (19, 52.8% and 2, 5.6%), P= 0.000. Antibiotic sensitivity tests showed resistance to cotrimoxazole (Ec, 76.4%; Kp, 100%; Enc, 3.1%) doxycycline (Ec, 78.2%; Kp, 71.4%; Enc, 6.2%) ciprofloxacin (Ec, 58.2%; Kp, 51.4%), gentamicin (Ec, 29.1%; Kp, 48.6%; Enc, 3.1%), azithromycin (Ec,54.5%; Kp, 31.4%), and meropenem (Ec, 12.7%).
Conclusion: The study demonstrated ongoing environmental contamination with antibiotic resistant bacteria including ESBL producing bacteria in Blantyre Malawi.

P5_002195. THE IMPACT OF KNOWLEDGE, ATTITUDE, AND PRACTICES ON ANTIBIOTIC USE AND ITS ASSOCIATED FACTORS IN BROILER CHICKENS IN PERI-URBAN AND URBAN AREAS OF BLANTYRE CITY
Author(s): Amon Abraham1, Gertrude Sitolo2, Tabitha Kayira2, Ibrahim Chikowe3, Francis Chiumia3, Happy Nyirongo3 and Bernard Thole2
Affiliation(s):
1.Malawi University of Business and Applied Sciences, Department of Environmental Health, Blantyre, Malawi
2.Malawi University of Business and Applied Sciences, Department of Physics and Biochemical Sciences, Blantyre, Malawi
3.Kamuzu University of Health Sciences (KUHeS), Pharmacy Department, Blantyre
Email: aabraham@poly.ac.mw

Introduction and Objective: Antibiotics are commonly used in livestock farming, primarily in broiler production, for treatment, disease prevention, growth promotion, and disease control, driven by the growing demand for poultry products. A survey was conducted in ten urban and peri-urban areas of Blantyre, involving 50 broiler farmers of varying scales. The study aimed to assess their knowledge, attitudes, and practices (KAP) regarding antibiotic use, analyze antibiotic residues in chicken meat, and explore the relationship between KAP and residue accumulation.
Methods: Chicken meat samples (40 in total) were collected from these farmers and tested for antibiotic residues, specifically ciprofloxacin, sulfamethoxazole, amoxicillin, and trimethoprim. Data on farmers’ KAP were gathered through face-to-face interviews using a structured questionnaire. Descriptive statistics were used to analyze the data, and chi-square tests determined associations with a significance level set at p<0.05.
Results: The results indicated that all farmers used antibiotics for their flocks, with 46% administering antibiotics for any disease. Notably, 62% lacked training in antibiotic use, and 58% were unfamiliar with antimicrobial resistance (AMR). A significant portion (66%) relied on recommendations from fellow farmers. Most farmers (82%) adhered to withdrawal periods, but 38% used antibiotics for longer than recommended in sick chickens. High-Performance Liquid Chromatography (HPLC) screening revealed amoxicillin as the predominant residue (92.5%), followed by trimethoprim (32.5%), ciprofloxacin (10%), and sulfamethoxazole (2.5%). Contamination levels varied among commercial, medium, and small-scale broiler management systems. Amoxicillin residue ranged from 0.058926 to 5.138996 µg/kg, trimethoprim from 0.33909 to 3.25580 µg/g, sulfamethoxazole from 0.058926 to 5.138996 µg/g, and ciprofloxacin from ND to 0.956627 µg/g. All residue levels were within the Maximum Residue Limit (MRL) established by the European Union.
Conclusion: This study identified antibiotic residues in chicken samples from urban and peri-urban broiler farmers in Blantyre. To prevent antibiotic resistance in broiler chickens, prudent antibiotic use is imperative.

P6_001832. EXTENSIVELY-RESISTANT SALMONELLA TYPHIMURIUM DT 104 ISOLATED FROM CHICKEN DROPPINGS; A CASE OF NTCHEU DISTRICT SMALL SCALE POULTRY FARMS
Author(s): Bashir Hussein Joe Merico1 , and Pizga Kumwenda2
Affiliation(s):
1.Department of Biological and Biomedical Health Sciences, University of Malawi, Zomba, Malawi
2.Faculty of Health Sciences, Department of Biomedical Sciences, Mzuzu University, Mzuzu, Malawi
Email: joemerico164@gmail.com

Introduction: Salmonellosis is ranked the second most common zoonotic infection in Europe. In Malawi, Salmonella remains among the leading cause of foodborne illness outbreaks. The dissemination of drug-resistant strains through the food chain directly impacts the treatment failure of infections. This has made surveillance studies in food-producing animals inevitable. Objective(s): To determine the antimicrobial resistance patterns of Salmonella species isolated from Ntcheu poultry farms. To determine the prevalence of multidrug-resistant Salmonella species isolated from Ntcheu poultry farms.
Methods: A cross-sectional study was conducted between September 2022 and October 2022 in Ntcheu District. A total of 44 commercial poultry farms within Traditional Authority Kwataine were targeted. Only 12 poultry farms met the study inclusion criteria. From the farms, chicken-dropping samples were collected aseptically through a multi-stage technique followed by sample pooling. To isolate the desired Salmonella species, all the samples were cultured on Salmonella-Shigella Agar and subcultured on Brilliant Green Agar after initial overnight incubation at 37oc in Buffered Peptone Water. An antimicrobial susceptibility test to determine resistance profiles was performed after the biochemical identification of the isolates. Resistance to more than two antibiotics was regarded as multidrug resistance.
Results: Non-typhoidal Salmonella species were isolated from 5 samples (41.6%). The serotypes isolated included S. typhimurium (60%), S. enteritidis (20%), and S. enterica sub-group 1 (20%). All isolates (n=5) were resistant to Tetracycline and susceptible to Ampicillin except one (n=4). 60% (n=3) of the isolates were identified as multidrug-resistant. 1 isolate, classified as S. typhimurium DT 104 was resistant to all antibiotics used. Interestingly, all multidrug-resistant isolates were from Layer chickens.
Conclusion: Chickens harbour several harmful drug-resistant Salmonella species. There is a need to conduct more surveillance and genome analysis studies to monitor the varied pathogenic strains in food-producing animals and their associated resistance genes and possible implications on the healthcare system.

P7_001862. ANTIMICROBIAL USE IN SMALL-SCALE BROILER FARMING IN LILONGWE DISTRICT
Author(s): Shareef M. Ngunguni1,2, Dishon Muloi1, Chisomo Msefula2, Rajab Mkakosya2 and Arshnee Moodley1,3
Affiliation(s):
1.International Livestock Research Institute (ILRI), Animal and Human Health Program, Nairobi, Kenya
2.Department of Pathology, Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi
3.Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen, Frederiksberg C, Denmark
Email: shareefngunguni1996@gmail.com

Introduction: It is widely documented that small-scale commercial poultry farmers mis(use) antimicrobials for curative and or preventive purposes to compensate for poor husbandry practices. This practice increases the development of antimicrobial resistance (AMR) ultimately, leading to treatment failures. However, there is lack of data describing antimicrobial use decision-making in low- and middle-income countries. Objective: This study aimed to investigate drivers and antimicrobial use practices in small-scale broiler farming.
Methods: A cross-sectional study design was used, conducting face-to-face interviews using a detailed, structured questionnaire from December 2022 to March 2023 in 132 broiler farms, with flock sizes ranging between 50-1000 birds in the Lilongwe district. Descriptive and logistic regression statistics were used to analyze practices and drivers of antimicrobial use respectively using R software
Results: Over half (53.1%, n=68) of the farms reported using an antibiotic at least once in the previous production cycle. Overall, 11 different types of antibiotics were used and the most frequent for treatment and prophylaxis purposes was oxytetracycline (88.2%, n=60), followed by erythromycin (29.4%, n=20), enrofloxacin (26.5%, n=18), trimethoprim (23.5%, n=16), sulfonamides (23.5%,n=16), colistin(20.6%,n=14) and streptomycin (19.1%, n=13). The least used antibiotics were neomycin (10.3%, n=7), doxycycline (5.8%, n=4), tylosin (4.4%,n=3) and amoxicillin (2.9%,n=2). Colistin, streptomycin, and neomycin were commonly used on healthy birds for disease prevention. Farmers primarily obtained antibiotics (63.3%, n=81) and antibiotic usage advice (32%, n=41) from veterinary drug stores. Antibiotic use was associated with incidences of chicken diseases (OR=15.0, 95% CI=5.56-48.2, p-value<0.0001), perceptions on the prophylactic use of antibiotics (OR=10.9, 95% CI=1.86-80.6, p-value=0.01) and entry of wild birds into chicken houses (OR=3.9, CI=1.50-11.3, p-value=0.008).
Conclusion: Inappropriate use of antimicrobials was noted in the study and in a resource-limited setting like Malawi, this study highlights key areas for urgent, targeted actions to reduce imprudent antimicrobial use practices in poultry production.

P8_002127. INVESTIGATING WITHIN FARM PREVALENCE OF E. COLI AND SALMONELLA RESISTANT TO CRITICALLY IMPORTANT ANTIBIOTICS IN LAYERS AND BROILERS CHICKEN FROM LARGE AND SMALL POULTRY FARMS IN BLANTYRE, MALAWI
Author(s): Charity Mkwanda1, Edna Ibrahim2, Edward Masoambeta1, Janelisa Musaya1,5, Jobiba Chinkhumba4, Watipaso Kasambara3, Rajhab Mkakosya1, Nicholas Feasey5 and Chisomo Msefula1,5
Affiliation(s):
1.Pathology Department, Kamuzu University of Health Sciences
2.Physics and Biochemical Sciences, Malawi University of Business and Applied Sciences
3.Public Health Institute of Malawi, AMR- National Coordinating Unit
4.Health systems Department, Kamuzu University of Health Sciences
5.Malawi Liverpool Wellcome Programme, Blantyre, Malawi
Email: charitymkwanda@gmail.com
Introduction: Antimicrobial resistance (AMR) is an existential worldwide threat to human and animal health. Surveillance and monitoring of AMR pathogens is a global health priority to stem the spread of drug resistant infections.
Objective: This study aims to investigate within farm prevalence of E. coli and Salmonella Enterica in layers and broilers chickens.
Methods: A total of 177 samples of fecal droppings (101), cecum (30), water (28), and boot swabs (12) have been collected so far in both layers and broilers chicken farms; the farms include 5 large farms (>50,000 chickens) from Zomba, Chiradzulu and Thyolo and 3 medium farms (at least 3,000 chickens) from Blantyre, Lilongwe and Zomba. The samples were analyzed using routine bacteriological culture and identification procedures for the isolation of E. coli and S. Enterica. 83 Presumptive isolates of interest were confirmed using the Analytical Profile Index 20E Biomereux (France). The identified isolates were tested against carbapenems (Meropenem 10 μg), cephems (ceftriaxone 30 μg), quinoles and fluoroquinoles (ciprofloxacin 5 μg), penicillin (ampicillin 10 μg), folates (trimethoprim/sulfamethoxazole 25 μg), aminoglycosides (gentamicin 120 μg, Tetracycline (Doxycycline) and macrolide (Azithromycin 15ug) for AMR profiling and interpreted using CLSI standards for both E. coli and S. Enterica.
Results: The results portrayed a high presence of E. coli in all samples types, with an identification rate of 54.2% (45/83). Meanwhile only 2 isolates were identified as S. Enterica from boot swabs; all 2 S. Enterica isolates were susceptible to Meropenem, Ciprofloxacin and resistant to trimethoprim/sulfamethoxazole, Doxycycline. E. coli identified isolates showed a 100% resistance to Ampicillin and Doxycycline, an 84.4% resistance rate to trimethoprim/sulfamethoxazole. The lowest resistant rate was to Gentamicin at 14%. Isolates were highly susceptible to Meropenem at a rate of 97.7%. all isolates portrayed a multi-drug resistance pattern as they were resistant to drugs of at least three antimicrobial classes.
ESBL producing E. coli was also identified at a rate of 88.2% by using a selective media, chromogenic agar (CHROMagar TM mixed with the ESBL supplement) and the isolates were resistant to Ceftriaxone.
Conclusion: The findings of this study indicate colonization of both layers and broilers chicken, and its environments with ESBL producing and multi-drug resistant E. coli, and also shows the presence of multi drug resistant S. Enterica. There is a need to regulate AMU and AMR.

P9_002194. PREVALENCE OF MACROLIDE-RESISTANT GENE MARKERS IN THE GASTROINTESTINAL TRACT OF RURAL MALAWIAN CHILDREN AFTER MASS ADMINISTRATION OF AZITHROMYCIN IN MANGOCHI DISTRICT
Author(s): Lyson Samikwa1, Khumbo Kalua1,2, Robin Bailey3, Tonney S Nyirenda1 and David Chaima1
Affiliation(s):
1.Pathology Department, Kamuzu University of Health Sciences, Blantyre Malawi
2.Blantyre Institute for Community Outreach, Blantyre Malawi
3.London School of Hygiene and Tropical Medicine, UK
Email: lsamikwa@kuhes.ac.mw
Introduction: Mass drug administration(MDA) has been implemented as a strategy to control trachoma and other neglected tropical diseases in resource-limited settings. However, concerns have emerged regarding the potential emergence of antibiotic resistance, particularly macrolide resistance, following the widespread distribution of azithromycin. This study investigated the prevalence of gastrointestinal macrolide-resistant gene markers of rural Malawian children in a biannual MDA of azithromycin in Mangochi District. Objectives: This study aims to assess the prevalence of macrolide-resistant gene markers in Malawian children who received azithromycin through Mass Drug administration. Additionally, it seeks to analyze the influence of location and time-point variables on the presence of these macrolide-resistant gene markers.
Methods: A retrospective cross-sectional study was conducted in Mangochi District, Malawi of rural children aged 1-59 months. Stool samples were collected from participants who had received azithromycin as well as from the control group who did not receive the drug. DNA extraction and subsequent PCR assays were done to detect the presence of macrolide gene markers including ermB and mefA.
Results: The study found no significant association between azithromycin treatment and macrolide-resistant markers in Mangochi District in Malawi. However, location and time-point variables significantly influenced marker presence (p < 0.001). Monkey Bay exhibited higher ermB prevalence (28.77%), while Chilipa showed elevated mefA levels (28.49%). The end-line survey had the highest positivity (50.98% mefA, 46.22% ermB). The 13-24 months age group displayed the highest positivity for both genes (22.38% mefA, 23.60% ermB).
Conclusion: This study provides us with no evidence that AZM-MDA may induce macrolide-resistant gene markers. However, location and time point(24 months) can influence the outcome hence a need for further research to elucidate the potential long-term effects on antimicrobial resistance and employ other robust laboratory methods that would tell the diversity, bacterial profiling, and proportion of bacteria carrying resistant gene markers like metagenomics.

P10_001901. TRANSMISSION DYNAMICS FOR INVASIVE NON-TYPHOIDAL SALMONELLA SEROVARS IN AFRICA (TINTS): STUDY PROTOCOL
Author(s): Peter Johnston1,2, Kenneth Chizani3, Chris Jewell4, Nick Feasey2,5, Tonney Nyirenda3 and Melita Gordon1,2
Affiliation(s):
1.University of Liverpool, United Kingdom
2.Malawi Liverpool Wellcome Clinical Research Programme, Malawi
3.Kamuzu University of Health Sciences, Malawi
4.University of Lancaster, United Kingdom
5.St Andrew’s University, United Kingdom
Email: pjohnston@mlw.mw

Introduction: Nontyphoidal salmonellae are the leading cause of community onset bloodstream infection in Africa. Salmonella Typhimurium Multilocus Sequence Type 313 (“ST313”) comprises the majority of invasive isolates, and exhibits genetic adaptation favouring invasion. A viable nidus has not been identified for ST313. The genomes of Salmonella Typhimurium shed in stool are near-identical to bloodstream isolates from the same individual. Genomically conserved isolates of ST313 have been recovered from household contacts of children with bloodstream infection. Objective: We hypothesise that ST313 exploits humans for transmission. Here we present “TiNTS”, a prospective household cohort study that will investigate this. We will simultaneously examine other circulating nontyphoidal Salmonella serovars, and determine the duration of Salmonella stool shedding.
Methods: We will recruit individuals of all ages residing in at least 60 households in Ndirande, Blantyre between November 2023 and November 2024. We will follow households for 28 days, obtaining stool on alternate days. At baseline we will collect nasopharyngeal swabs, perform bootsock sampling of household environments, conduct questionnaires, and obtain household / river water samples. We will test for Salmonella Typhimurium and Enteritidis O-Ag IgG at day 28 (and 28 days after any Salmonella positive stool culture). We will follow individuals who have Salmonella in stool at weekly intervals until two consecutive negative stool samples are demonstrated. Recovered salmonellae will be genome sequenced, and selected samples will undergo metagenomic analysis.
Results: We will prospectively derive household transmission networks. We will determine the duration of stool shedding, serologic responses to de novo colonization, proportions of participants with diarrhoeal and asymptomatic Salmonella carriage, and risk factors for individual / household Salmonella colonization.
Conclusions: Transmission data generated through TiNTS will inform public health interventions including modelling the impact of future vaccines.

P11_002147. IN SILICO DETERMINATION OF DRUG RESISTANCE PROFILES FOR SALMONELLA TYPHIMURIUM STRAINS IN BLANTYRE, MALAWI
Author(s): Albert Mukatipa1, Samuel Gwayi1, Chisomo Msefula2 and Benjamin Kumwenda1
Affiliation(s):
1.Kamuzu University of Health Sciences (KUHeS), School of Life Sciences & Allied Health Professions, Blantyre, Malawi
2.Pathology Department, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
Email: mukatipaalbert@gmail.com

Introduction: Salmonella infections remain a significant public health concern worldwide. Non-typhoidal salmonella causes diarrhoea and in immuno-compromised individuals as it invades sterile parts of the body to cause invasive diseases. Globally, in 2017, iNTS disease caused 535,000 illnesses and 77,500 deaths, sub-Saharan had 85.8% of the deaths. In Malawi, Salmonella Typhimurium MDR became dominant in 2001 (72% isolates) and was sustained until 2008. In 2014, the majority (59%) of isolates remained multi drug resistance (MDR). Emergence of MDR has further complicated the treatment of these infections. Drug resistance has predominantly been determined in the wet lab. Assessment of every strain in the lab for MDR is time consuming and expensive.
Objective: The aim of this project is to use the existing work to classify unclassified strains for MDR to create a knowledge base from which future predictions can be made.
Methods: A total 239 S. Typhimurium strains were subjected to Whole Genome Sequencing. Genomic data from unclassified strains, along with sequences of known drug-resistant and susceptible strains, will be used. Initial work performed MDR analysis on the Salmonella strains on several antibiotics. The u nclassified strains will be matched against strains with known resistance profile based on which genetic features will be determined. The genetic features will be used for future MDR prediction on new strains. Multiple sequence alignment and phylogenetic techniques will be used to identify genetic features and classify strains.
Results: The study will predict drug resistance strains in S. Typhimurium strains using in silico approach at the same time advance knowledge of Salmonella evolution in the context of antibiotic resistance.
Conclusion: A knowledge base from which future MDR predictions will be made on new strains. This will be faster and less expensive than predominant laboratory techniques.

P12_002165. COMPARATIVE ANALYSIS OF THE P13_002306. ECONOMIC COSTING METHODOLOGIES OF DRUG RESISTANT INFECTIONS IN SUB-SAHARAN AFRICA: A SYSTEMATIC REVIEW
Author(s): Edward Masoambeta1, Charity Mkwanda1, Edna Ibrahim1, Chantal Morel2, Chikondi Chapuma3, Kenneth Chizani1,3, Rajhab Mkakosya1, Janelisa Musaya1, Chisomo Msefula1, and Jobiba Chinkhumba1
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi.
2.University Hospital Bonn, Switzerland,
3.Malawi Liverpool Welcome Trust
Email: masoambeta.edward@gmail.com

Introduction: There has been wide research on direct clinical AMR related infections’ burden in both developed and developing countries which include prevalence, morbidity, mortality, and drivers of antimicrobial resistance. AMR surveillance has been a key strategy for identifying and trying to keep AMR on the agenda as one way of reducing mortality due to AMR related infections in developing countries. Unfortunately, many developing countries have not estimated economic costs which would help to determine exact policies and take most fit actions. In most cases, clinical costs have been used to determine expenses associated with AMR infections using projections mostly from developed countries which do not fit their local contexts. Moreover, most economic costs have not been included which tends to undermine the gravity of AMR infections in humans. Additionally, robust methodologies in the estimation of AMR infections’ clinical and more especially economic costs have been lacking. We therefore reviewed the different methodologies that have been used in sub-Saharan Africa to estimate economic costs with the aim to inform researchers of the best methodologies in practice and situations.
Methods: We conducted a literature review in sub-Saharan Africa on costing methods of AMR related infections in humans. The developed selection criteria and Boolean search strategy was applied in papers from social sciences and medical libraries such as PubMed, CINAHL, Embase, Cochrane library, regional database; African journals online, African index medicus, and grey literature. Data was extracted using a modified Covidence template and a JBI modified assessment tool for economic evaluations to assess quality of the papers. Papers were reviewed by country distribution, frequency of types of AMR infections by country, study design and sample size reported, level of costing and the methodologies used to account for various costs based on the country, type of AMR infections and health system levels.
Results: Using PRISMA, 1839 papers were screened at title and abstract level in the Covidence platform out of which 31 were retrieved for full text review leading to 22 full texts included. Most papers (10) had a quality assessment score of 100% while only 1 scored 63% at minimum. Most of the papers were from South Africa (41%) and on TB-MDR. 55% of the studies accounted for costs at health system level. Most studies analysed costs descriptively (10) followed by economic evaluation analyses (2), and modelling and regression techniques with 2 studies each.
Conclusion: Most of the reviewed papers used descriptive statistics indicating lack of plausible costing methodologies in AMR related infections in humans at least in sub-Saharan Africa.

P15_002066. RISK FACTORS FOR KLEBSIELLA PNEUMONIAE INFECTION IN INFANTS LESS THAN 3 MONTHS OF AGE AT QUEEN ELIZABETH CENTRAL HOSPITAL (QECH)
Author(s): Tadala Mzengo1, Oliver Pearse2, Alan Zuza1, Patriciah Siyabu3, Edith Tewesa3, Sam Lissauer1,5, Jen Cornick1,5 and Nicholas Feasey1,2,4
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
2.Liverpool School of Tropical Medicine
3.Kamuzu University of Health Sciences
4.St Andrews University
5.University of Liverpool
Email: tadmzengo@gmail.com

Introduction: Sepsis is one of the leading causes of neonatal death in Malawi. Beta-lactams are crucial for treating neonatal infections. However, cephalosporin-resistant extended-spectrum beta-lactamase Enterobacteriaceae (ESBL-E) infections are increasing. Klebsiella pneumoniae has become the dominant neonatal pathogen in these settings, serving as the primary cause of neonatal infection at Queen Elizabeth Central Hospital (QECH). Risk factors for K. pneumoniae infection in infants need further investigation to identify those at risk, who would benefit from targeted antibiotic therapy, ultimately reducing drug-resistant infection mortality.
Objectives: This study describes the risk factors for K. pneumoniae infection in infants less than 3 months of age in QECH.
Methodology: A case-control study was conducted to investigate risk factors for K. pneumoniae infection. Cases were neonates who had culture confirmed K. pneumoniae sepsis or meningitis. Controls, free of sepsis, were selected with 2:1 matching. Risk factors likely to impact K. pneumoniae exposure were included: birthweight, prematurity, age(days), Maternal HIV status delivery mode, and birthplace. Missing data was dealt with using multiple imputation. Logistic regression was performed with the exposures of interest.
Results: The study included 37 cases and 74 controls. 16% of cases were born in QECH rather than outside QECH. Compared to controls, cases were on average born, 2.69 weeks earlier, 483g [95% CI (185-781)] lower birthweight, 7 days older. In a multivariate logistic regression model increasing birthweight was protective against K. pneumoniae infection (OR 0.13 [95% CI 0.027-0.53], p = 0.006), age (an indicator for ward time) was associated with an increased risk of K. pneumoniae infection (OR 1.03 [95% CI 1.01 – 1.06, p=0.01]. Other variables were not significantly associated with K. pneumoniae infection.
Conclusion: In conclusion, low birthweight neonates are more susceptible to K. pneumoniae infection partly due to vulnerability to infection and longer hospital stays compared to normal birthweight neonates.

P16_002185. PRESCRIBERS PERSPECTIVE OF ANTIBIOTICS RESISTANCE AND PRESCRIPTION PATTERN AT NENO DISTRICT HOSPITAL- A MIXED METHOD APPROACH
Author(s): Priscilla Kalawa1 and Evanson Sambala2
Affiliation(s):
1.Ministry of Health, Neno District Health Office, Neno P.O. Box 52 and School of Global and Public Health, Kamuzu University of Health Sciences
2.Community and Environmental Health, School of Global Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3
Email: priscillakalawa49@gmail.com

Introduction: Antimicrobial Resistance (AMR) has emerged as one of the leading public health threats of the 21st century. Occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat.
Objectives: To explore the influence of Prescribers perspective of antibiotics resistance and prescription pattern at Neno district hospital from January 2020 to December 2021. To investigate the prevalence of antibiotic use at Neno District Hospital. To investigate the pattern of prescription of antibiotics at Neno district hospital. To assess prescriber’s perspective on antibiotic resistance at Neno district hospital
Methods: We conducted a mixed method study study in Neno District Hospital which looked at the prescriber’s perspective of antibiotic resistance and prescription pattern. In-depth interviews were conducted with health workers using a purposive sampling technique. Patients’ files (n=400) were systematically sampled for review. Descriptive statistics, including mean and standard deviation were used for continuous variables. Frequency and percentage for categorical variables were used to summarize socio-demographic and relevant characteristics of the study and the prescribing pattern of antibiotics.
Results: Out of the 400 patient files that were reviewed, (77%) patients were prescribed antibiotics. The age group most subjected to antibiotics were those aged between 0 to 15 years (42.3. Benzylpenicillin (25.7%) from the penicillin class was the most frequently administered, followed by Gentamycin (23.8%) from the aminoglycosides class and Ceftriaxone (22.4%) from the cephalosporin class. On qualitative component, four themes emerged from the prescribers. These included Prescribers perspective regarding antibiotic prescription; Knowledge of antibiotic resistance; Preventive measures of antibiotic resistance and Use of guidelines and Laboratory Investigation.
Conclusion: There is need to improve antibiotic prescribing patterns among health professionals. Developing an Antimicrobial Stewardship Program(ASP) is paramount.”

CANCER
P17_001856. IMPACT OF UNDERNUTRITION ON THE PHARMACOKINETICS OF CHEMOTHERAPY IN CHILDREN WITH CANCER: A SYSTEMATIC REVIEW
Author(s): Sterre Schoon1,2, Nthongase Makamo3,4, Aniek Uittenboogaard1,5, Melanie B. Bernhardt6, Nmazuo W. Ozuah4,6, Gertjan J.L. Kaspers1,5 and Minke H.W. Huibers1,7
Affiliation(s):
1.Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
2.Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
3.Baylor College of Medicine Children’s Foundation, Malawi
4.Texas Children’s Global Hemtology-Oncology-Pediatric-Excellence (HOPE) Program, Malawi
5.Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands
6.Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston
7.Global Child health group, Amsterdam UMC, Amsterdam, the Netherlands
Email: nthongasemakamo@gmail.com

Introduction: The majority of children with cancer in low- and middle-income countries are at risk for malnutrition. There is limited data on its effect on the pharmacokinetics of chemotherapeutic agents. Objective: This systematic review provides an overview of the effect of malnutrition on the pharmacokinetics of chemotherapy in children with cancer.
Methods: PubMed, Embase and Cochrane were searched to identify eligible studies. Studies on chemotherapy pharmacokinetics in children with cancer, assessing the effect of malnutrition referring to undernutrition were included. Risk of bias assessment was performed using the Quality Assessment Tool for Quantitative Studies. Malnutrition was defined by the World Health Organization (WHO) criteria and the Gomez classification.
Results: Four studies with a total of 668 children were included, containing 18% (n=121) malnourished children. Clearance rates and volume of distribution (VD) of methotrexate, doxorubicin, vincristine and etoposide were commonly lower in malnourished children.
Conclusion: Decreased clearance rates, increased area under the curve, and decreased VD among children with malnutrition and cancer are suggestive of pharmacokinetic alterations of chemotherapy. However, data is scare, groups are small, and the majority of the studies have been performed in high-income countries where nutrition status is mild. Pharmacokinetic research among severely malnourished children with cancer is needed in order to improve their outcome.

P18_001869. INVESTIGATION OF GENETIC VARIANTS ASSOCIATED WITH CERVICAL CANCER AMONG MALAWIAN WOMEN
Author(s): Samuel Duncan Gwayi1, Tamiwe Tomoka2, Lameck Chinula2, Emile R. Chimusa4, George Fedoriw3 and Benjamin Kumwenda1
Affiliation(s):
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.Department of Applied Science, Northumbria University, United Kingdom
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. Objective: 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.
Method: This is a case control study comprising 20 Malawian cases and the 1000 public genomes and the African genomes from the UK biobank 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.
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: This study will facilitate the development of genetic based approach to cervical cancer screening, diagnosis and management, which are robust and efficient in combating the disease.

P19_001924. ANTICANCER PHYTOCONSTITUENTS AND HEAVY METALS’ DETERMINATION IN SELECTED MEDICINAL PLANTS USED BY TRADITIONAL HERBAL PRACTITIONERS TO TREAT CANCERS IN MZIMBA AND NKHATA BAY DISTRICTS, MALAWI
Author(s): Friday Fosta Fred Masumbu1, Anthony Mwakikunga2, David Tembo3, and John Finias Kamanula1
Affiliation(s):
1.Chemistry Department, Faculty of Science, Technology and Innovations, Mzuzu University, Malawi
2.Biomedical Sciences Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre 3, Malawi
3.Physics and Biochemical Sciences Department, Faculty of Applied Sciences, Malawi University of Business and Applied Sciences, Blantyre 3, Malawi
Email: kwatenetikugonje@gmail.com

Introduction: This study validates the presence of anticancer phytoconstituents in the studied herbal plants and also highlights the toxic effects that might be associated with ingestion of the studied herbal plants.
Objectives: This study fingerprinted anticancer phytoconstituents and determined heavy metals in Piliostigma thonningii (Schumach.) Milne-Redh, Psorospermum febrifugum Spach, Inula glomerata Oliv. and Hiern, Zanthoxylum chalybeum Engl. and Monotes africanus A.DC., which are claimed to manage specific types of cancers by Malawian traditional herbal practitioners.
Methods: Anticancer phytoconstituents were fingerprinted from dried methanolic plant extracts of the selected five plants using gas chromatography-mass spectrophotometry (GC-MS) while dried and ground samples were analysed for heavy metals using atomic absorption spectrophotometry (AAS).
Results: Five known anticancer phytoconstituents were fingerprinted and they included L-Ascorbyl 2,6-dipalmitate, 1,3,5-Triazine-2,4-diamine, N,N’-bis(methyl)-6-(methylsulfonyl)- and Pyrimidine-4,6(3H,5H)-dione, 2-butylthio-. Also fingerprinted were S-(2-Fluoroethyl) methanesulfonothioate, (Z)-1-chloro-2-(methyl sulfonyl) ethylene and Eicosanoxy ethanol compounds whose anticancer properties were not found in literature. All the five herbal plants had cancer-causing cadmium (Cd) levels between 0.30 mg/kg to 6.27 mg/kg which were above the 0.21 mg/kg maximum acceptable levels for medicinal plants as per World Health Organisation.
The availability of known anticancer phytoconstituents in the selected five plants seem to suggest that the studied herbs would prevent and manage health problems associated with cellular oxidation such as cancer. The three compounds whose anticancer properties were unknown had essential anticancer functional groups which may qualify them as potential anticancer compounds.
Conclusion: Due to the high Cd levels in the five plant samples, their recipes should be treated with adsorbants to remove the harmful cadmium element. Further studies would include investigating anticancer activity of both the known and the unknown but fingerprinted phytoconstituents using cell lines.

P20_001936. PAEDIATRIC ONCOLOGY EDUCATION AND TRAINING INITIATIVES FOR NURSES. A SCOPING REVIEW
Author(s): Maureen D. Majamanda1, Felix Chisoni2, Apatsa Selemani3, Irene Kearns4, and Johanna Maree4
Affiliation(s):
1.Kamuzu University of Health Sciences, School of Nursing, Blantyre, Malawi
2.Kamuzu University of Health Sciences, Library, Blantyre, Malawi
3.Kamuzu University of Health Sciences, Library, Blantyre, Malawi
4.School of Therapeutic Studies, Nursing Education Department University of the Witwatersrand, Johannesburg, South Africa.
Email: mdmajamanda@kuhes.ac.mw

Introduction: A number of paediatric oncology education and training programmes have been developed for nurses.
Objective: This scoping review was conducted to map content, delivery methods, duration and mode of assessment for paediatric oncology nursing education and training programs.
Methods: A structured search strategy was conducted in the following data bases: CINAHL, Dimensions, Embase, PubMed and Scopus. Other relevant articles were identified from reference lists of included studies and through hand searching of other databases and journals. Search terms used were: paediatric oncology nursing, childhood cancer nursing, continuing education, orientation training, educational programmes, in-service training. To be included, the article had to describe a paediatric oncology nursing education programme, from any setting and published from 2012 to 2022. Extracted data included authors, year, journal, country, collaborations, project title, theory content, programme delivery methods, programme duration and mode of assessment.
Results: Of the 2310 articles screened, 20 articles were included in this review. Content identified for the paediatric oncology education and training programme for nurses include chemotherapy course, supportive care, paediatric oncology overview, common paediatric cancers, management of venous access devices, oncological emergencies, patient and family education, infection prevention and control, nursing considerations, communication, ethical legal issues, grief and bereavement, overview of haematology and haematological cancers. Didactic methods using traditional face to face and virtual approaches were used to deliver theory and practical content of the programmes. The duration for the trainings ranged from two hours to six weeks. Both qualitative and quantitative methods of assessments were utilised before, during and after the interventions.
Conclusion: This review provides guidance when planning a paediatric oncology education and training programme for nurses. However, there is a need to consider context specific issues and availability of resources when developing the programmes to ensure relevancy and sustainability.

P21_002021.TRANSCRIPTOMIC ANALYSIS OF HUMAN ENDOGENOUS RETROVIRUS IN DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS IN MALAWI
Author(s): Peter Kazembe1, George Fedoriw2 and Benjamin Kumwenda1
Affiliation(s):
1.Bioinformatics Unit, Biomedical Sciences Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences
2.Institute of Global Health and Infectious Disease, School of Medicine, University of North Carolina, USA
Email: 202240190007@kuhes.ac.mw

Introduction: Human Endogenous Retroviruses (HERVs) are exogenous retroviruses that became fixed in our genome about 30 million years ago through germline retroviral infections and transmission of integrated proviruses to the descendants. The transactivation of HERVs by Cancer associated viruses like the Epstein-Barr virus (EBV) and human immunodeficiency virus-1 (HIV-1) could help drive the heterogenicity of non-Hodgkin lymphomas (NHL). Cancers in general present a global public health concern as they kill about 10 million people annually. In Malawi alone, there is an estimated prevalence of 8,151 cases annually. Cervical cancer is the most common cancer in Malawi, amounting to 45.4%, followed by Kaposi sarcoma at 21.1%, esophagus cancer at 8.2%, breast cancer at 4.6% and NHL at 4.1%. Diffuse large B-Cell lymphoma (DLBCL) is one of the most prevalent forms of NHL accounting for 25% to 30% of all NHL cases but its underlying molecular mechanisms remain incompletely understood due to their highly heterogenicity.
Objective: The study aims at establishing the association between HERV with DLBCL in HIV positive patients in Malawi. Establishing the link between HERV and DLBCL will diversify cancer prevention measures and treatment. This link will be established by carrying out several Transcriptomic analysis’ on DLBCL data.
Methods: Analysis will include a HERV expression analysis in DLBCL patients, a differential Gene Expression (DGE) of HERV in HIV+ and HIV- DLBCL patients will be analyzed and compared to determine the association and lastly a functional enrichment analysis. From this analysis, we expect to find notable differences in HERV expression between the DLBCL HIV positive group and HIV negative group.
Conclusion: Establishing the link between HERV expression to DLBCL will allow directing treatment options and prevention of DLBCL.

HEALTH SYSTEMS AND POLICY
P23_002293. EXPLORATION OF NURSE’S PERCEPTIONS OF THEIR ROLE IN WOUND CARE AT SOUTH LUNZU HEALTH CENTRE, BLANTYRE
Author(s): Phiri E.1, Chinsesera E. 1, Tchuwa E. 1, Machili M. 1, Katete P. 1, Chitani N. 1, and Mbeba M. 1
Affiliation(s):
1.School of nursing department of adult health nursing _ kamuzu university of health sciences.”
Email: phirienery@gmail.com

Introduction: Wound care is a crucial aspect of clinical nursing practice, and it necessitates the application of knowledge, practice, and positive attitudes to promote favorable healing outcomes. It was noted that a significant proportion of wound management responsibilities were being entrusted to untrained personnel, rather than skilled nurses. This unfortunate circumstance led to several adverse consequences, including delayed wound healing, increased susceptibility to infections, and, in severe cases, the necessity of amputating affected areas.
Objective: The objective of the study was to explore the perceptions of nurses regarding their role in wound care at South Lunzu Health Centre.
Methods: This was qualitative study that used thematic analysis methodology. A semi-structured face-to-face interview with a sample of ten nurses were done from August 24, 2023, to September 12, 2023.
Results: The findings showed that three out of ten nurses demonstrated both good knowledge and practice in wound care, while the remaining nurses exhibited good knowledge but inadequate practice. Eight out of ten nurses demonstrated positive attitudes and a sense of responsibility towards wound care, whereas the remaining nurses did not adequately fulfill their role. All nurses expressed an interest in implementing strategic improvements to enhance their involvement in wound care.
Conclusion: conclusively the nurses understood their roles in wound care. However, due to challenges such as staff shortages, they resorted to delegating their tasks to untrained personnel, such as hospital attendants and maids.

P25_002175. COMMUNITY STAGE OF BEHAVIOUR CHANGE FOR SUSTAINABLE SANITATION FOUR YEARS AFTER DEFECATION-FREE STATUS CERTIFICATION OF BALAKA DISTRICT IN MALAWI
Authors: Kamwana, L1, Tembo M2 and Chidya, R2
Affiliation(s):
1.Malamulo College of Health Sciences, Malawi Adventist University, Makwasa, Thyolo
2.Department of Water and Sanitation, Mzuzu University, Luwinga, Mzuzu
Email: kamwanal@mchs.adventist.org

Introduction: Community-Led Total Sanitation (CLTS) trigger communities to stop open defecation (OD) by constructing latrines and hand washing facilities (HWF), and using latrines and hand washing washing with soap(HWWS) after defecation. The TransTheoretical Model- Stages of Change (TTM-SoC) is greatly used behaviour change in sanitation practices studies. Malawi adopted CLTS in 2008 to become OD free by 2015. Balaka District became an OD free model District in 2017 and slipped to OD in 2019.
Objective: The study was conducted to determine community SoC, readiness to change (RtC) and committed action to change (CAtC) in latrine and HWF construction, latrine use and HWWS.
Methods: The study was descriptive cross-sectional. Data was collected from households heads using University of Rhode Island Change Assessment questionnaire.
Results: On SoC, the community is at Action Stage for latrine construction (4.308) HWWS (4.349). latrine use (4.335) and at pre-contemplation for HWWS (3.171). On RtC, the community is at contemplation and intermediate at latrine and HWF construction. (9.340, 9.665) intermediate on latrine use (9.549) and least ready for HWWS (6.660). About CAtC, the community is least committed to start constructing latrines (0.027) construct HWF (0.017) and least committed to start using latrines (0.113) with negative commitment to HWWS (-0.055)
Conclusion: Behaviour change is minimal for sustainable latrine and HWF construction, latrine use and HWWS after defecating four years after ODF certification. There is need to emphasize health promotion and ODF follow.

P26_001819. HEALTHCARE WORKERS’ KNOWLEDGE AND TRADITIONAL HEALERS’ PRACTICES ON SNAKEBITE MANAGEMENT IN NENO DISTRICT, MALAWI
Author(s): Moses Banda Aron1,2, Fabien Munyaneza2, Anat Rosenthal3, Deborah Hosemann1, Luckson Dullie2, Clara Sambani4, Emilia Connolly2,5,6, Enoch Ndarama7, Jörg Blessmann1, Chiyembekezo Kachimanga2, Jürgen May8,9,10 and Benno Kreuels 1,9,11
Affiliation(s):
1.Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
2.Partners In Health / Abwenzi Pa Za Umoyo, Neno, Malawi
3.Department of Health Policy and Management, Ben-Gurion University of the Negev, Israel
4.Department of Research, Ministry of Health, Lilongwe, Malawi
5.Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, United States of America
6.Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, United States of America
7.Neno District Health Office, Ministry of Health, Neno, Malawi
8.Department Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany
9.German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, 20359 Hamburg, Germany
10.Tropical Medicine II, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
11.Section for Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg, Germany
Email: mosaron@gmail.com

Introduction: Snakebite envenoming is one of the 20 neglected tropical diseases (NTDs) common in tropical countries including Malawi. Unlike other NTDs, there is almost absent literature regarding snakebite in Malawi. Objective: To assess healthcare workers’ (HCWs) knowledge and explore the practices of traditional healers on snakebite management in Neno District, Malawi.
Methods: We conducted a cross-sectional mixed-method study by interviewing 105 healthcare workers and 16 traditional healers in Neno district using surveys and semi-structured guides. We collected data on snake identification, snakebite treatment and prevention. We used descriptive statistics for the survey and thematic analysis for the interview transcripts.
Results: Of 105 HCWs interviewed, 58% were males, and 60% had less than five years of work experience. Over 85% of HCWs acknowledged snakebite envenoming as a problem in the district. However, 42% of clinicians reported previous prescriptions of snake antivenom (SAV), while only 26% of nurses had administered SAV. Knowledge gaps were evident, particularly in dosing SAV and identifying snake species. Over 95% of HCWs reported that snakebite victims primarily sought treatment from traditional healers rather than hospitals. Between 2018 and 2021, 185 snakebite cases were registered in the district, of these, 52% (n=97) were treated as inpatients of which two died. Of the 16 THs interviewed, 68.8% were male, and 43.8% were aged between 40 and 60 years. THs offered first aid and main treatment using a wide range of concoctions for free or on a “”pay later”” basis. THs also claimed to have a snakebite “”vaccine”” for prevention or neutralization of venom, however, all these were not scientifically proven. There was no formal relationship between THs and HCWs.
Conclusion: We found knowledge gaps in both HCWs and THs regarding snakebite management. We recommend training HCWs and educating THs on identifying danger signs requiring prompt referral to health facilities.

P27_001925. MORTALITY SURVEILLANCE USING MOBILE PHONE SURVEYS IN MALAWI: FEASIBILITY AND DATA QUALITY
Author(s): Jethro Banda1, Malebogo Tlhajoane2, Stephane Helleringer3, Amelia Crampin1,2,4, and Georges Reniers2
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit
2.London School of Hygiene and Tropical Medicine
3.New York University- Abu Dhabi
4.University of Glasgow
Email: jethro.banda@meiru.mw

Introduction: Mobile phone surveys (MPS) are a promising alternative or complement to classical face-to-face surveys and censuses for collecting data on demographic trends. However, our understanding of the quality of these data remains limited. Objectives: We evaluate the quality of mortality data generated in MPS.
Methods: Using data collected in Malawi, we compared MPS responses from a non-random sample (N=1995) to data recorded in Karonga Health and Demographic Surveillance System (KHDSS) to assess the quality of survey responses. We use Myers Blended Indices (for age data) and individual level comparisons to understand levels of misreporting and omissions. Analysis focuses on age of respondents; age, vital status, and date of death of parents; household membership and deaths; and reports on survival of children born to women of reproductive ages. We use logistic regression and audio recordings to assess how respondent, enumerator and interview attributes correlate with data quality.
Results: Respondent’s age data showed little evidence of heaping in the MPS. Myers Blended Indices were relatively higher for parent’s ages. 86% of respondents had own ages within 2 years of their age recorded in KHDSS. MPS was able to capture HDSS deaths of parents and birth and deaths amongst children with specificity and sensitivity of over 90% and child deaths with 89.5% sensitivity and 98.8% specificity. MPS, however, tended to overestimate household sizes. Overall, MPS data showed higher odds of people misreporting their own age if respondents were older, interviewed at workplaces/school or on the road, and late in the afternoon. There were also substantial differences in age data quality by interviewers.
Conclusion: Even though differences were observed, data from MPS were of good quality. For future studies, researchers should focus on eliminating interviewer differences, and ensuring interviews are done earlier in the day and at comfortable location.

P28_002128. FEASIBILITY OF INTEGRATING COVID-19 SELF-TESTING AMONG HEALTHCARE WORKERS: A NON-RANDOMIZED TRIAL IN BLANTYRE, MALAWI
Author(s): Chimwemwe Kwanjo-Banda1, Augustine T. Choko1,2, Wezzie S. Lora1, Lucky G. Ngwira1,3, Yasmin Dunkley4, Emily Nightingale4, Hendricks Mwenelupembe5, Richard Chilongosi5, Gabrielle Bonnet6, Nicola Desmond1, 2, Elizabeth L Corbett1,4 and Karin Hatzhold7
ekudowa@mlw.mw
Affiliation(s):
1.Department of Public Health, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2.Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3.Department of Economics and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
4.Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
5.Family Health Services, Blantyre, Malawi
6.Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
7.Population Services International Global, Washington, USA.
Email: joychikoko@yahoo.co.uk

Introduction: Efficient and sustainable models of Corona Virus Disease of 2019 (COVID-19) screening among healthcare workers (HCWs) such as self-testing is essential for averting transmission within and outside health care facilities.
Objective: We evaluated the uptake and feasibility of implementing twice weekly self-testing of COVID-19 using Antigen Rapid Diagnostic Test kits (Ag-RDT) in HCW.
Methods: Between December 2022 and May 2023, 12 primary health facilities in Blantyre, Malawi, were purposively allocated (1:1) aiming for geographical and size balance in a 2-arm non-randomised cluster trial. Arm-1 was standard of care (SOC) and Arm-2 was COVID 19 self-testing (C19ST). Both arms had professional-use rapid diagnostic tests for diagnostic testing of symptomatic HCWs. HCWs in the C19ST arm had twice-weekly COVID-19 Ag-RDT self-testing. The primary outcome compared by arm the harmonic mean number of early COVID-19 positive diagnoses among HCWs. Analysis was by intention-to-treat using cluster-level summaries and t-test, with adjustment for imbalance.
Results: Participation was 99.8% among eligible HCWs across all facilities (1081/1083). Of the 1081 participating, 612 (56.6%) and 469 (43.4%) were in SOC and C19ST arm, respectively. Overall mean age was 35.5y (sd: 9.3); 183/612 (29.9%) in SOC were male, compared to 166/469 (35.3%) in C19ST; overall prior vaccination was 865/1081 (80.0%) with no difference between SOC (499/612, 81.5%) and C19ST (366/469, 78.0%). Follow-up at 28-days was high (SOC: 593/612 [97%]; C19ST: 436/469[93%]) and 1 and 4 HCWs had early COVID-19 diagnosis in SOC and C19ST arms, respectively. Acceptability of twice weekly self-testing was high (95.8%) in the C19ST arm and participants reported continued ease of self-testing with repeat tests.
Conclusion: COVID-19 self-testing was feasible to integrate for routine screening among healthcare workers potentially reducing disruption to health services. This model has potential for wide scale up programmatically especially in resource-constrained settings.

P29_002167. PATTERNS OF BLOOD ORDERING AND BLOOD USAGE AT NSANJE DISTRICT HOSPITAL, MALAWI
Authors: Wongani Mtabayira Nyondo1, Bridon M’baya2, Emmanuel Singogo3, Maganizo Chagomerana3, Adamson S. Muula1, Mina C. Hosseinipour3,4, Titus Chiwindo3, Tiyamike Nthani3, Robert M’bwana2, Victor Mwapasa1
Affiliation(s):
1.Kamuzu University of Health Sciences – School of Global and Public Health
2.Malawi Blood Transfusion Services (MBTS)
3.University of North Carolina (UNC) Project, Malawi
4.University of North Carolina at Chapel Hill, USA
Email: wonganimtabayiranyondo@gmail.com

Introduction: Blood and blood products are essential for the management of many life-threatening conditions. Despite limited availability of blood in Malawi, little is known about the patterns of blood requisitions from the Malawi Blood Transfusion Services (MBTS) and distribution of blood units in hospital inpatient wards of Malawi.
Objective: to assess the ordering and distribution pattern of blood units in the inpatient.
Methods: A facility-based cross-sectional study was done at Nsanje District Hospital (NDH) using hospital records for a period between November 2020 and October 2021 to assess the ordering and distribution pattern of blood units in the inpatient. Data for blood units issued by MBTS, blood units issued to inpatient wards, expired, and wastage and patient health related conditions or diagnosis were extracted from the Blood requisition book, Blood Issue Notes and Blood Transfusion Crossmatch Registers. Frequencies and percentages were used to summarise the data.
Results: A total of 1639 units of blood were ordered from MBTS, with only 1001 (61.2%) issued to the hospital. Of 1001, 700 (69.9%) were distributed to various hospital wards 179 were not transfused while 122 (12.2%) expired. Almost one-third (29%) of blood was distributed to the female ward, 26% to the paediatric ward, 24% to maternity ward and 21% to the male ward. The top three inpatient diagnosis requiring transfusions were: malaria (37%), pneumonia (29%), and low HB (13%).
Conclusion: Female ward, maternity and paediatric wards were top users of the ordered blood units. High rates of expired blood units indicate poor coordination between the hospital and MBTS. Efforts to reduce expired blood units and improve record keeping for reconciliation of blood units before placing new orders ought to be encouraged.

P30_002242. QUANTIFYING TRAVEL TIME, MAPPING AND VALIDATING HEALTH FACILITY CATCHMENT AREAS IN BLANTYRE CITY.
Author(s): Patrick Ken Kalonde1, 2, Owen Tsoka1, Blessings Chiepa1, 2, Chifuniro Baluwa1, Clinton Nkolokosa1, Donnie Mategula1, 2, 3, Suresh Muthukrishnan4, Nicholas Feasey1, 2, Marc Henrion1, 2, Michelle C Stanton 2, Nicolas Ray5, Dianne Jannette Terlouw 1,2, Joshua Longbottom2, and James Chirombo1
Affiliation(s):
1.Malawi-Liverpool Wellcome 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.Kamuzu University of Health Sciences, Blantyre, Malawi.
4.Department of Earth, Environmental and Sustainability Sciences, Furman University, Greenville, SC, United States.
5.Institute of Global Health, University of Geneva, Office G6-02, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland.
Email: pkalonde@mlw.mw

Introduction: Mapping health facility
catchment areas is crucial for accurately estimating the population served by each facility, a vital metric for understanding disease burden distribution. However, such mapping efforts are costly and infrequently updated. In Malawi, catchment areas were last generated in the early 2000s and have not been revised since.
Objective: This study aims to demonstrate that health facility catchment areas can be regularly updated using geospatial methods.
Methods: We assumed individuals seek care at their nearest health facility. Using OpenStreetMap, we crowdsourced the mapping of all roads. Travel speed observations were conducted in Blantyre city and used to calculate travel times to facilities. AccessMod 5.8.1, an open-source software, was employed to generate catchment areas for health facilities in Blantyre city. These areas were validated using georeferenced data from malaria registers at three health facilities.
Results: Crowdsourced mapping efforts led to 21,293 new map changes on OpenStreetMap. This data together with observations of travel speeds, maps of travel times and catchment areas for 14 public and 24 private health facilities were generated. When these catchments were compared with georeferenced patients originating communities, an average of 94.2 percent of the patients come from communities within the generated catchments.
Conclusion: This study demonstrates that health facility catchment areas can be continually updated using crowdsourced data and open mapping tools. Additionally, travel time maps reveal spatial disparities in access to health services within Blantyre city. Consequently, existing facilities may face increased costs in terms of both travel distance and financial resources required to organize community health programs. The generated catchment areas hold potential for quantifying disease burden and estimating facility catchment populations, serving as a crucial denominator for disease prevalence assessments.

P31_001813. DEVELOPMENT OF A NATIONAL ESSENTIAL DIAGNOSTICS LIST IN MALAWI
Author(s): G. Ali1, C. Chavula1, C.Banda1, T Sumani2, C. Hiwa2, L. Hattingh3, J. Tuttle4, F. Chitanda1, J. Makondesa1, T. Mwenifumbo1, K. Kao3 and A. Gunda1
Affiliations:
1.Clinton Health Access Initiative (CHAI), Malawi
2.Malawi Ministry of Health, Diagnostics
3.Foundation for Innovative New Diagnostics (FIND)
4.Clinton Health Access Initiative (CHAI), Global Diagnostics Team
Email: cbanda.ic@clintonhealthaccess.org

Introduction: Access to diagnostic services in Malawi is limited, owing to different factors such as compromised infrastructure and inadequate funding. Development of a national essential diagnostics list (NEDL) is a key step in ensuring availability and access to diagnostic services. In 2023, the Malawi Ministry of Health (MoH) in collaboration with Clinton Health Access Initiative and the Foundation for Innovative New Diagnostics developed the first ever NEDL, becoming one of the first five countries to do so after a model EDL by WHO. The NEDL encompasses in-vitro diagnostics (IVDs) and medical imaging examinations for all three tiers of Malawi’s healthcare system which include tertiary, secondary and primary including community settings.
Methods: The list was developed over a 12 months period through a consultative process. A step wise approach was used which included establishing stakeholder buy-in, conducting a national diagnostics situation analysis and drafting a wish-list of tests and examinations. Eight evidence-based criteria were used to select essential IVDs and imaging examinations from the wish-list and these included disease burden, availability of treatment pathways, test/examination utilization, cost-effectiveness, infrastructure availability, supply chain, human resources availability and biosafety and biosecurity.
Results: The Malawi NEDL includes 266 IVDs across biochemistry, haematology, microbiology, parasitology, serology, toxicology among other disciplines and 180 imaging examinations encompassing ultrasound sonography, X-rays, intervention radiology, computerized tomography scanning and magnetic resonance imaging. Tests and their methodology are specified for each health tier and are also aligned to meet the minimum health services specified in other strategic documents such as the Malawi Health Sector Strategic Plan III and Health Benefits Package.
Conclusion: The development of the Malawi NEDL is a milestone in the diagnostic landscape of Malawi. The document will be useful in setting priorities and resource mobilisation to ensure availability of quality diagnostic services at all levels of the health care system in Malawi.

P32_001848. PRIMARY HEALTHCARE SERVICE DELIVERY FOR OLDER PEOPLE WITH PROGRESSIVE MULTIMORBIDITY IN LOW- AND MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW
Author(s): Duncan Kwaitana1, Felix Chisoni1, Dorothee van Breevoort1, Thomas Mildestvedt2, Eivind Meland2, Jane Maya Bates1 and Eric Umar1
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi
2.University of Bergen, Oslo, Norway
Email: dkwaitana@kuhes.ac.mw

Introduction: Ageing is a natural process which presents unique challenges for all sections of society including being a relevant risk for a wide range of medical conditions and multimorbidity. Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, the older people aged ≥50 years in Low- and Middle-Income Countries (LMICs) face challenges to effectively access and utilize PHC.
Objective: The aim of this review was to establish the effectiveness of PHC services in improving accessibility for older people with progressive multimorbidity living in LMICs.
Methods: The Andersen-Newman theoretical framework for health services utilization was used. This review was duly registered and got published in the online international prospective register of systematic reviews (PROSPERO). The reviewers applied guidelines of the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA). Searching for literature included four databases namely, PubMed, Scopus, Embase and Dimensions. Additional searching was done using Google Scholar. For purposes of heterogeneity, databases were searched using MeSH terms and free text words. Eligible articles included both qualitative and prevalence studies published between 2012 and 2022.
Results: Seven publications were identified, and a narrative analytical method revealed less research in this area. Facilitating factors included: family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included: long distance and disjointed PHC services, less numbers of health professionals and lack of person-centered care. The following needs were reported: increasing the numbers of health professionals, provision of PHC services under one roof and regular screening services.
Conclusion: There is need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC for the older people living with progressive multimorbidity.

P33_001863. PREDICTORS OF STUDENTS’ PERFORMANCE IN NURSING AND MIDWIFERY TECHNICIAN LICENSURE EXAMINATION IN SOUTHERN MALAWI
Author(s): Mc Geofrey Mvula1,2 and Annie Msosa1
Affiliation(s):
1.Kamuzu University of Health Sciences, Lilongwe, Malawi
2.Partners in Health, Neno, Malawi
Email: mvula2017macgeofrey@kcn.unima.mw

Introduction: Success in the nursing and midwifery licensure examination is the only legal prerequisite to practice as a nurse and midwife in Malawi. However, the past decade has registered poor performance of students in Nursing and Midwifery Technician (NMT) licensure examinations for candidates who failed on the first attempt.
Objective: The study sought to unravel whether students’ socio-demographic and academic characteristics could predict NMT licensure examination performance on the first attempt.
Methods: We conducted a quantitative ex post facto using stratified random sampling. We reviewed 280 former NMT licensure exam candidate records from 2013 to 2017 with a study population of 2,668 NMTs. We reported descriptive statistics and used Chi-square / Fisher’s exact test and logistic regression to determine the significance of associations and predictors respectively.
Results: We found that the NMT licensure examination could be predicted by students’ academic characteristics, especially entry Malawi School Certificate of Education (MSCE) point scores [p < 0.001, OR 0.830, 95% CI (0.771-0.892)], and exit college final scores [p < 0.001, OR 1.214, 95% CI (1.131-1.303)]. We established that students’ socio-demographic characteristics like age [χ2 (2, N =280) =13.143, p < 0.001], and marital status [χ2 (1, N = 280) = 5.645, p = 0.018] were significantly associated with NMT licensure examination performance but were not predictors of NMT licensure examination outcome. Furthermore, we did not find any association between NMT licensure examination performance and the sex of the students [χ2 (1, N = 280) = 0.523, p = 0.470].
Conclusion: NMT licensure examination performance predictors are academic variables like entry MSCE and exit college final scores. Consequently, teaching institutions should frame relevant admission criteria, and timely support the students at risk of failure in licensure exams.

P34_001920. ASSESSMENT OF SELF-DIRECTED LEARNING AMONG UNDERGRADUATE HEALTH CARE PROFESSIONALS FROM THREE INSTITUTIONS OF HIGHER LEARNING IN MALAWI
Authors: Evelyn Chilemba1, Felistas Chiundira1, Felix Chisoni1, Ellemes Ngayiye1, Nanzeni Kaphagawani1, and Chrissie Phiri1
Affiliation(s):
1.Kamuzu University Of Health Sciences
Email: echilemba@kuhes.ac.mw

Introduction: Self-directed learning is a critical competency for undergraduate health care professionals to achieve their professional development. Thus, it is an active process in which students take an initiative for their own learning regardless of the presence or absence of the support of their educators. Self-directed learning approaches empower students to actively search for, examine, understand, and utilise information to achieve learning needs. However, some students find it challenging to acquire self-directed learning skills in clinical setting due to the dynamic nature of the clinical environments.
Objective: To analyse self-directed learning abilities among undergraduate health care professionals in practice
Methods: A survey, part of sequential explanatory mixed methods design was deployed to uncover the undergraduates’ self-directed learning abilities in practice. Simple random sampling was used to recruit 405 participants at level three and four from Kamuzu University of Health Sciences, Mzuzu University and Malawi College of Health Sciences. Data were analysed using SPSS version 23.0 where the subscales were quantified to find mean scores and standard deviations and the Cronbach alphas for SDL
Results: There was an overall total mean score of 165.15 on the self-directed learning scores among the participants, this signifies presence of readiness for self-directed learning. Overall, the Cronbach alphas for SDL was 0.85; with scores for subscales of SDL of self-control (0.72), self-desire for learning (0.63) and self-management (0.61). Findings revealed students’ readiness for self-directed learning and high scores were on self-control, self-management, and lastly self-desire for leaning.
Conclusion: The survey has revealed that the undergraduate health care professionals have self-directed abilities to enable them utilize clinical learning indicators for leaning in clinical practice. Despite that others have minimal self-directed abilities 14.1% (n=57) it is important that all clinical learning should be structured to support self-directed learning.

P35_001970: ENHANCING GEOSPATIAL DATA COLLECTION THROUGH ELECTRONIC PARTICIPANT LOCATOR (EPAL)
Authors: Diksha Patel1, Vincent K Phiri1, Thokozani Ganiza1, Alfred Muyaya1, McEwen Khundi1, Lingstone Chiume1, Kruger Kaswaswa5, Augustine Choko1,3, Marriott Niwasa1,2,3, James Mpunga5, Emily Webb3, Peter MacPherson1,4, Rebecca C. Harris3, and Elizabeth Corbett1,3
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
2.Kamuzu College of Health Sciences
3.London School of Hygiene and Tropical Medicine
4.Liverpool School of Tropical Medicine
5.National TB and Leprosy Programme
Emails: dpatel@mlw.mw

Introduction: In research, geo-coordinate data collection and analysis, enhances understanding of spatial patterns and implications. ePAL, an innovative mobile application was developed for clinic-based identification of the residence of patients registering for TB treatment in Blantyre urban. The aim was to harness geo-coordinates from participants, with the goal of performing spatial analysis to uncover trends, preferences, and potential disease prevalence in Blantyre.
Objectives: The primary objective was to leverage geo-coordinate data collected from participants using a digital platform. ePAL was developed and used to visually identify TB spatial hotspots for efficient targeting of the intervention program, understanding transmission, disease risk factors and other factors of interest.
Methods: ePAL was integrated to work with Open Data Kit (ODK). The application collected geo-coordinate data by allowing the TB participants to select their area of residence. This information was then processed using spatial analysis techniques to identify any patterns of interest. Data visualizations were developed to show data clusters and their significance.
Results: The application has been successfully implemented in 18 TB registration centers across Blantyre. Since its initiation in January 2015, government TB officers have routinely employed ePAL to geolocate over 6000 TB cases. This approach has enabled the accurate mapping of TB cases and the identification of geographical patterns in the distribution of cases, facilitating more targeted and efficient interventions. The application has also been used by many research projects thereby demonstrating its ability to collect and enhance the analysis of geo-spatial data effectively.
Conclusion: ePAL has emerged to be a pivotal tool in geolocating TB cases within Blantyre and potentially in similar settings with limited geographical data. The successful integration of ePAL into clinical practice demonstrates its potential to enhance disease control efforts, ultimately leading to more effective interventions, improved patient follow-up and a deeper understanding of disease dynamics.

P36_001980. INFLUENCE OF SUPPORTIVE LEADERSHIP ON THE PERFORMANCE OF INEXPERIENCED NURSE LEADERS IN THE CENTRAL WEST QUALITY SATELLITE ZONE HOSPITALS OF MALAWI
Author(s): Annie M. Namathanga1, Wilson J.O. Odiyo2 and Caren Ouma2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Pan Africa Christian University, Nairobi, Kenya
Email: anamathanga@kuhes.ac.mw

Introduction: Registered Nurses with inadequate clinical experience serve as ward managers in hospitals in Malawi because of a shortage of professional nurses. The inexperienced nurses are anticipated to lead successfully with support from Senior Nurse Leaders. Research confirms that Supportive Leadership (SL) can enhance performance. This research examined the influence of SL on the performance of Inexperienced Nurse Leaders (INLs) in the Central West Quality Satellite Zone (CWQSZ) Hospitals of Malawi.
Objectives: 1. To establish the influence of mentoring; 2. To investigate the influence of relationships; 3. To establish the influence of team working; and 4. To examine the influence of work environment; on the performance of INLs in the CWQSZ Hospitals of Malawi.
Methods: Convergent mixed methods, the quantitative strand used total population sampling, and comprised 42 Senior Nursing Officers (SNOs) and 53 INLs. Data was collected through survey questionnaires. The qualitative strand utilized purposive sampling, and in-depth interviews were conducted with ten SNOs and ten INLs. Quantitative data was analysed using descriptive and inferential statistics while qualitative data used Collaizi’s thematic method.
Results: SL had positive influence on the performance of INLs, F=57.162, P < 0.001, R2 0.812. Mentoring encouraged INLs to take a leading role however, it was done inconsistently. The INLs acknowledged the existence of interpersonal and work relationships in the wards. There were collaborative healthcare teams that facilitated the attainment of clinical goals. The work environment was conducive in certain wards but not in others. Shortage of nurses, material, and financial resources were the main challenges.
Conclusion: The results have shown the significance of SNOs’ SL in the CWQSZ hospitals of Malawi despite the existing shortage of resources. The leadership approach enhanced the performance of INLs. The findings of the research add to the existing minimal body of knowledge about SL in nursing practice.

P37_001991.TOWARDS THE ESTABLISHMENT OF AN AFRICAN POPULATION COHORTS CONSORTIUM: METHODS AND PRELIMINARY FINDINGS FROM THE EXISTING COHORTS WORKSTREAM
Author(s): Edith Chikumbu1, Jethro Banda1, Jim Todd2,3 and Amelia Crampin1,3,4 on behalf of the CE-APCC
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit (MEIRU)
2.National Institute for Medical Research (Tanzania)
3.London School of Hygiene and Tropical Medicine
4.University of Glasgow
Email: edith.chikumbu@meiru.mw

Introduction: Recent events including Covid-19 and climate change-related extreme weather crises have highlighted the role of scientific collaboration to understand and intervene in global public health issues. Robust and timely data on biology, genetic variation, health, behavior, socioeconomics, and the environment are needed to predict and combat future health crises. HDSS, and other population-based cohorts, have a long history of providing important scientific insights into the burden of disease and responsive interventions in Africa. The realization that a consortium of population cohorts in Africa can contribute massively to harnessing the genetic, socio-economic, cultural, and environmental diversity of Africa for scientific discovery underlies the efforts of the Wellcome-funded Collaboration for the Establishment of an African Population Cohort Consortium (CE-APCC).
Objective: We describe CE-APCC work-packages and preliminary findings from existing cohorts.
Methods: Following a preliminary criteria generated by co-investigators, existing cohorts were identified through online literature searches and snowballing. Further cohort data were collected via surveys and workshops. We present data on the current status of cohort research in Africa, including research focus, future aspirations, opportunities and challenges.
Results: We identified 85 operational population cohorts in Africa. Majority were in HDSSs and affiliated with research networks. Over 70% of surveyed cohorts’ funding had ended or ending before 2025. All surveyed cohorts reported collecting social data, and over 50% collected hypertension, reproduction, bio-samples, HIV and diabetes data. During workshops, cohort leaders highlighted potential benefits of APCC including capacity strengthening, sharing of skills and resources, funding and improving their research.
Conclusion: Existing African cohorts acknowledge the potential benefits of a supported consortium. They also recognise the changing research landscape with increased interest in climate change, urbanization, aging, and genomics. Challenges encountered in the process of identifying cohorts include sparse information on North African cohorts, limited online information and limited engagement by some cohorts.

P38_002024. THE PERCEIVED IMPACT OF THE 6 KEYS ROLES OF A FAMILY MEDICINE PHYSICIAN IN DISTRICT TEACHING HOSPITALS IN MALAWI
Author(s): Dorothee van Breevoort1, Judith Spekreijse2, Patrick Chisepo3 and Martha Makwero1
Affiliation(s):
1.Department Family Medicine, Kamuzu University of Health Sciences, Malawi
2.Training institute Global Health and Tropical Medicine (OIGT), Netherlands
3.Nkhoma Mission Hospital, Malawi
Email: dorotheevb@hotmail.com

Introduction: 81% of Malawi’s 20 million population live in rural areas. Access to healthcare in rural areas is sparse. There is a shortage of medical doctors in district hospitals and currently, there are no or a few specialists in the district hospitals. The department of Family Medicine at the Kamuzu University of Health Sciences host since 2015 the MMED postgraduate program for Family Medicine to train primary health care leaders. Six key roles have been described for a family physician in Sub-Sahara Africa to contribute to achieve universal health coverage.
Objectives: This study aims to evaluate how these key roles are perceived in Malawian district hospitals.
Methods: This is a primary health care educational research. Surveys among health care providers in Mangochi district hospital and Nkhoma Mission hospital are conducted to gain deeper understanding on the perception on the 6 key roles and the perceived impact of Family Medicine physicians at district training sites.
Results: This study provides inside on the perceived impact of family medicine physicians. Family medicine physicians have, besides impact as clinical trainer and supervisor, also a role as capacity builder and care provider at the district teaching hospitals. Their impact is perceived as a high impact for all the six key-roles by co-workers.
Conclusion: This is the first study evaluating the impact of family medicine in Malawi. This study provides the first inside of the impact of family medicine at district training sites. Furthermore, the results of this study will contribute to further develop the curriculum for Family Medicine in Malawi.

P39_002026. EFFECTS OF COVID-19 ON MATERNAL AND NEONATAL OUTCOMES AND ACCESS TO ANTENATAL AND POSTNATAL CARE IN MALAWI
Author(s): Leonard Mndala1,2,Chikondi Chapuma1,2, Jennifer Riches 1,2, Luis Gadama1,3, Fannie Kachale1,4, Rosemary Bilesi1, Malangizo Mbewe1,4, Andrew Likaka1,4,5, Moses Kumwenda1,3, Regina Makuluni1, Bertha Maseko1, Chifundo Ndamala1, Annie Kuyere1, Laura Munthali1, Deborah Phiri1, Edward J.M. Monk1, Marc Y.R. Henrion1,6, Maria L. Odland1,2,7 and David Lissauer1,2
Affiliation(s):
1.Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
2.University of Liverpool, Liverpool, England, UK
3.Kamuzu University of Health Sciences, Blantyre
4.Ministry of Health, Lilongwe, Malawi
5.Universidade de Pernambuco, Recife, Brazil
6.Liverpool School of Tropical Medicine, Liverpool
7.St. Olavs University Hospital, Trondheim, Norway
Email: leonardmndala@gmail.com

Introduction and Objective: The COVID-19 pandemic impacted maternal and neonatal health not only through direct infections, but also through disrupting the health system. We used facility-level data from all government hospitals in Malawi to understand the wider impact of the second and third waves on maternal and neonatal outcomes, and access to care.
Method: We analysed data for pregnant and recently pregnant women enrolled in MATSurvey. To assess
overall effect of the second and third waves on access to care, maternal and neonatal outcomes, we used a segmented regression approach for the time series for each outcome using the interrupted time series (ITS) regression framework. We modeled the impact to allow for comparison of counterfactual scenario (of no impact on outcomes of the two waves) to the observed events.
Results: We noted a cumulative 15.4% relative increase in maternal deaths (MDs) than anticipated across the two waves. The second wave was associated with a 56% increase in MDs, and women admitted in the third wave were 2 times more likely to die, as compared to the counterfactual scenario of no impact. We observed a sustained decrease in post-natal care visits by 41% and 0.2% at the onset of the second and third COVID-19 waves respectively.
Conclusion: At the height of COVID-19 in Malawi, disruptions of the healthcare system by the pandemic impacted critical maternal outcomes and access to care. Our findings demonstrate the need for health systems strengthening, particularly in resource-constrained settings in preparation for further such threats.

P40_002076. FEASIBILITY AND ACCEPTABILITY OF HEALTH TECHNOLOGY ASSESSMENT IN MALAWI.
Author(s): Joseph Mfutso-Bengo1,2*, Faless Jeremiah1, Florence Kasende-Chinguwo1, Wingston Ng’ambi1,3, Nthanda Nkungula1, Isabel Kazanga-Chiumia1, Mercy Juma1, Marlen Chawani1,4, Jobiba Chinkhumba1, Pakwanja Twea5, Emily Chirwa5, Kate Langwe5, Gerald Manthalu5, Lucky Gift Ngwira1, Dominic Nkhoma1, Tim Colbourn6, Paul Revill7 and Mark Sculpher7
Affiliation(s):
1.Health Economics and Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences (KuHes), Private Bag 360, BLANTYRE 3, Lilongwe, Malawi
2.Centre of Bioethics in Eastern and Southern Africa, Blantyre, Malawi
3.Centre of Excellence in Ethics and Governance, Blantyre, Malawi
4.Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
5.Ministry of Health, Malawi Government, Lilongwe, Malawi
6.University College London, London, United Kingdom
7.Centre for Health Economics, University of York, York, UK
Email: Lngwira@kuhes.ac.mw

Introduction: World Health Organization defines health technology assessment (HTA) as any new drug, pricing, infrastructure, new technology designed to improve health. HTA is used as a tool for priority setting and policy decision-making. While HTA is being used by high income countries, it is not utilized in resource constrained settings. The Health Economics and Policy Unit carried out an HTA feasibility study in Malawi.
Objectives: The objective were to benchmark HTA structures in Africa; to explore the acceptability and feasibility of HTA establishment in Malawi; and to format HTA structure/funding mechanism.
Methods: The study utilized mixed methods: secondary data review, a focus group discussion and 12 key informant interviews (KIIs) with policymakers at the Malawi Ministry of Health (MoH). The interviews were audio-recorded and transcribed verbatim. The analysis involved line by line coding, and emerging concepts were combined into themes.
Results: Majority of countries in Africa had no HTA. Desk review established that only three countries had some form of HTA- Ethiopia, Ghana and South Africa. The common values/principles were acceptability, equity, evident data, and evidence-based decision-making. The current HTA structure in Malawi was committee-based. This was funded in part or full by government, in-kind and through private companies. While there may be agreed values/principles for decision-making, this was different at implementation level. The study revealed three salient HTA structures for decision-making: committee- based, a hybrid of committee based and partial HTA institutional mechanisms and a fully functional institutionalized HTA.
Conclusion: There was consensus among policy makers for the introduction of HTA for equitable, efficient, fair, and transparent resource allocation and prioritization. However, there is need to assess all HTA aspects including governance and structure, funding, capacity, and value sets/principles. The MoH Senior Management Team adopted these findings and instituted an HTA taskforce which is looking into these areas.

P42_P002102. EXPLORING THE RESEARCH LANDSCAPE OF KUHES: A BIBLIOMETRIC ANALYSIS
Author(s): Kondwani Wella1 and Apatsa Selemani1,2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.School of Public Health, University of Witwatersrand, South Africa
Email: aselemani@kuhes.ac.mw

Introduction: In an era of rapid scientific advancement, understanding and evaluating the research productivity and impact of academic institutions have become essential for informed decision-making and strategic planning to address local and global challenges including the global burden of diseases. This study aimed at analysing the research output and influence of the Kamuzu University of Health Sciences (KUHeS).
Objectives: The study tracked the year-wise research productivity of KUHeS, examined the extent of national and international collaborations in KUHeS research publications, assessed the subject focus distribution of KUHeS research publications, analysed the journals KUHeS researchers use to publish their research, and established highly cited papers and major funders of research published by KUHeS researchers.
Methods: The study used data collected from Dimensions and Scopus. The data were analysed using bibliometric tools provided by Dimensions and Scopus, and VOSViewer software.
Results: KUHeS has a total productivity of 4413 publications by 668 authors. There has been a steady increase in productivity over a 35-year span with 2021 being the most productive year. The most productive author is Adamson Muula, but the author with highest H-index is Elizabeth Monyleaux. The journal with most KUHeS publications is the Malawi Medical Journal, followed by PLoS One. Malawi Liverpool Welcome Trust is the most popular collaborating partner. The most cited author and article is “Prevention of HIV-1 infection with early antiretroviral therapy’’ by Cohen et al. published in 2011. The most popular subject focus is medicine, followed by immunology and microbiology, and nursing. Major funders of the studies include National Institute of Allergy and Infectious Diseases, Wellcome Trust, and National Institute for Health (NIH).
Conclusion: KUHeS has made a substantial contribution to address health challenges locally, regionally and globally through relevant research publications. This study offers a comprehensive assessment of KUHeS’s research landscape, enabling the university to make data-driven decisions for future research priorities, interventions and collaborations.

P43_002103. A SYSTEMATIC METHODOLOGY FOR DESCRIBING COMPLEX INTERVENTIONS: BRIDGING THE REPORTING GAP IN IMPLEMENTATION SCIENCE
Author(s): Chikondi Chapuma1, Fabiana Lorencatto2, Lou Atkins2, Catherine Dunlop3, Jenny Riches4, James Cheshire3, Andrew Weeks3 and David Lissauer3
Affiliation(s):
1.University of Liverpool, Malawi Liverpool Research Program
2.University College London
3.University of Birmingham
4.University of Liverpool
Email: chikondi.chapuma@liverpool.ac.uk

Introduction and objective: The field of implementation science has a paucity of comprehensive reporting when it comes to complex interventions. This study proposes a systematic methodology for describing complex interventions using a logical model.
Method: This is a multifaceted and multi-methodological study to formulate a proposed methodology. Using the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) Program as an example, the research team, consisting of a public health researcher, two behavioural change experts, and two Implementation Science Experts, performed a literature review to identify gaps in reporting the necessary information related to complex interventions. These gaps were then mapped to methodological strategies designed to address them. The strategies were applied to ten years of multi-faceted formative work aimed at improving adverse outcomes for maternal sepsis in Malawi and Uganda.
Results: We propose using a logic model to describe the APT-Sepsis by incorporating baseline data from its assessment through a cluster randomized trial to assess the intervention’s effects on the “”situation”” and “”external factors”” components. We also recommend applying the Behavioral Change Wheel components and the Actor, Action, Context, Timeframe, and Target (A-A-C-T-T) framework to describe the “outputs”, short-term and intermediate outcomes of the intervention. Additionally, we propose conducting a systematic literature review and meta-analysis to gain a comprehensive understanding of the causes and antimicrobial resistance related to maternal infections in sub-Saharan Africa, thus contributing to the description of external factors.
Conclusion: This study offers a systematic methodology for describing the theoretical foundations and operational aspects of an intervention designed to improve severe adverse outcomes in maternal infections. It not only provides guidance on how to adapt and customize this methodology but also highlights the importance of considering individual and facility-level influencers in complex interventions. This approach has the potential to enhance the transparency and comprehensiveness of reporting in complex intervention research.

P44_002132. NATIONAL DIGITAL MATERNAL HEALTH SURVEILLANCE PLATFORM (MATSURVEY): ENHANCING MATERNAL CARE DURING THE COVID-19 PANDEMIC
Author(s): Lumbani Makhaza1, Samson K Mphamba1, Thokozani Ganiza1, Deborah Phiri 1, Leonard Mndala1, Chikondi Chapuma 1, Alfred Muyaya1, Clemens Masesa 1,3, Luis Gadama 2 and David Lissauer 1,4
Affiliation(s):
1.Malawi-Liverpool Wellcome Programme
2.Kamuzu College of Health Sciences
3.Liverpool School of Tropical Medicine
4.University of Liverpool
Email: lmakhaza@mlw.mw

Introduction and objective: In response to the first wave of the COVID-19 pandemic in 2020, Malawi Liverpool Wellcome Programme collaborated with Ministry of Health to introduce MATSurvey, a National Digital Maternal Health Surveillance Platform in Malawi. MATSurvey aimed to collect comprehensive maternal health data, including maternal COVID-19 and near-miss cases, maternal deaths, and weekly facility audit data, which encompassed crucial information like Personal Protective Equipment stock levels, maternal and neonatal outcomes outside healthcare facilities.
Methods: Data collection occurred in 33 district hospitals in Malawi using Open Data Kit (ODK) platform on Android devices. MATSurvey, an in-house android application was developed to complement ODK, improving data management workflow. MATSurvey empowered safe motherhood coordinators (SMCs) to efficiently follow up on maternal cases, guiding them to the relevant follow-up forms. MATSurvey enabled SMCs to collect weekly facility data, enroll maternal cases, and monitor them daily until resolution. In cases of maternal deaths, the application facilitated comprehensive death audits. Additionally, real-time email notifications were sent for maternal deaths and confirmed/suspected COVID-19 cases reported in healthcare facilities. We also developed real-time data visualization through interactive MATSurvey dashboards.
Results: MATSurvey significantly improved the collection of critical maternal health data, proving invaluable during the COVID-19 pandemic. The digital data has enhanced healthcare systems at national level and is now being integrated in the National Digital Health Information System (DHIS2). Furthermore, it has supported various publications, including “”Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey),”” published on PubMed in 2022.
Conclusion: MATSurvey represents the power of innovation and collaboration in healthcare. Its deployment during the pandemic not only improved maternal care but also informed decision-making. The platform sets a precedent for addressing critical healthcare needs with digital solutions, serving as a blueprint for similar initiatives in the future.

P46_002160. ENHANCING NATIONAL HEALTH RESEARCH THROUGH INNOVATIVE TRANSCRIPTION PRACTICES: A CASE STUDY ANALYSIS
Authors: Nengezi Chirwa1, Evaristar Kudowa1, Brian Ngwira1, Fanny Kapakasa1
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
Email: nc@mlw.mw

Introduction: Accurate and timely transcription is integral to high-quality research, especially in the healthcare field.
Objective: This study investigated the challenges faced with transcription practices of qualitative data in national health research and propose for innovative solutions that can align with national health research programs and guidelines.
Methods: We conducted an observational case study of transcription challenges in transcription department at the Malawi Liverpool Well-come Programme. We focused on the flow of data during transcribing and translation, mostly in pattern uniformity, discourse analysis, consistency in interview questions and systematic techniques of data collection, cultural diversity, and language accent. The study also focused on the multidisciplinary approach of transcription from both medical and field researchers.
Results: The case study revealed that these challenges impact data accuracy, contextual analysis, cost-effectiveness and may lead to data loss or biased results. Inaccurate transcripts may affect data interpretation and analysis, affecting the progress of the health research initiatives.
Conclusion: This case study demonstrates the critical role of high-quality transcription in ensuring the integrity and accuracy of health research data, which is essential for advancing scientific knowledge and improving public health. There is need for a well-developed medical glossary of words or dictionary with standard culturally acceptable vocabulary. This will guide the transcription of medical research for uniformity of information. We also need a standardized operational guideline for medical research transcripts, which will focus on the multidisciplinary approaches of transcription from both medical expertise and linguistic fields researchers. The integration of advanced technology in transcription particularly artificial intelligence tools, that accommodate local languages is recommended. This will improve the accuracy, speed and efficiency of the process and can be used to transcribe a wide range of content.

P47_002178. FLEXING MUSCLES AND THE RACE TO FUNDING FLAGSHIP PROGRAMS”: A POLITICAL ECONOMY ANALYSIS OF ADOLESCENT HEALTH AND WELLBEING IN MALAWI
Authors: Monica Patricia Malata1, Medrina Mbotwa-Mtende1, Patani Mhango1, Anita Gumeni1, Effie Chipeta1, Alinane Linda Nyondo-Mipando2, and Alexander Morton3,4, on behalf of the Adolescent Health and Wellbeing Group Malawi
Affiliation(s):
1.Centre for Reproductive Health, Kamuzu University of Health Sciences
2.Department of Health Systems and Policy, Kamuzu University of Health Sciences
3.Department of Management Science, University of Strathclyde
4.National University of Singapore”
Email: mpmalata@kuhes.ac.mw

Introduction: Improving adolescent wellbeing is a “wicked problem”: one which involves multiple stakeholders, agencies, and budgets; and which impacts on multiple dimensions of social and economic wellbeing. A Political Economy Analysis can help policy implementers, donors, and other stakeholders to navigate this complex and contested landscape so that they can more effectively coordinate with other players in order to attain their objectives.
Objective: The aim of this study was to conduct a meso-level political economy analysis of adolescent wellbeing in Malawi.
Methods: We used a qualitative case study design. We interviewed policy makers and development partners working in the fields of health, youth development, gender, and education. We reviewed 19 policy documents across the same sectors. We analysed the policies using a review matrix which captured the main characteristics and themes of these documents relating to adolescent wellbeing. Qualitative interviews were analysed using reflexive thematic analysis.
Results: The overarching policy framework is provided by Malawi’s Vision 2063 which lays out the country’s youth development vision in terms of health and nutrition; education and skills development; water sanitation and hygiene; gender; science technology and innovation; and managing population growth. The Malawi’s Vision 2063 is operationalised through a range of sector-specific policies and strategies. The study participants reported high levels of engagement and commitment to the strategic plan but highlighted challenges of implementation. In particular, independence across government sectors and funding agencies led to poor coordination of activities. Furthermore, lack of public funding towards adolescents constituted another challenge. Meaningful youth engagement in policy development and implementation was a further challenge.
Conclusions: The Malawi’s Vision 2063 outlines a collaborative framework for long-term adolescent and youth development. The coordination across all stakeholders is necessary for achieving this vision.

P48_002190. ESTABLISHING REFERENCE INTERVALS OF FULL BLOOD COUNT AMONG HEALTH ADULT MALAWIANS
Author(s): Monica Lukhere1, Yohannie Mlombe 2, and Anthony Mwakikunga3
Affiliation(s):
1.Medical Laboratory Science Department, Kamuzu University of Health Sciences, P/B 360, Chichiri, Blantyre 3, Malawi.
2.Pathology Department, Kamuzu University of Health Sciences, P/B 360, Chichiri, Blantyre 3, Malawi.
3.Biomedical Science Department, Kamuzu University of Health Sciences, P/B 360, Chichiri, Blantyre 3, Malawi
Email: lukheremonica@gmail.com

Introduction: In most African countries, normal reference values for laboratory variables utilised in scientific trials and medical care are derived from European and American populations. However, research studies have shown that there are marked significant variations in values of haematological parameters among populations.
Objectives: This study aimed to establish reference intervals of full blood count among health adult Malawians and to compare these with other populations.
Methods: This was a descriptive cross sectional study. Participants were blood donors composed of 382 males and 18 female blood donors who were selected randomly. Samples were analysed using Mindray BC 5150 haematology analyser.
Results: The results that had higher values for upper reference limit for the study were WBC, HCT, MCV, MCH, neutrophil count RBC, Hgb, MCHC, PLT, HCT and EOS. The results that had lower values of lower reference limit for the study were WBC, HCT, MCV, MCH, neutrophil count RBC, Hgb, MCHC, PLT, HCT and EOS. Reference limits of Lymphocyte count were higher for the study and Monocytes were higher for the haematology analyser. Reference limits of Basophil count for were equal for haematology analyser and of the study. The results that showed variation of haematology parameters within the regions in Malawi were WBC, RBC, HCT, MCV, MCH, MCHC, PLT NEUT, Lymph, Mono and Basophil count.
Conclusion: This study has shown that there are variations in full blood count parameters based on geographical regions, suggesting that populations should establish their own haematological reference values.

P49_002198. WHY INFRASTRUCTURE MATTERS IN HEALTH CARE SERVICES: MINOR INFRASTRUCTURE DEVELOPMENT AT AN ADULT EMERGENCY DEPARTMENTS OF A TERTIARY HOSPITAL AND A DISTRICT HOSPITAL IN MALAWI
Author(s): J. Mbamba1,2 and P. Lutala1
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of family medicine, Malawi
2.Ministry of health, Malawi
Email: jmbamba@kuhes.ac.mw

Introduction: Ninety percent of injuries occur in LMIC. In Malawi, there has been an increase of DALYs secondary to trauma and injuries with an increase of 1.21% from 2010 (3.39%) to 2019 (4.5%). Resources to upgrade the infrastructure of emergency department (ED) are important for patient flow and urgent case management. Objective: To demonstrate the impact of the minor infrastructure expansion on the emergency care systems at two case studies of Zomba central hospital (ZCH) and Mangochi district hospital (MDH).
Methods: Case Study 1 ZCH: The ED has evolved from a 3 bed casualty room and 2 consultation rooms in 2017 to an ED with all required sections in 2022. Despite the small size of the ED, this has remarkably changed service delivery and enhanced process. Before expansion: resuscitation room, consultation room. Now: sectioning of the ED, Gate house (TRIAGE, REGISTRATION), Diarrhoea room, storage room, Short stay ward, Resuscitation room, Priority, conference room. Case Study 2 MDH: In 2018 MDH saw the expansion of the 2 bed casualty to a 6 bed casualty with a corridor to wheel patients in and a waiting area. Before expansion:2 bed casualty for minor trauma, multiple entries, urgent cases queue in corridor. Now: Triage area, single entry for all patients, resuscitation area
Results: All the indicators listed below were not available prior to ED (ZCH) and casualty (MDH) expansion respectively. Both ZCH and MDH now have Triage area, Triage system, Staff allocation in all sections, Data availability. ED assessment forms and point of care investigations are available for ZCH (to be presented in a table).
Conclusion: Infrastructure plays a big role in emergency service delivery. In our context resources for emergency services are misallocated to other services. There is need to invest in the vibrant infrastructure development to enhance emergency systems.
P50_002213. REVOLUTIONIZING PCR QUALITY CONTROL: REAL-TIME DATA ASSURANCE AND PLATE MANAGEMENT
Author(s): Alfred Matengeni1, Peter Ntenda1, Christopher Chikhosi Stanley1, Samson Gowa1, Harrison Msuku1, Wangisani Kumalakwaanthu1, Charles Mangani2, Lauren Cohee3, Karl Sydel2, Terrie Taylor2, Don P. Mathanga1,2, and Clarissa Valim3,5
Affiliation(s):
1.MAC- Communicable Disease Action Center (MAC-CDAC),
2.Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
3.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
4.Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
5.Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Email: amatola@mac.kuhes.ac.mw

Introduction: The modern molecular laboratory necessitates both efficiency and precision in Polymerase Chain Reaction (PCR) protocols. In response to this demand, a web-based PCR–QC System was developed to simplify PCR plate management and real-time QC. This paper delves into the evolution and integration of this pioneering system, shedding light on its capacity to potentially transform laboratory procedures.
Objectives: Evaluate the web-based PCR-QC system’s impact on lab efficiency and data quality. To measure user satisfaction and efficiency gains with the PCR-QC system. To analyze its influence on decision-making and plate management in molecular labs.
Methods: We developed a laboratory PCR-QC system that integrated field sample and laboratory results. It was automatically accessing samples’ records from field database which has sample id and participant id. It also accessed sample results and plates data generated from PCR machine, that has parameters like CT, original quantity and other variables. Then the system could execute an algorithm that processed the plates to determine negative control wells, standard control wells, test samples, and defined standard CT boundaries, standard curve, estimate quantity of standards and test samples, discrepancy between original and newly estimated quantity, false positive. Finally determined plate failure status.User-friendly dashboard displayed real-time statistics visualizations.
Results: The dashboard displayed, in real-time, plates run ever, plates run in the last 7 days, plates rejected in the last 7 days, samples pending rerunning, and plates with warnings. It also included visuals showing plates pass rate ever, summary distribution of reasons for plate failure, which ranged from slope out of boundary, R-Squared out of boundary, too many outliers, and negative control positives. System sent instant emails were used to signal the status of the plates, making decision-making faster.
Conclusion: This system marks a significant advancement, streamlining plate management and promising enhanced efficiency and reliability in PCR procedures.

P51_002228. PROPOSING THE “VALUE- AND EVIDENCE-BASED DECISION MAKING AND PRACTICE” (VEDMAP) FRAMEWORK AS A TOOL FOR HEALTH TECHNOLOGY ASSESSMENT (HTA) IN MALAWI AND BEYOND.
Author(s): Mfutso Bengo1
Affiliation(s):
1.Kamuzu University of Health Sciences (KUHES), Malawi
Email: mfutsobengo@kuhes.ac.mw

Introduction: The existence and availability of evidence on its own does not guarantee that the evidence will be demanded and used by decision and policy makers. Decision and policy-makers, especially in low-income settings, often confront ethical dilemmas about determining the best available evidence and its utilization. This dilemma can be in the form of conflict of evidence, scientific and ethical equipoise and competing evidence. Consequently, decisions are made based on convenience, personal preference, donor requirements, political and social considerations which can result in resource wastage and inefficiency.
Objective: To assess the feasibility and acceptability of using VEDMAP as a decision making modelling tool for Priority-Setting and knowledge translation.
Methods: The study used mixed research methods. A desk review was used to map out and benchmark normative values of different African countries with HTA in South Africa, Ethiopia and Ghana. Focus group discussions and key informant interviews were used to map out the actual (practiced) values in Malawi.
Results: The results identified three types of value sets used in decision making: normative, actual and optimal. However, the evidence suggest a great deal of fidelity and value misalignment indicating discrepancy between policy intentions and actual practice. The review show that there were different types of decision making frameworks: value-based and evidence-based decision making. However, it was observed that one framework on its own could not lead to an optimal decision because one needs the other. Hence a new integrated approach of the two with proper ranking of evidence and values to optimize decision making was proposed. This process led to the development of the VEDMAP decision making modelling tool and App.
Conclusion: The use of VEDMAP framework was found to be feasible and acceptable in HTA to bring efficiency, traceability, transparency and integrity in decision- policy making process and implementation.

P52_002234. REVOLUTIONIZING PCR QUALITY CONTROL: REAL-TIME DATA ASSURANCE AND PLATE MANAGEMENT
Author(s): Ernest Matola1, Alfred Matengeni1, Peter Ntenda1, Christopher Chikhosi Stanley1, Samson Gowa1, Harrison Msuku1, Wangisani Kumalakwaanthu1, Charles Mangani2, Lauren Cohee3, Karl Sydel4, Terrie Taylor5, Don P. Mathanga1,2, and Clarissa Valim6
Affiliation(s):
1.MAC- Communicable Disease Action Center (MAC-CDAC),
2.Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
3.Center for Vaccine Development and Global Health,
4.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.Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Email: ematola@mac.kuhes.ac.mw

Introduction: The modern molecular laboratory necessitates both efficiency and precision in Polymerase Chain Reaction (PCR) protocols. In response to this demand, a web-based PCR–QC System was developed to simplify PCR plate management and real-time QC. This paper delves into the evolution and integration of this pioneering system, shedding light on its capacity to potentially transform laboratory procedures.
Methods: We developed a laboratory PCR-QC system that integrated field sample and laboratory results. It was automatically accessing samples’ records from field database which has sample id and participant id. It also accessed sample results and plates data generated from PCR machine, that has parameters like CT, original quantity and other variables. Then the system could execute an algorithm that processed the plates to determine negative control wells, standard control wells, test samples, and defined standard CT boundaries, standard curve, estimate quantity of standards and test samples, discrepancy between original and newly estimated quantity, false positive. Finally determined plate failure status.
User-friendly dashboard displayed real-time statistics visualizations.
Results: The integration of the Laboratory PCR Quality Control System into molecular laboratories yielded significant improvements in efficiency, data quality, and the overall management of PCR plates. The dashboard displayed, in real-time, plates run ever, plates run in the last 7 days, plates rejected in the last 7 days, samples pending rerunning, and plates with warnings. It also included visuals showing plates pass rate ever, summary distribution of reasons for plate failure, which ranged from slope out of boundary, R-Squared out of boundary, too many outliers, and negative control positives.
Instant emails were sent to researchers indicating plate failure or not. The automated reporting and messaging features expedited the decision-making.
Conclusion: This system marks a significant step forward, offering real-time data assurance and efficient plate management, promising increased overall efficiency and reliability in PCR procedures.

P53_002243. EXPLORING EXPERIENCES OF GUARDIANS PROVIDING HOME HEALTH CARE TO CHRONICALLY ILL PATIENTS DISCHARGED FROM REFERRAL HOSPITAL IN BLANTYRE, MALAWI
Author(s): Beauty Waekha Moyo1, Robert Akpalu1, and Patrick Owili1
Affiliation(s):
1.Adventist University of Africa
Email: beautywaekha@yahoo.com

Introduction: Home health care has become a widely used approach to care delivery to chronically ill patients globally. However, it remains below global average of utilization in Sub-Sahara Africa (Annobil, et al., 2021). Moreover, much emphasis has been given on the actual home health care without examining care giver’s perspective in detail. Nevertheless, with the type and nature of care and effort that is demanded, guardians usually face a wide range of issues with a special emphasis on Malawi where relatives are guardians in this system.
Objectives: To explored experiences guardians who provide home health care to their chronically ill relations go through.
Methods: In this study, qualitative research employing narrative autoethnography approach to purposively recruit 17 participants out of desired 20 to 30 participants was done and saturation was reached at 17 participants. Researcher used in-depth interviews to collect data on the experiences of guardians providing home health care to chronically ill patients discharged from Referral hospital in Blantyre Malawi. Data was analyzed using thematic method of analysis. The recorded interviews were protected with passwords while associated transcripts were kept in lockable containers. The data access has been limited to research team members only.
Results: The study found that motivation to give care is the main influencing factor for using home-based care. The study further revealed that guardians provide both basic care and daily supportive activities to the patients. Home health care poses several experiences to guardians -most prominently, caregiving, experience compromised routine duties, emotional distress, financial and time constraints and limited economic activities. The study has however revealed that guardians adopt positive coping mechanisms or strategies that include seeking help, faith and prayers and taking the experience as a learning process.
Conclusions: This study concludes that home health care delivery in Malawi is solely given by guardians. With limited resources and lack of sound policy, this creates a critical challenge to guardians. The study therefore recommends that a comprehensive policy should be developed and implemented. Specifically, it should be designed to address the negative social and psychological experiences and financial and logistical inconsistences.

P54_002258. EVALUATING WORKPLACE WELL-BEING OUTCOMES OF AN EMPLOYEE ASSISTANCE PROGRAM IN MALAWI
Author(s): Maclean Vokhiwa1, Susan Carnes Chichlowskaa1, and Augustine T. Choko2

1.Public Health Department, College Of Medicine University of Malawi, Blantyre, Malawi
2.Public Health Group, Malawi Liverpool Wellcome (MLW) Trust Clinical Research Program, Blantyre, Malawi”
Email: eapwellness@gmail.com
Introduction: The lack of local evidence on the effectiveness of Employee Assistance Programs (EAP) has restricted the scope of Malawi workplace well-being programs, as well as hindering training for local EAP professionals. Such evidence is relevant to support the spread of EAP into African countries. Global statistics indicate that EAPs significantly improve workplace outcomes (p<0.05) with equal effectiveness across demographic factors. However, the effectiveness of EAP within localised African settings has received little attention in academic research. In 2023, Malawi universities still lack formal wellness and EAP training. Objectives: This study sought to establish the effectiveness of an EAP intervention on work-related outcomes among Malawian employees. Methods: It adopts a mixed method, quantitative correlational ‘pre-post’ design to examine improvement over time in employees after EAP health and stress management intervention, during 2018/2019. The target population was 335 employees working in a local organisation receiving EAP services. Dependent on chance and employee consent, 318 participants enrolled at pre-test and 226 (71%) completed assessments after EAP. The Chestnut Global Partners’ Workplace Outcomes Suit (CGP-WOS) measuring absenteeism, presenteeism, work engagement, distress, and life satisfaction, and a basic demographic questionnaire were used. Results: Descriptively, there was no characteristic difference among participants between the two time-points, as well as between post-test responders and non-responders, p>0.05. Paired mean comparison tests indicated statistically significant improvement after EAP in four of five outcome scores. In addition, regression analysis indicated that participant characteristics do not predict this improvement. Furthermore, analysis of themes indicated that the intervention met participant expectations.
Conclusions: The study established that EAP locally reduced absenteeism, presenteeism, and workplace distress, and increased employee life satisfaction, p<0.05. It also recommends adoption of EAP policies across Malawian organisations, training of local professionals, as well as the need for rigorous research among local workplace well-being programs.

P55_002279. ENHANCING NATIONAL HEALTH RESEARCH THROUGH INNOVATIVE TRANSCRIPTION PRACTICES: A CASE STUDY ANALYSIS
Author(s): Nengezi Chirwa1, Evaristar Kudowa1, Brian Ngwira1, and Fanny Kapakasa1
Affiliate(s):
1.Malawi Liverpool Wellcome Programme
Email: nchirwa@mlw.mw

Introduction: Accurate and timely transcription is integral to high-quality research, especially in the healthcare field. This study investigated the challenges faced with transcription practices of qualitative data in national health research and propose for innovative solutions that can align with national health research programs and guidelines.
Methods: We conducted an observational case study of transcription challenges in transcription department at the Malawi Liverpool Well-come Programme. We focused on the flow of data during transcribing and translation, mostly in pattern uniformity, discourse analysis, consistency in interview questions and systematic techniques of data collection, cultural diversity, and language accent. The study also focused on the multidisciplinary approach of transcription from both medical and field researchers.
Results: The case study revealed that these challenges impact data accuracy, contextual analysis, cost-effectiveness and may lead to data loss or biased results. Inaccurate transcripts may affect data interpretation and analysis, affecting the progress of the health research initiatives.
Conclusion: This case study demonstrates the critical role of high-quality transcription in ensuring the integrity and accuracy of health research data, which is essential for advancing scientific knowledge and improving public health. There is need for a well-developed medical glossary of words or dictionary with standard culturally acceptable vocabulary. This will guide the transcription of medical research for uniformity of information. We also need a standardized operational guideline for medical research transcripts, which will focus on the multidisciplinary approaches of transcription from both medical expertise and linguistic fields researchers. The integration of advanced technology in transcription particularly artificial intelligence tools, that accommodate local languages is recommended. This will improve the accuracy, speed and efficiency of the process and can be used to transcribe a wide range of content.

P56_002291. ENGAGING HUMAN-CENTERED DESIGN TO UNDERSTAND RELATIONSHIPS BETWEEN HUMAN BEHAVIOURS AND MALARIA CONTROL IN HIGHLY ENDEMIC AREAS OF MALAWI
Author(s): Blessings N. Kaunda-Khangamwa1,2, John Gimnig3, Themba Mzilahowa¹, Don P Mathanga¹, Michael Kayange 4, Shadrach Mulenga 4, Akuzike Banda 4, and Julie-Anne A. Tangena5
Affiliate(s):
1.Malaria Alert –Communicable Diseases Action Centre, Kamuzu University of Sciences, Blantyre, Malawi,
2.School of Public Health, University of the Witwatersrand, Johannesburg, South Africa,
3.Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA,
4.Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi,
5.Liverpool School of Tropical Medicine, Vector department, Pembroke Place, Liverpool, UK.
Email: b.n.kaunda@gmail.com

Introduction: Transmission of malaria is a dynamic process that requires a thorough understanding of the complex relationship between humans, vector, parasite, environmental and social dynamics. Indoor and outdoor activities, physical movement of the local population and their understanding of the malaria disease dynamics profoundly impact malaria outcomes. Currently, the human dynamics that influence malaria disease transmission are well-established, yet relatively few studies have included human behaviour when investigating exposure to malaria vectors.
Methods: In this study, we illuminated how everyday activities and malaria dynamics are understood in the local human behaviour context, with the population actively involved and given ownership throughout the study process. Using purposive sampling, we involved 80 participants through a human-centred design, conducting eight focus group discussions, nine key informant interviews and nine participatory rural appraisal activities (problem ranking, village mapping, seasonal and day calendars) to illustrate diverse spaces, sites and experiences contributing to residual malaria transmission in two vector surveillance sentinel sites, Chilungo and Cholokhoto village in Salima District, Malawi. Thematic analysis identified how adolescents and adults representing different communities communicate, interact, empathize and stimulate local people’s involvement in malaria control.
Results: Human behaviors, lifestyles, daily, weekly and monthly activities of the community members are important determinants of malaria transmission. Distinctive male and female adolescents in/out of school (15–23-year-old) and adults (24-45-year-olds) perspectives show the different ways communities see what malaria, including intervention programmes, are today.
Conclusion: The human-centred design identified and empathized challenges related to human behaviours and contextual particularities that influence malaria transmission, informed practices, including sustainable solutions that meet their malaria needs and lifestyles. Inclusive approaches to understanding human behaviours and malaria control are key to improving malaria outcomes for priority populations.

P57_002019. COST ANALYSIS OF COMMUNITY-BASED DELIVERY AND ADMINISTRATION OF SARS-COV-2 ANTIGEN RAPID DIAGNOSTIC TESTS (AG-RDT) IN MALAWI.
Author(s): Chavula Chancy1, Makondesa Joseph1, Ali Gracious1, Mwenifumbo Tamara1, Banda Confidence1, Chitanda Francis1, Mtaula Jonathan1, Bitilinyu-Bangoh Joseph2 and Gunda Andrews1.
Affiliation(s):
1.Clinton Health Access Initiative
2.Ministry of Health, Malawi
Email: jmakondesa@clintonhealthaccess.org

Introduction: COVID-19 testing in Malawi has been largely limited to facility-based settings and is below the WHO recommendations of 1 test per 1000 population per week. Many countries have adopted and implemented population-scale testing to monitor and reduce viral transmission (Mercer & Salit, 2021). Our objective was to estimate the cost of delivery and administration of SARS-CoV-2 RDT using the community testing model. Our results will inform Ministry of Health (MoH) in evidence-based decision making whether to include community testing in COVID-19 testing guidelines.
Methods: Four community testing sites were set-up in districts of Blantyre and Lilongwe. Our study views cost from MoH perspective and followed a micro-costing approach which has been favoured in the literature to be the most precise approach. For primary data, we used data collected between June and September 2022 the period in which the community testing for COVID-19 operational research was fielded.
Results: 2,348 samples were tested. Total cost per sample collected and tested was USD 5.45. Personnel cost for Health care workers (HCWs)) were the main cost drivers (66%) followed by equipment cost (e.g. tents,) and public awareness (25%). Among all sites, the least cost drivers were vehicles cost (7%). Monthly allowances for HCWs were found to be a high percentage of HCWs’ monthly salary (110% for Health Surveillance assistants (HSAs)) 70.5% for Nurse technicians and 75% for clinicians.
Conclusion: Despite community testing being feasible and, accessible and contributing highly (21%) to the national volumes, the costs per test conducted was found to be high considering the per capita health expenditure for Malawi. MOH should consider minimizing the personnel cost when implementing population-scale testing programs through the normalisation and integration of COVID-19 services into routine care. This could be done by including COVID-19 services among the services offered by HSAs.

P58_002082. ENABLERS AND BARRIERS TO ADHERENCE TO NEWLY INTRODUCED ORAL TREATMENT FOR MULTI-DRUG RESISTANT TUBERCULOSIS IN MANGOCHI DISTRICT, MALAWI: A CROSS-SECTIONAL QUALITATIVE STUDY.
Author(s): Margaret Jenny Nyalugwe1, Chifundo Michael Manong’a1. Evetta Chisope1, and Towela Maleta1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: nyalugwemag@gmail.com

Background: The Malawi National Tuberculosis Program (MNTP) recently switched the MDR-TB treatment regimen from a combination of injectable and oral anti TB drugs to an all-oral regimen in 2018. This has increased the pill burden and increased the treatment period from 12 to 18 months. The change was necessitated by the need to minimize amikacin-induced side effects which include vertigo, convulsions, and numbness. However, the longer treatment period and pill burden may affect treatment adherence.
Objective: The purpose of the study was to assess factors that influence adherence to the newly introduced all-oral drugs for MDR-TB.
Methods: This was a descriptive qualitative study which employed 10 in-depth interviews, 2 focus group discussions and 7 key informant interviews with patients, guardians and health workers. Previously treated MDR TB Participants were identified through purposive sampling from Traditional Authorities Chowe and Mponda in Mangochi district. Data analysis was done through a thematic approach.
Results: Patients expressed satisfaction with the newly-introduced all-oral treatment for MDR-TB owing to the fewer side effects the treatment has. Again, clients expressed experiencing quick improvement in health condition as opposed to the previous injectable treatment. Factors which promoted adherence were rapid change in the patient’s condition, proper counselling healthcare workers, good relationship with healthcare workers, family support as well as patient’s desire to get cured. However, some patients highlighted barriers to adherence such as lack of food, transport costs (delayed food provision, and delayed transport refund by MNTP through partners) and medication stockouts. Recommendations to improve adherence included interventions such as linking MDR-TB patients to community financial activities such as social cash transfers and village savings loans, and timely provision of food and transport.
Conclusion: Efforts aimed at increasing adherence should aim at uplifting the socioeconomic status of MDR TB patients, to overcoming the financial constraints that impact adherence.”

P59_002151. RECRUITMENT STRATEGIES USED TO ENROLL HEALTHY VOLUNTEERS IN THE FIRST PNEUMOCOCCAL HUMAN INFECTION STUDY IN AFRICA: LESSONS FROM BLANTYRE, MALAWI
Author(s): Edna Nsomba1, Anthony Chirwa1, Clara Ngoliwa1,3, Vitumbiko Nkhoma1 , Pemphero Liwonde1, Edward Mangani1 , Modesta Reuben1,3, Lorensio Chimgoneko1, Lumbani Makhaza1, Evaristar Kudowa1, Marc Y.R. Henrion1,2, Neema Toto1, Stephen B. Gordon1,2, Dingase Dula1, on behalf of the Malawi Accelerated Research in Vaccines using Experimental Laboratory Systems (MARVELS) consortium
Affiliation(s):
1.Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
3.Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
*Equal contribution
Email: ensomba@mlw.mw

Introduction: Human infection studies (HIS) also known as Controlled Human Infection Models (CHIM) are a relatively new concept in African countries to clinicians, scientists, and communities alike. We have introduced HIS/CHIM studies to Malawi during the last four years by developing an experimental human pneumococcal carriage model. This CHIM was used to test the efficacy of a licensed 13-valent Pneumococcal Conjugate Vaccine (PCV13) against experimental nasal pneumococcal carriage. Traditional and digital recruitment strategies into this novel trial were explored.
Objective: To describe various methods of recruitment in this first CHIM study in Malawi.
Methods: The clinical trial within the context of which these data were recorded was registered with the Pan African Clinical Trials Registry (REF: PACTR202008503507113) on 03 August 2020. The project was conducted at the Malawi Liverpool Wellcome Programme (MLW) in Blantyre, Malawi between April 2021 and September 2022. Source populations were college students and community members within Blantyre. Recruitment strategies were: sharing study information in written or visual form, community sensitization meetings, snowball sampling, branded clothing and participating in radio and television programs.
Results: 299 volunteers were screened, 278 recruited. Sixty-six recruited (23.7%) were college students whereas 212 (76.3%) were from the community. Snowball sampling was the most successful recruitment strategy, with 201 (72.3%) participants recruited using this method. 195 (70.1%) were men of whom 149 (76.4%) joined the study through snowballing.
Conclusion: Using a variety of recruitment strategies led to successful recruitment in this novel controlled human infection study. Most participants were recruited through snowballing.

P60_001955. IMPACT OF MOBILE HEALTH ON IMPROVING MATERNAL HEALTH CONTINUUM OF CARE CASCADE IN SUB-SAHARAN AFRICA: A SYSTEMATIC REVIEW WITH NARRATIVE SYNTHESIS
Authors: Chiyembekezo Kachimanga1, Alexandra Kulinkina2, Ibukun- Oluwa Omolade Abejirinde3, and Thomas van den Akker4
Affiliation(s):
1.Athena Institute, Vrije Universiteit Amsterdam, Netherlands and Partners In Health, Malawi
2.Swiss Tropical and Public Health Institute, Switzerland, University of Basel, Switzerland and Partners In Health, Malawi
3.Women College Hospital Institute for Health System Solutions and Virtual Care, Canada and Dalla Lana School of Public Health, University of Toronto, Canada
4.Athena Institute, Vrije Universiteit Amsterdam, Netherlands
Email: chembekachimanga@yahoo.co.uk

Introduction: No synthesis exists on the impact of mobile health (mHealth) use by community health workers (CHWs) to improve the utilisation of maternal health services in sub-Saharan Africa (SSA).
Objectives: This systematic review with narrative synthesis examined the impact of mHealth use by CHWs on improving the utilisation of antenatal care (ANC), facility-based births and postnatal care (PNC) in SSA.
Methods: We comprehensively searched six databases (Embase, Web of Science, Medline, CINAHL, Scopus, and Africa Index Medicus). We limited the search to SSA and did not restrict the search by language or time. Two independent reviewers conducted title and abstract screening, full-text screening, and data extraction. We report the findings from experimental and quasi-experimental studies. The protocol was registered in PROSPERO (ID CRD42022346364).
Results: Of the 2594 articles retrieved in September 2022, 11 were included (five randomised control studies and six quasi-experimental studies). The studies were published between 2015 and 2022 in six countries. Eight studies reported on ANC and facility-based births, and four reported on PNC. Three studies that used an SMS-based mHealth platform increased ANC visits, mainly four or more ANC visits. Two SMS-based platform studies, one voice-based study and two mobile applications studies showed no improvement in ANC utilisation. Facility-based births increased in three of the four studies that used mHealth applications, one of three studies that used SMS-based platforms, and one that used voice calls. Among the four studies that reported on PNC, two out of three that used SMS-based platforms showed an increase in the utilisation of PNC after mHealth use. In contrast, one study that used a mHealth application did not show any improvement in PNC utilisation.
Conclusion: Using SMS-based platforms, voice calls, and mobile applications by CHWs increases the utilisation of ANC, facility-based births and PNC in SSA.

P61_001972. GLOBAL EVIDENCE, LOCAL ADAPTATION (GELA): ENHANCING EVIDENCE-INFORMED GUIDELINE RECOMMENDATIONS FOR NEWBORN AND YOUNG CHILD HEALTH IN THREE COUNTRIES IN SUB-SAHARAN AFRICA
Author(s): Nyanyiwe Masingi Mbeye 1, Emmanuel Effa2, Taryn Young3, Per Olav Vandvik4, Claire Glenton5, Simon Lewin6 and Tamara Kredo7, on behalf of the GELA Team
Affiliation(s):

1. Department of Community and Environmental Health, Kamuzu University of Health Sciences, Malawi
2. University of Calabar Teaching Hospital, Cochrane Nigeria
3. Stellenbosch University, Cape Town, Republic of South Africa
4. MAGIC Evidence Ecosystem Foundation
5. Norwegian University of Science and Technology
6. Hogskulen pa Vestlandet
7. South African Medical Research Council, Republic of South Africa
   Email: nmbeye@kuhes.ac.mw

Introduction: Despite progress in the health of newborns and children, most countries in sub-Saharan Africa have not met the Sustainable Development Goals for under-five mortality. Clinical practice guidelines (CPGs) are needed to bridge the gap between research evidence and practice impacting directly on patient care, health system funding and access to health services.
Objectives: The Global Evidence, Local Adaptation (GELA) project is working with ministries of health in South Africa, Nigeria and Malawi to maximise the impact of research through increasing decision makers’ and researchers’ capacity to use global research to develop locally relevant CPGs for newborn and child health.
Methods: We are implementing a multi-faceted, multidisciplinary research and capacity strengthening programme, adaptation methodology and digital platforms to support authoring delivery for contextually rich CPGs. This is delivered through partnerships with national CPG groups, including policy makers, epidemiologists and civil society representatives.
Results: A three-year project was successfully initiated in all countries. Steering Group members and Guideline Development Panelists were identified and are participating in various project related activities. Recently, the teams completed a landscape analysis of CPGs in newborn and child health; and concluded the priority setting process identifying three topics for new CPGs for newborn and child health per country. Monitoring and evaluation activities are using variety of approaches including integrated knowledge translation, observation of CPG groups and evaluation of capacity needs for decision-makers.
Conclusion: Overall, the project is on course to achieving its targets with priority topics identified and CPG groups being convened. Our success is enabled through a project team of African and international leaders in the field of evidence-based healthcare and CPG methods who have partnered with national ministries in Malawi, Nigeria and South Africa, the WHO HQ and Afro regional office and the civil society groups. Ongoing evaluation will help us learn which aspects work well to reduce waste and save resources for our settings and may be scalable to other countries like ours.

P62_001979. THE INFLUENCE OF TELEMEDICINE ON MATERNAL HEALTH AND EQUITY OUTCOMES IN SUB-SAHARAN AFRICA: A CASE STUDY OF THE REPUBLIC OF MALAWI.
Author(s): Kalala Elisee Kabuya1
Affiliation(s):
1.Africa University
Email: kabuyakalala8@gmail.com

Introduction: Telehealth, defined by the World Health Organization (WHO) as the use of technology to provide healthcare services across geographical distances, presents an innovative solution for healthcare delivery. In Sub-Saharan Africa, accessing maternal healthcare remains a formidable challenge despite global efforts, particularly within the Sustainable Development Goals (SDGs) framework. Recognizing the pivotal role of maternal, neonatal, and child health in poverty reduction and narrowing health disparities, telehealth offers promise in improving maternal health outcomes. It addresses barriers such as limited access to in-person consultations, a shortage of skilled birth attendants, and inadequate health promotion activities.
Objectives: This study examines the potential exclusionary nature of telehealth in the context of technology-based maternal health programs in the Republic of Malawi. We aim to shed light on the challenges and limitations in implementing telehealth initiatives, with a specific focus on how wealth disparities, educational levels, and geographical location contribute to unequal access to maternal healthcare, placing women at risk.
Methods: Our study adopted a mixed-method approach, combining quantitative analysis with qualitative examination. Data was collected from existing literature, reports, and field observations. Statistical analysis and thematic coding were employed to identify patterns, disparities, and barriers related to the adoption of telehealth in maternal healthcare in Malawi.
Results: Our findings indicate that wealth disparities, educational attainment, and geographical location significantly hinder the implementation of telehealth in maternal healthcare in Malawi. Lower-income women face restricted access to telehealth services, which are predominantly concentrated in urban areas. Limited educational attainment exacerbates these challenges. Rural areas, lacking telehealth infrastructure, further intensify the disparities, resulting in inequitable access to maternal healthcare services.
Conclusion: Addressing these limitations is crucial to ensure that telehealth offers equitable access to maternal healthcare for all women, aligning with the principle of leaving no one behind. To harness the full potential of telehealth in advancing maternal healthcare in Malawi, policy-makers and stakeholders must prioritise inclusivity and equitable access, bridging the wealth, education, and geographic gaps. This focus will improve maternal health outcomes, contributing to poverty alleviation and the reduction of healthcare disparities.

P63_002009. A COMBINED HEALTH CARE PROVIDER AND LAY PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT IN APT SEPSIS AND LACTATE STUDIES. A CASE FOR MALAWI
Author(s): Bertha Maseko1, Alinane Linda Nyondo-Mipando1,2,3 and David Lissauer1,3
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
2.Kamuzu University of Health Sciences
3.University of Liverpool
Email: bmaseko@mlw.mw

Introduction: Patient and Public Involvement (PPI) significantly contribute to clinical and implementation science research to make it relevant, acceptable, and beneficial to the public concerned. Research poses challenges to the lay public contributors to understand Medical Jargon, procedures, processes, and practice. Yet the need for their contribution towards research that is context specific remain critical. We formed a combined professional committee including medical professionals and lay members of the Public to contribute to the conduct of LACTATE and Active Prevention and Treatment of Maternal Sepsis (APT Sepsis) studies.
Methods: The research team contacted health care providers, staff, and fellow PPI members to help identify and nominate sepsis survivors, carers, and spouses to survivors to contribute to LACTATE and APT SEPSIS studies. Health care providers experienced in Maternal and Fetal health were contacted to be part of the committee. The committee reviews Study document, receive implementation updates and discuss progress of studies in a combo approach. Health care providers provide a learning platform to lay public contributors to understand medical jargon and contribute effectively to clinical research while the public contributors provide personal, community and public perspectives about research and care services. Together they shape the research conduct.
Results: Twelve members, both lay public contributors and health care professionals formed a strong committee in Maternal and Fetal health research group. No negative power imbalances have been observed within the members. The committee successfully informed the development of participant information sheet and contributed to recruitment and dissemination plans of studies. More protocols use the committee to guide the development and implementation of the research studies.
Conclusion: Combining health care professional and lay public contributors is feasible and effective in contributing to research. Combination approach provides instant learning opportunity and real-life experiences and suggestions from lay public contributors and health professionals alike.

P64_002042. MIDWIVES’ PERCEPTIONS OF THE CLINICAL TEACHING AND LEARNING OF MIDWIFERY AT KAMUZU UNIVERSITY OF HEALTH SCIENCES
Author(s): Chrissie Phiri1, 2, S. L. Edwards1, and A. Potter1
Affiliation(s):
1.Swansea University, Singleton Park, Swansea, SA2 8PP.
2.Kamuzu University of Health Sciences Private Bag 1 Lilongwe
Email: phiric@kuhes.ac.mw

Introduction: Malawi has one of the highest maternal and neonatal mortality rates globally. In response, Kamuzu University of Health Sciences introduced midwifery into the generic nursing programme to empower graduate nurses/midwives to promote safe motherhood. Additionally, an outcome-based curriculum model was adopted to produce graduates who will respond to the needs and emerging issues in the country. This was assumed to be an effective approach to meeting clients’ reproductive health needs. Integrating nursing and midwifery means that all graduates can attend to all female clients holistically. However, reports indicate that graduates perform of graduates below the expected standards. This study explored midwives’ perceptions of the clinical teaching and learning practices utilized by midwifery lecturers, students in preparation for effective midwifery practice.
Objectives: 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 was selected in first phase. Data were collected using face to face semi structured interviews. In the second phase, 26 students, five graduates from KUHeS and four graduates from Mzuni were selected. Data from KUHeS students and graduates were collected using focus group discussions, face to face interviews were used for Mzuni graduates. Old timetables, curriculum and students’ clinical assessment forms were checked to verify data from respondents. Using NVivo software, a thematic analysis approach was used for data analysis.
Methods: Clinical teaching and learning are compromised, due to the integration, lack of equipment, role models, lack of supervision, poor relationships, infrastructure, and lack of objectivity in students’ clinical assessments.
Conclusion: Students’ interest in a profession and a conducive teaching and learning environment is crucial in the production of a competent midwife.

P66_002167. PATTERNS OF BLOOD ORDERING AND BLOOD USAGE AT NSANJE DISTRICT HOSPITAL, MALAWI
Authors: Wongani Mtabayira Nyondo1, Bridon M’baya2, Emmanuel Singogo3, Maganizo Chagomerana3, Adamson S. Muula1, Mina C. Hosseinipour3,4, Titus Chiwindo3, Tiyamike Nthani3, Robert M’bwana2, Victor Mwapasa1
Affiliation(s):
5.Kamuzu University of Health Sciences – School of Global and Public Health
6.Malawi Blood Transfusion Services (MBTS)
7.University of North Carolina (UNC) Project, Malawi
8.University of North Carolina at Chapel Hill, USA
Email: wonganimtabayiranyondo@gmail.com

Introduction: Blood and blood products are essential for the management of many life-threatening conditions. Despite limited availability of blood in Malawi, little is known about the patterns of blood requisitions from the Malawi Blood Transfusion Services (MBTS) and distribution of blood units in hospital inpatient wards of Malawi.
Objective: to assess the ordering and distribution pattern of blood units in the inpatient.
Methods: A facility-based cross-sectional study was done at Nsanje District Hospital (NDH) using hospital records for a period between November 2020 and October 2021 to assess the ordering and distribution pattern of blood units in the inpatient. Data for blood units issued by MBTS, blood units issued to inpatient wards, expired, and wastage and patient health related conditions or diagnosis were extracted from the Blood requisition book, Blood Issue Notes and Blood Transfusion Crossmatch Registers. Frequencies and percentages were used to summarise the data.
Results: A total of 1639 units of blood were ordered from MBTS, with only 1001 (61.2%) issued to the hospital. Of 1001, 700 (69.9%) were distributed to various hospital wards 179 were not transfused while 122 (12.2%) expired. Almost one-third (29%) of blood was distributed to the female ward, 26% to the paediatric ward, 24% to maternity ward and 21% to the male ward. The top three inpatient diagnosis requiring transfusions were: malaria (37%), pneumonia (29%), and low HB (13%).
Conclusion: Female ward, maternity and paediatric wards were top users of the ordered blood units. High rates of expired blood units indicate poor coordination between the hospital and MBTS. Efforts to reduce expired blood units and improve record keeping for reconciliation of blood units before placing new orders ought to be encouraged.

P68_002031. SYSTEMIC AND STRUCTURAL BARRIERS TO COMPREHENSIVE SEXUALITY EDUCATION ACCESS AND DELIVERY TO ADOLESCENTS IN MALAWI
Author(s): Medrina Mtende-Mbotwa1, Patani Mhango1, Effie Chipeta1, Princess Kaira1, Razak Mussa1, Wanangwa Chimwaza-Manda1, Monica Patricia Malata1, Anthony Ajayi2, Gavin George3, and Adamson S. Muula4
Affiliation(s):
1.Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
2.African Population and health research center. P.O BOX 10787-00100, Nairobi, Kenya
3.University of KwaZulu-Natal, Durban 4041
4.School of Global and Public health; KUHeS. P/Bag 360, Blantyre 3, Malawi.”
Email: mmtende@kuhes.ac.mw

Introduction: Despite the presence of Comprehensive Sexuality Education (C.S.E) within Malawi’s Life Skills Education (L.S.E) program since 2000, young people encounter obstacles in accessing information about their sexuality. The program, initiated by the Ministry of Education, focuses on HIV risk reduction through abstinence, delayed sexual activity, and safe sex education. However, studies highlight content limitations due to censorship and restrictions. Challenges persist in delivering C.S.E, safe abortion, and contraceptive education to adolescents, impacting their health, rights, and potential due to inconsistent policies and implementation hurdles.
Objective: To identify the systematic and structural barriers to delivery of CSE to adolescents.
Methods: Mixed-methods approach involving qualitative methods and desk-based document review was utilized. The study conducted 42 qualitative interviews and reviewed documents to understand socio-economic factors impacting Comprehensive Sexuality Education (CSE) and adolescent sexual and reproductive health (SRH) services. Interviews were recorded, transcribed, and analyzed using Nvivo software for thematic content analysis.
Results: The study revealed economic obstacles: lack of technical support, insufficient resources, donor reliance, and limited political coherence and funding. Culturally, moral standards and religious beliefs impede CSE acceptance, affecting both mainstream and special-needs students. Institutionally, ambiguity around age-appropriate content and a focus on science subjects led to the omission of crucial CSE components. The absence of trained teachers and exclusion of minority groups further exacerbated the problem. Environmentally, inadequate infrastructure, rural-urban disparities, poor roads, and distance constraints limited CSE coverage.
Conclusions: Malawi’s political, economic, institutional, cultural, and environmental framework restricts young people’s access to comprehensive sexuality education. Addressing challenges of coordination across several ministries, the community, and non-governmental organizations is critical to the delivery and implementation of comprehensive sexuality education.

P69_002135. LEGAL AND POLICY LEVEL BARRIERS TO DELIVERY OF COMPREHENSIVE SEXUALITY EDUCATION AND ACCESS OF SEXUAL REPRODUCTIVE HEALTH SERVICES IN MALAWI
Author(s): Razak Mussa1, Effie Chipeta1, Adamson S. Muula1, Medrina Mtende-Mbotwa1, Patani Mhango1, Princess Kaira1, Wanangwa Chimwaza-Manda1, Monica Patricia Malata1, Anthony Agayi 2 and Gavin George 3
Affiliation(s):
1.Kamuzu University of Health Sciences, Malawi.
2.The African Population and Health Research Center, APHRC Campus, Kitisuru,Nairobi, Kenya
3.University of Kwazulu Natal Health Economics and HIV/AIDS Research Division (HEARD)
Email: rmussa@kuhes.ac.mw

Introduction: The Malawi government has demonstrated commitment to addressing adolescents and young people’s sexual and reproductive health needs by ratifying several international and regional human and reproductive rights frameworks. Despite these commitments and supporting policy and legal frameworks, the delivery of adolescent SRH services, including CSE, safe abortion, and contraceptive use continues to face implementation challenges.
Objective: To understand Legal and Policy Level Barriers to the delivery of CSE and SRH services to adolescents in Malawi.
Methods: 42 qualitative interviews with key stakeholders were conducted. In addition, a desk-based review on existing legal, policy, adolescent sexual and reproductive health, rights and services guidelines was conducted. Interviews were audio recorded and transcribed. Data was coded using Nvivo software followed by thematic content analysis.
Results: The research identifies several critical policy-level impediments. Tension exists between international commitments and state-level instruments; Policy and legal ambiguities surround the age of consent for contraceptive access and abortion discouraging adolescents from seeking these services; Ministry of Education’s stance on no provision of contraceptives within a 100-meter radius of the school is at odds with the Ministry of Health’s objective of making accessible to sexually active adolescents; Limited funding to implement policies; and lack of involvement of all stakeholders in policy-making and limited dissemination of policy documents were the key findings.
Conclusion: Addressing these policy-level challenges is vital for upholding adolescent SRHR rights in Malawi. Solutions include harmonizing domestic laws with international commitments, clarifying age-of-consent policies, fostering inter-ministerial cooperation, and enhancing national funding for SRH.

P70_002094. CAPABILITY WELLBEING AS AN EVALUATIVE SPACE FOR EQUITABLE ECONOMIC EVALUATION: DEVELOPING ATTRIBUTES FOR TANZANIA AND MALAWI
Author(s): Edith Chikumbu6, Nateiya Mmeta Yongolo 1,2,3,4,5, Victor Katiti1,2, Elizabeth F. Msoka-Bright1,2,3, Christopher Bunn6,7, Blandina T. Mmbaga1,2,3, Emma McIntosh7, Joanna Coast8 and Sally Wyke7
Affiliation(s):
1.Kilimanjaro Christian Medical University College, Moshi, Tanzania
2.Kilimanjaro Clinical Research Institute, Moshi, Tanzania
3.Kilimanjaro Christian Medical Centre, Moshi, Tanzania
4.Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow
5.Liverpool School of Tropical Medicine
6.Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
7.School of Social and Political Sciences, School of Health and Wellbeing University of Glasgow
8.University of Bristol
Email: edithchikumbu01@gmail.com

Introduction: Questionnaires developed in the global north, like the EQ-5D and SF-36, are often used across sub-Saharan Africa to assess impact of health interventions on quality of life. One problem with this, is they likely contain assumptions grounded in European and American life values. Second, they assess health-related quality of life, undervaluing broader impacts on quality of life.
Objectives: (1) Identify an ‘evaluative space’ that can capture a person’s capability by exploring what people value in their lives in Tanzania and Malawi. (2) Compare two evaluative spaces (Tanzania and Malawi), to determine whether the same or different evaluative spaces would be necessary to capture capability wellbeing in the two countries.
Methods: The research was conducted in two stages: 1) Semi structured in-depth interviews with 68 adults from urban and rural Tanzania and Malawi. Data collection and analysis were initially conducted independently by two teams; analysis was then brought together to generate a common set of attributes across the two countries. 2) Further interviews to check wording for attributes in both countries.
Results: The combined list of attributes of capability wellbeing across both countries comprised: financial security; basic needs; achievement and personal development; attachment, love and friendship; participation in community activities; faith and spirituality; health; making decisions without unwanted interference. Finally, the appropriate wording for the attributes was explored across the two countries.
Conclusion: We identified conceptual attributes for use in evaluations of health and care interventions conducted within a capabilities evaluative space. An explicit focus of the work was to address some of the structural inequalities in evaluation that arise from importing measures to very different settings as a result of power and resource imbalances, with little consideration about their cultural appropriateness. The capabilities that were important to people in Tanzania and Malawi included health, but went well beyond health.

P71_002181. EXPLORING BARRIERS AND FACILITATORS TO BLOOD COLLECTION AND REPEAT DONATIONS IN HIGH AND LOW PERFORMING DISTRICTS IN MALAWI
Authors: Effie Chipeta1, Princess Kaira1, Patani Mhango1, Emmanuel Singogo4, Victor Mwapasa2, Adamson S. Muula2, Andrew Likaka3, Titus Chiwindo4, Mina C. Hosseinipour4,5, Bridon Mbaya3 for the Bloodsafe Program
Affiliation(s):
1.Center for Reproductive Health, Kamuzu University of Health Sciences
2.Department of Community and Environmental Health, Kamuzu University of Health Sciences
3.Malawi Blood Transfusion Services
4.University of North Carolina Project, Malawi
5.University of North Carolina at Chapel Hill, USA
Email: pkayira@kuhes.ac.mw

Introduction: Despite the Malawi Blood Transfusion Service increasing the amount of blood collected since its inception in 2003, Malawi remains with a 27% deficit in required blood supplies. We sought to understand the facilitators and barriers to first-time donation and repeat donation among voluntary non-remunerated blood donors in Malawi.
Objective: The study aimed at assessing strategies that can increase blood donation in Malawi.
Methods: A qualitative cross-sectional design was used to examine factors that influence blood donation. One hundred thirty-five participants were purposively selected in eight districts namely, Mzuzu, Nsanje, Lilongwe and Balaka (with high donation rates) and Neno, Machinga, Dowa and Rumphi (with low donation rates). Data were collected using In-depth interviews, Key Informant Interviews and Focus Group Discussions. We utilized the key domains of the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to blood donation. The five CFIR domains and constructs informed the development of interview guides, data collection and analysis outcomes. This paper focuses on 3 domains, the internal and external factors and individual characteristics influencing blood donation.
Results: Main facilitators to blood donation included: Altruism, incentives, milestone awards, donor education/motivation talks, and availability of transport to blood collection sites. The barriers reported included: fear of the painful needle prick, negative health effects, fear of knowing one’s health status, as well as concerns around blood and blood products being sold or reserved for the rich and staff relations. In addition, other barriers mentioned were unsupportive school environment, the poor quality of incentives and large gaps between “milestone awards” lack of privacy in inappropriate donation venues, and the lack of punctuality by the donation team.
Conclusion: Blood donors face different barriers and facilitators which could be addressed through increased education and awareness on blood donation and provision of transport to the blood collection sites.

INFECTIOUS DISEASES (MALARIA)
P72_002221. WASTEWATER SURVEILLANCE AND DETECTION OF ROTAVIRUS AND ADENOVIRUSES AT THYOLO DISTRICT HOSPITAL AND MALAWI UNIVERSITY OF SCIENCE AND TECHNOLOGY
Author(s): Saad Kamwendo¹, Justice Sandram¹, Oscar kanjerwa2, Yohane kazembe1, Petros Chigwechokha¹, Kayla Barnes2,3 and Gama Bandawe1
Affiliation(s):
1.Biological Sciences Department, Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
2.Malawi Liverpool Wellcome Trust, Blantyre, Malawi
3.Broad Institute, Boston, Massachusetts, USA
Email: mmb-015-18@must.ac.mw

Introduction: Waterborne infections are a significant public health issue that continues to affect populations worldwide. Human Adenoviruses (HAdV) cause respiratory and ocular infections, while Rotavirus (RV) infections lead to severe gastrointestinal symptoms. Diarrhea remains the fourth leading cause of death in under 5 children at an estimated 250,000 deaths annually. Wastewater serves as reservoir of these viruses. Although wastewater surveillance has proved to be a vital public health tool globally, the current body of literature on wastewater surveillance studies for gastroenteric viral pathogens in Malawi is sparse.
Objective: This study aimed to detect Rotaviruses and Adenoviruses in wastewater at Thyolo District Hospital and the Malawi University of Science and Technology (MUST) wastewater treatment plant (WWTP).
Methods: We investigated HAdV and RV presence in influent and effluent samples from MUST’s wastewater treatment plant and Thyolo District Hospital’s onsite sewage system. A total of 16 samples were taken and analysed at MUST laboratories. PEG concentration method was used to concentrate waste water and the samples were analysed using quantitative reverse transcription PCR (RT-qPCR) specific for HAdV and RV..
Results: At MUST WWTP, adenovirus was found in all influent 100% (4/4) and effluent samples had a detection rate of 75% (3/4). However, rotavirus detection rate at the influent was 50% (2/4) and 25% (1/4) at the effluent. At Thyolo, adenovirus was detected in all the pediatric and general sewer samples 100%. However, rotavirus detection rate was 25% (1/4) and 50% (2/4) for the pediatric and the general sewer respectively.
Conclusions: Our study demonstrate that there is a significant amount of HAdV in circulation at both MUST campus and Thyolo District Hospital. One important finding is that there are higher levels of detectable RV in the general wastewater compared to the pediatric ward wastewater. This can be attributed to the current RV vaccination that is part of the childhood immunization program in Malawi. Further investigations are needed to explore the diversity of enteric viruses in both wastewater and rural communities.

P75_001904. ANALYSIS OF RISK FACTORS FOR MORTALITY IN UNDER-12 CHILDREN WITH MALARIA ADMITTED TO QUEEN ELIZABETH CENTRAL HOSPITAL
Author(s): Reuben Simfukwe1, Bright Chinyama1, Enoch Tonde1, Rizine Mzikamanda2, Taylor E. Terrie3, and Takondwa Msosa1,4
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Global Hope Malawi, National cancer center, Kamuzu Central hospital
3.Malaria Alert Centre Queens Elizabeth Central Hospital
4.Helse Nord Tuberculosis Initiative
Email: m201850044656@stud.medcol.mw

Introduction: Malaria remains a public health crisis in areas with high transmission like Malawi. Despite the government implementing comprehensive malaria control initiatives, malaria remains a burden in children and contributes to high mortality rates. The predictors of mortality in children admitted with malaria have been determined in previous studies.
Objectives: This study aimed at identifying the risk factors for mortality applicable in a Malawian setting.
Methods: This was a retrospective cohort study of children under 12 years admitted with malaria at QECH in Blantyre, Malawi. Between 1 January 2022 to 31 December 2022. Dependent variables found in other studies were that children with comorbidities, severe clinical manifestations, severe anaemia, abnormal vital signs and poor quality of care and poor administrative factors would be at high risk of mortality from malaria. A z-test of single proportions was used to estimate the risk and to identify risk factors of mortality, bivariate analysis using Chi-square tests and Mann-Whitney tests were used. Logistic regression was then used in multivariate analysis with covariates of p value of less than 0.05 from bivariate analysis.
Results: Out of 448 participants, 251 (56%) were male with a median age of 3.00 years. The risk of death was 42.4 per 1000 population (95% CI:25.72–65.44 using Fisher Exact (Clopper-Pearson) test). Multivariate Analysis showed that length of stay in the ward (p=0.015; OR=0.53; 95% CI:0.22-0.84), oxygen saturation (p<0.001, OR=0.82, 95% CI:0.73-0.91), hypoglycaemia on admission (p=0.023, OR=45, 95% CI:3.81-531.54) and BCS (p=0.033, OR=0.23, 95% CI:0.08-0.67) were associated with high risk of mortality.
Conclusion: This research shows that length of stay, oxygen saturation, hypoglycaemia on admission and BCS are independent predictors of mortality in under 12 children with malaria. The study showed that most children died within 2 days post-admission. We recommend that children with the aforementioned risk factors need close monitoring.
P76_001986.

THE RELATIONSHIP BETWEEN GUT HEALTH, MALARIA AND ENTERIC NON-TYPHOIDAL SALMONELLA INFECTION EVENTS
Author(s): Esmelda B. Chirwa1,2, Helen Dale1,2, Benwell Magona4, Innocent Kadwala1, Niza Silungwe1, Theresa Misiri2, Felistas Mwakiseghile2, Georgina Makuta2, Paul Kambiya1, Richard Wachepa1, Marc Y. R. Henrion1,3, Neil French2, Tonney Nyirenda2,4, Robert K. M. Choy5 and Melita Gordon1,2
Affiliation(s):
1.Malawi Liverpool Wellcome Programme, Blantyre, Malawi,
2.University of Liverpool, Liverpool, United Kingdom,
3.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom,
4.Kamuzu University of Health Sciences, Blantyre, Malawi,
5.PATH Center for Vaccine Innovation and Access, Seattle, United States of America
Email: echirwa@mlw.mw

Introduction: Non-Typhoidal Salmonella (NTS) in African children presents as 3 distinct syndromes: asymptomatic enteric NTS exposure (eNTS); diarrhoeal illness (dNTS); or invasive bloodstream disease (iNTS), the most devastatingly severe of these 3 phenotypes. Enteric NTS infections can thus lead to either diarrhoeal or invasive disease. eNTS exposure events are common in Malawi and represent a common primary exposure leading to protective immunity. In SSA, individuals with malaria, anaemia, HIV, malnutrition, or sickle cell disease are particularly at risk of iNTS. Although the mechanisms by which these risk factors increase an individual’s susceptibility to iNTS remain unclear, it is hypothesized that this may be mediated by the effects of these risk factors, particularly malaria, on gut health.
Objective: Explore the relationship between eNTS exposure, malaria, malnutrition, and gut health.
Methods: We randomly recruited 1000 children aged 0-5 years from a community-based census, resident in rural area of high malaria prevalence in Malawi from whom stool, and serum samples were collected. Data on risk factors, socioeconomic status, water, and sanitation were collected via rapid diagnostic tests (malaria, sickle cell disease, HemoCue), anthropometry, and electronic reporting. Stool samples were processed for NTS culture and pan-Salmonella polymerase chain reaction (ttr). Gut health was assessed through the Micronutrient and Environmental Enteric Dysfunction Assessment Tool (MEEDAT), and stool myeloperoxidase.
Results: Severe acute malnutrition/wasting was present in 1% (n=9) by WHZ (<-3SD) and 3% (n=27) by MUAC (<12.5cm). Chronic malnutrition/stunting was present in 12.5% (n=114) by HAZ (<-3SD). MEEDAT/MPO data correlations will be presented after subsequent analysis.
Conclusion: An improved understanding of the impact of malaria on gut health would be essential for informing iNTS disease control measures, either by preventing initial eNTS colonization or preventing those colonizations from becoming iNTS cases through identification of nutritional/malaria interventions, including informing oral/parenteral vaccine development.
P77_001999. QUANTIFYING PREDICTORS OF HUMAN-TO-MOSQUITO MALARIA PARASITE TRANSMISSION IN SOUTHERN MALAWI
Author(s): Patience C. Simbi1, Nellie Kaunde1, Joyce Nyirongo1, Wangisani Kumalakwaanthu1, Jessy Goupeyou-Youmsi2, Miriam K. Laufer3, Clarissa Valim4, Don P. Mathanga1, Themba Mzilahowa1, Lauren M. Cohee1,3 and Robert McCann1,3
Affiliation(s):
1.Kamuzu University of Health Sciences, Malaria Alert Centre
2.Pan African Mosquito Control Association
3.Center for Vaccine Development and Global Health, University of Maryland School of Medicine
4.Boston University School of Public Health
Email: psimbi@mac.kuhes.ac.mw

Introduction: A better understanding of human-to-mosquito transmission dynamics and human infectious reservoirs of Plasmodium in Malawi will improve the design and deployment of malaria interventions.
Objectives: To quantify the predictors of infectiousness among participants in a longitudinal cohort in southern Malawi using membrane feeding assays, including gametocyte presence and density, and participant age and sex.
Methods: Asymptomatic participants of all ages (n=140) in 25 households from 4 clusters (5-7 households/cluster) were screened by qPCR fortnightly from Nov 2022 to July 2023. Venipuncture samples were obtained 7-10 days later from participants with at least 1 parasite/µl. Whole blood was fed to Anopheles gambiae Kisumu strain mosquitoes (40-50/Cup). Oocysts in the mosquito midgut were detected and quantified by microscopy 10 days after feeding.
Results: Of 188 feeds that were conducted, 150 (80%) had at least 30 mosquitoes that were dissected, and 11 (7.3%) of these feeds had at least one infected mosquito (infectious feeds). From 9,356 dissected mosquitoes, 149 (1.6%) infected mosquitoes were found. Most infectious feeds were from people with microscopically detectable gametocytes, 82% (9/11), while 4% (5/139) of non-infectious feeds contained gametocytes. Infectious feeds were from participants aged 3-28 years old, and over half (55%) were from school-aged children from 6 to15 years old. Further, more infectious feeds were from female participants (82%) than males (18%).
Conclusion: Relatively low infectiousness was observed across the target population in this setting. For the next steps, we will run additional statistical analyses and molecular quantification of gametocytes, including sex ratio, in samples from day of feeding. We anticipate this data to contribute to quantifying the predictors for human-to-mosquito malaria parasite transmission.

MATERNAL AND CHILD HEALTH
P78_002173. RESIDUAL EFFICACY OF FLUDORA FUSION, SUMISHIELD 50WG AND ACTELLIC 300CS FOR INDOOR RESIDUAL SPRAYING IN FOUR IRS DISTRICTS IN MALAWI
Authors: Naomi Kaore1, Leonard Dandalo2, Nellie Kaunde2, Abdoulaye Bangoura2, Martin Chiumia1, Wangisani Kumalakwaanthu1, Don Mathanga1, Themba Mzilahowa1
Affiliation(s):
1.Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Abt-associates, PMI Evolve
Email: nkaore@mac.kuhes.ac.mw

Introduction: Indoor Residual Spraying (IRS) and Insecticide Treated Nets (ITN) serve as primary interventions for malaria control in Malawi. To assess the entomological impact of these two interventions, wall cone bioassays are employed.
Objective: To evaluate the efficacy of insecticides sprayed on different wall surfaces and its impact against malaria vectors post-IRS intervention.
Methods: IRS was implemented in four districts: Nkhotakota and Mangochi with Actellic and S.S spraying, Nkhata Bay with Actellic and F.F, and Balaka with Actellic alone. The residual decay rate was monitored from October 2022 to September 2023, post-IRS intervention. The WHO wall bioassays were conducted in four villages within each district. Two to five days old unfed susceptible female Anopheles gambiae s.s. (Kisumu) strains were exposed to the sprayed wall surfaces for a period of 30 minutes. The knockdown effects at both 30- and 60-minutes post-exposure were observed. For both S.S and F.F, mortality was recorded every 24 hours over a five-day period. However, for Actellic, the mortality data was collected for only 24 hours.
Results: Three insecticides showed 100% mortality in Nkhotakota, Nkhata Bay, and Mangochi districts, indicating their satisfactory efficacy. In these districts, both FF and SS remained effective, maintaining a 100% mosquito mortality rate within the recommended five-day observation period even nine to ten months after spraying. In contrast, the mortality rates in areas where Actellic was used fluctuated over the nine to ten months following exposure, with some exceptions. Two sites in Nkhotakota consistently maintained mortality rates above 80%. Initially, all sites in Balaka exhibited mortality rates above 80%, but over time, a steady decline was observed.
Conclusion: Both S.S and F.F exhibited a prolonged and enduring efficacy in all the districts where they were applied. In contrast, Actellic displayed diminished residual effectiveness.

P79_001910. PREVALENCE AND CORRELATES OF MEETING THE GLOBAL PHYSICAL ACTIVITY, SEDENTARY BEHAVIOURS, AND SLEEP GUIDELINES AMONG 3-4-YEAR-OLD CHILDREN IN MALAWI: THE SUNRISE MALAWI STUDY
Author(s): Tawonga W. Mwase-Vuma1,2, Xanne Janssen2, Anthony D. Okely3, Janine J. Kayange1, Kar Hau Chong3, Penny Cross3, Seth Evance1, and John J. Reilly2
Affiliation(s):
1.Centre for Social Research, University of Malawi, Zomba, Malawi
2.Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
3.Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
Email: tmwase-vuma@unima.ac.mw

Introduction: The World Health Organization recommends that 3-4-year-olds should spend at least 3 hours/day in total physical activity (TPA), not being restrained for more than 1 hour/day, spend less than 1 hour/day in screen time, and have at least 10-13 hours of good quality sleep for optimal health and development. However, no study has reported the prevalence and correlates of meeting these guidelines in a Malawian context.
Objective: To examine the levels and correlates of meeting the TPA, sedentary behaviours, and sleep guidelines among Malawian pre-schoolers.
Methods: The study sample comprised 417 children from 24 pre-schools in Zomba district. TPA was assessed using step-count data from hip-worn ActiGraph GT3X accelerometers worn continuously for at least five consecutive days. Restrained sitting, screen time and sleep duration were assessed using parent questionnaire. Analyses were conducted in Stata using chi-squared test and survey logistic regression for binary outcomes.
Results: Of the 417 pre-schoolers, 51.5% were girls and 75.9% were from rural setting. The average age was 4.0 years (standard error=0.0). Prevalence of meeting the TPA, restrained sitting and sedentary screen time, and sleep recommendations were 98.4% (95% confidence interval [CI]=96.0–99.4), 90.9% (95% CI=84.2–94.9), 79.4% (95% CI=71.2–85.7), and 94.2% (95% CI=90.8–96.3), respectively. Nearly three-quarters met the (four) combined guidelines (73.7%; 95% CI: 65.7–80.4). The proportions of meeting restrained sitting, sedentary screen time, and combined guidelines were significantly lower among children from urban setting than rural in the multivariable models. Meeting restrained sitting guideline was significantly higher among girls than boys (OR=3.59; 95% CI=1.36–9.48; p=0.012). No correlates were identified for the TPA and sleep guidelines.
Conclusions: A high proportion of Malawian pre-schoolers adhered to the global guidelines, with the adherence rate being influenced by factors such as residential settings and sex.

P80_001966. BRIDGING THE GAP: ENHANCING EVIDENCE-INFORMED DECISION-MAKING IN NEWBORN AND CHILD HEALTH THROUGH THE GLOBAL EVIDENCE, LOCAL ADAPTATION (GELA) PROJECT
Authors: Suzgika Lakudzala Munthali1, Nyanyiwe Masingi Mbeye1, Sarah cooper2, Tamara Kredo2, and Denny Mabetha2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Cochrane South Africa, South African Medical Research Council, South Africa
Email: slakudzala@kuhes.ac.mw

Introduction: Poverty-related diseases (PRD) continue to be major contributors to child mortality in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) grounded in evidence-based practices play a pivotal role in strengthening healthcare systems and improving equitable access to care for PRD. However, the guideline development process in SSA can be complex and resource-intensive, needing improvements. The Global Evidence, Local Adaptation (GELA) project seeks to enhance researchers’ and decision-makers’ capacity to create locally and contextually relevant CPGs in newborn and child health. This longitudinal, mixed-methods study is informed by an overarching Theory of Change and includes a Monitoring and Evaluation (M&E) work package, which this protocol outlines.
Objectives: The primary objective is to monitor GELA project activities and assess their impact on evidence-informed decision-making and guideline adaptation in Malawi, South Africa, and Nigeria. Specific activities to monitor include ongoing stakeholder engagement, capacity development, utilization of qualitative research reviews, and the overall experiences of the project.
Methods: This research uses a combination of qualitative and quantitative data collection methods, such as knowledge translation tracking sheets, capacity assessment surveys, user testing, in-depth interviews, and non-participant observations. Participants consist of project staff, guideline panel members, guideline steering group committees, and other local stakeholders in the three African countries.
Results: By tracking engagement with stakeholders, capacity development, and the utilization of evidence from qualitative research reviews, the study will provide insights into the project’s impact on enhancing evidence-informed practices and guideline adaptation capacities. Preliminary results outline the areas for Capacity building as well as effective ways of engaging with stakeholders.
Conclusion: This research plays a vital role in understanding the influence of the GELA project on evidence-informed decision-making and guideline adaptation. The findings will help improve the implementation of the project and provide a comprehensive understanding of its impact. Based on the preliminary findings, the study recommends enhancing guideline development in sub-Saharan Africa by streamlining the processes, reducing resource barriers, and fostering stakeholder collaboration. Furthermore, there is need to have tailored capacity-building strategies for healthcare professionals, researchers, and decision-makers to create contextually relevant clinical guidelines.

P81_001816. EXPERIENCES OF WOMEN WITH PHYSICAL DISABILITIES ACCESSING PRENATAL CARE IN LOW- AND MIDDLE-INCOME COUNTRIES
Author(s): Abigail Kazembe1, Andrew Simwaka1,2, Kylie Dougherty3, Chisomo Petross2, Ursula Kafulafula2, Bertha Chakhame1, Elizabeth Chodzaza1, Isabella Chisuse1, Martha Kamanga1, Carolyn Sun2 and Maureen George2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Columbia University, School of Nursing
Email: cpetross@kuhes.ac.mw

Introduction: Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman’s’ burden— and need—is greatest. Objective: To review the evidence on the reported experiences of women with physical disabilities in accessing prenatal care and childbirth services in LMICs.
Methods: We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom’s EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 – September 2018. These results were augmented by hand searching of reference lists.
Results: Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied. Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people’s knowledge; and (4) public stigma and ignorance.
Conclusion: People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.

P83_001896. KNOWLEDGE, ATTITUDES AND PRACTICES OF EXCLUSIVE BREASTFEEDING OF MOTHERS ATTENDING PRIMARY HEALTH CARE CENTRES IN IMOTA LOCAL COUNCIL DEVELOPMENT AREA, LAGOS STATE, NIGERIA
Author(s): Oluwaseyifunmi Oladipo1, and Qianling Zhou1
Affiliation(s)
1.Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China,
Email: seyifunmi.ladipo@gmail.com

Introduction and Objective: The 2018 Nigeria Demographic and Health Survey (NDHS) shows that just 29% of Nigerian infants receive recommended exclusive breastfeeding. With 88% of healthcare facilities being primary health centers (PHCs), their role in child healthcare is crucial. Research emphasizes the link between healthcare professionals’ IYCF knowledge and quality information for PHC-engaged women. Previous investigations in Lagos State, Nigeria, underscored the insufficiency of exclusive breastfeeding (EBF) practices, especially in rural areas. The study’s objectives extended beyond exploring variables and challenges concerning EBF among healthcare professionals; but also sought to comprehend the attitudes, knowledge, and practices related to EBF among mothers attending PHCs in the Imota Local Community Development Area (LCDA).
Methods: This study adopted a cross-sectional design, utilizing convenient sampling to recruit 422 nursing mothers and 12 healthcare professionals from three primary healthcare institutions. The gathered data underwent analysis using IBM Statistical Package for Social Sciences software. Descriptive statistics were employed for data examination, with chi-square analyses discerning variations in EBF across socio-demographic variables. Binary logistic regression analyses were executed to probe the independent influence of socio-demographic factors on EBF practices.
Results: unveiled suboptimal exclusive breastfeeding (EBF) practices, with most introducing inappropriate foods and liquids before 0-3 months, such as glucose water (62.6%), infant formula (69%), juice (84.1%), herbs (57.3%), and other feeds like pap and golden morn (66.6%). Though respondents had fair EBF knowledge and positive attitudes, only 39.1% exclusively breastfed. Healthcare workers encountered barriers in EBF promotion, such as inadequate funding for breastfeeding management/counseling training and healthcare professional shortages at primary health centers (PHCs).
Conclusion: This study has illuminated gaps in both healthcare workers’ comprehension of EBF and mothers’ actual EBF practices in the rural community. The findings emphasize the urgent need for initiatives and interventions to enhance EBF rates, a critical component of child survival strategies, especially in these rural areas.

P84_001939. INVESTIGATING KNOWLEDGE AND DETERMINANTS OF BIRTH PREPAREDNESS AMONG PREGNANT WOMEN IN MANGOCHI DISTRICT
Authors: Peter Malipa1, Innocent Lanjesi1, Richard Abuduo1, Macdonald Gondwe1, Towera Maureen Maleta2, and Linda Mipando2
Affiliation(s):
1.Ministry of Health, Mangochi District Health Office
2.Kamuzu University of Health Sciences
Email: malipapeter@gmail.com

Introduction: Birth preparedness (BP) has been globally endorsed as an essential component of safe motherhood programs to reduce delays for care, so as to reduce maternal and neonatal mortality rate. In spite of the benefit of BP, no study has been documented that assessed the knowledge and determinants of birth preparedness in Mangochi District, Malawi. Therefore, this study wanted to investigate knowledge and determinants of Birth Preparedness (BP) among pregnant women attending antenatal clinic in Mangochi District, South-east Malawi.
Methods: A descriptive cross sectional study design with a sample of 382 respondents and five focus group discussions were used for the study. Simple random sampling was used to select the respondents in the study area. Research administered questionnaire was used for quantitative data collection.
Results: Of the sampled mothers, 382 making response rate of 99.5% were successfully interviewed. Majority of women, 97.6% had heard about birth preparedness. High proportion of the respondents, 93.7% got information on BP from health professionals during antenatal clinics.73.3% the mothers had knowledge on birth preparedness as they were able to mention at least four elements of the birth preparedness. Among the factors associated with birth preparedness were religion (r=-0.013, p=<0.05), maternal education (r=-0.017, p=<0.05), maternal occupation (r=-0.044, p=<0.05) and husband occupation (r=-0.000, p=<0.05) showed statistically significant association.
Conclusion: Nearly three‑fourth pregnant women in this study had knowledge in birth preparedness. The factors most associated with birth preparedness were maternal and husband occupation, maternal education and religion. There is a need to intensify health education on birth preparedness to all women in the reproductive age band.

P86_001996. CHARACTERIZING THE REFERRAL PROCESS FOR OBSTETRIC EMERGENCIES IN BLANTYRE DISTRICT: A MIXED-METHODS APPROACH
Author(s): Oveka Mwanza1, Ashley Mitchell2, Luseshelo Simwinga1, Sellina Chikuyu3, Dingase Kumwenda3, Kimberly Baltzell2, Alden Blair2 and Miranda Rouse2

Affiliation(s):
1.Global AIDS Interfaith Alliance
2.University of California San Francisco
3.Queen Elizabeth Central Hospital
Email: ovekajana@gaiamalawi.org

Introduction: Despite increased hospital delivery and skilled birth attendance, Malawi continues to register high maternal and neonatal mortality rates, underscoring the need to improve the quality of care and health systems. The Global Action in Nursing project (GAIN) conducted a study in Blantyre district at seven peripheral facilities and Queen Elizabeth Central Hospital (QECH) to characterize peri-referral care and identify facilitators and barriers to optimal obstetric referral.
Objectives: (1) To characterize peri-referral care for obstetric referrals from Blantyre DHO facilities to QECH. (2) To understand the facilitators and barriers to the referral process for obstetric emergencies in the district.
Methods: The team utilized a convergent, parallel mixed methods approach comparing patient data and patient/provider experiences. 398 obstetric chart reviews were conducted for referrals occurring between March 2019 and March 2020, from seven health centres. Bi- and multi-variate models were built to explore factors associated with patient care and outcomes. Qualitatively, transcripts from three semi-structured focus group discussions and 18 in-depth interviews with clinicians, nurse-midwives and patients were thematically analyzed.
Results: Quantitatively, patients who died during childbirth were more likely to come from a health facility more than 10km away, to have arrived in critical condition, and to experience a complication during their hospital stay compared to those who lived. The referral interval ranged from an average of 1.75 hours (SD: 0.80) at the closest facility to 5.16 hours (SD:7.56) at the furthest (p=0.01). Qualitatively, systemic and structural challenges, inconsistent inter- and intra-facility communication, and community influences on maternal perspectives emerged as barriers to efficient and effective referral.
Conclusion: Our triangulated findings underscored that challenges to the referral process are multifaceted. Improvements must be multidisciplinary to address availability of emergency transportation services, human and material resources; improve communication between providers and patients, and standardize communication within and between facilities.

P87_001997. DETERMINANTS OF IRON DEFICIENCY ANEMIA AMONG NON-PREGNANT WOMEN OF REPRODUCTIVE AGE IN MALAWI: A CROSS SECTIONAL STUDY
Author(s): Andrew Chiwaya¹, Chisomo Singano² and William Stones³
Affiliation(s):
1.Malawi Police Hospital, Zomba, Malawi.
2.National Statistics Office, Zomba, Malawi
3.Centre for reproductive health, Kamuzu University of Health Sciences, Blantyre, Malawi
Email: andrew.chiwaya1@gmail.com

Introduction: In Malawi, the prevalence of Iron Deficiency Anemia (IDA) among women of reproductive age is 8%. There is lack of up-to-date information on factors associated with IDA among women of reproductive age in Malawi.
Objective: This cross sectional study aimed at identifying factors that are associated with IDA among non-pregnant women of reproductive age in Malawi using secondary data from the Malawi Micronutrient Survey, a sub study of the Malawi Demographic and Health Survey, 2015-16.
Methods: A total of 751 non-pregnant women aged 15-49 years were included in the final analysis. Univariate and multivariate logistic regression analysis were carried to analyze the data.
Results: The study found IDA prevalence of 7.19% and was statistically associated with age of the woman, type of residence (rural/urban), contraceptive use, BMI, and region. In the multivariate analysis, age (40-49) years (OR=4.37, CI=1.72-11.09) was significantly associated with increased odds of IDA while rural residence (OR=0.29, CI=0.14-0.57), using injectable contraceptives (OR=0.18, CI=0.05-0.64), and overweight (OR=0.48, CI=0.16-1.40) showed a protective effect against IDA.
Conclusion: There is a need to scale up family planning services especially use of injectable contraceptives. Women living in urban areas should be encouraged to consume food rich in iron. Health education on nutrition and dietary modification should be fostered.

P88_002012. MORTALITY AMONG LOW BIRTHWEIGHT BABIES BORN VIA CAESAREAN SECTION VS TRIAL OF LABOUR AT A TERTIARY HOSPITAL IN MALAWI
Author(s): Madalitso D Zulu1, Evaristar N Kudowa2, Wanangwa Kumwenda1 and Samuel S Meja3
Affiliation(s):
1.Queen Elizabeth Central Hospital, Department of Obstetrics and Gynecology, Blantyre, Malawi,
2.Malawi Liverpool Wellcome Trust, Blantyre, Malawi,
3.Kamuzu University of Health Sciences, Blantyre, Malawi.
Email: mdzulu2014@gmail.com

Introduction: Approximately 20 million babies have low birthweight (LBW, <2500g) globally, with 60% Asia and sub-Saharan Africa. International guidelines recommend a trial of labour for babies with LBW, in the absence of an indication for caesarean birth. However, local data are needed to adapt this recommendation to our setting. We compared mortality among babies born via spontaneous vertex delivery (SVD), and caesarean section (CS) at Queen Elizabeth Central Hospital in Malawi.
Methods: Routine data are recorded in registers in real time by midwives and clinicians, and entered into an electronic database by 2 hired clerks. We extracted data variables on fresh still births and early neonatal deaths among babies with LBW between January and June of 2023, and used logistic regression to estimate adjusted odds ratios of mortality for mode of delivery, antepartum hemorrhage, preterm labour, preeclampsia/eclampsia, and fetal distress.
Results: A total of 843 babies had low birth weight, with 424 born to mothers aged between 20 and 29 years, 331 (40%) born at a gestation age between 28 and 33 weeks, and 106 (13%) HIV exposed. Among the 231 (27.4%) babies born via CS, 13 (5.6%) died, and among the 568 babies born via SVD, 25 (4.4%) died. Odds of mortality were 1.3 (p=0.509, 95% CI 0.59, 3.19) among babies born via SVD compared to CS, 8.2 (p<0.001, 95% CI 2.85, 22.40) among babies from mothers with antepartum hemorrhage, and 0.19 (p=0.010, 95% CI 0.05,0.76) among babies with birthweight between 1500-2500g compared to babies with birthweight <1500 kg.
Conclusion: We did not find significant differences in mortality among babies via CS and SVD. Mortality was higher among babies born to mothers with antepartum hemorrhage. There is need for ongoing data analysis to monitor these outcomes to guide future decisions on mode of delivery for LBW babies.

P89_002014. AN EXPLORATION OF THE CONCEPT OF THE MOTHER-FOETUS BOND AMONG PREGNANT MALAWIAN WOMEN: CONVERSATIONS WITH WOMEN FROM LILONGWE DISTRICT, MALAWI – PRELIMINARY ANALYSIS
Author(s): Salome Chibwana1, Chris Bunn2, Melissa Gladstone3, Angus MacBeth4 and Robert C Stewart5
Affiliation(s):
1.University of Edinburgh/Malawi Epidemiology and Intervention Research Unit
2.University of Glasgow/Malawi Epidemiology and Intervention Research Unit
3.University of Liverpool
4.University of Edinburgh
5.University of Edinburgh/Malawi Epidemiology and Intervention Research Unit”
Email: S.Chibwana@sms.ed.ac.uk

Introduction: The mother-foetus bond is defined as an affiliation of the mother to the foetus expressed in terms of thoughts, feelings, or behaviours. I explore the concept of the mother-foetus bond among pregnant Malawian women as part of my PhD research. I am contributing to the discourse around antenatal bonding which currently lacks analyses from the ‘Global South’, especially sub-Saharan Africa.
Objective: To explore the thoughts, feelings, and behaviours that pregnant Malawian women from Lilongwe district, have towards their unborn child and how they understand and explain these experiences.
Method: Data was collected using audio recorded interviews from both multipara and primipara women (≥ 28 weeks pregnant), purposively selected from antenatal clinics at Area 25 Health Centre (n=10) and Kabudula Community Hospital (n=10). A four-step analysis recommended by Smith and Osborn (2003) for Interpretative Phenomenological Analysis was used: i) iterative reading, coding, and identification of emergent themes from one interview ii) identification of patterns across themes and clustering of themes; iii) analyses of the remaining interviews following steps (i) and (ii), leading to a final table of superordinate and subordinate themes; and iv) development of a narrative account of the participants responses based on these themes.
Results:The emergent thoughts, feelings, and behaviours that the women have towards their unborn child begin with an intellectual awareness, graduating into a physical awareness once quickening starts. These are either in relation to the foetus or in preparation for the baby. The women understand and explain this affiliation based on how they interpret the foetus’s movements; their supernatural beliefs; and their personal and relational past/present experiences.
Conclusion: This preliminary analysis indicates the existence of the mother-foetus bond amongst pregnant Malawian women. This is not fixed but depends on how the women interpret their realities and the supernatural that is beyond their control.

P90_002027. REVISING THE EMERGENCY OBSTETRIC AND NEWBORN CARE INDICATOR SET TO MEET THE NEEDS OF COUNTRY-LEVEL USERS: KEY INSIGHTS FROM MALAWI
Author(s): Elizabeth Chodzaza1, Martha Kamanga1, Chifundo Zimba2, and Emas Potolani2.
Affiliations:
1.Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
2.School of Maternal, Neonatal and Reproductive Health, Leopard Street, Area 25 C Sector 2, Lilongwe, Malawi
Email: echodzaza@kuhes.ac.mw

Introduction: Over the past 20 years, the emergency obstetric care (EmOC) indicators and framework have been used extensively to plan and monitor EmOC services at national and subnational levels. The current framework and indicators have provided critical information to help develop data-driven approaches to reducing maternal mortality and set targets and track progress towards strengthening EmOC services. At the same time, health systems have evolved, the evidence base has expanded, and implementation lessons have been collected about what works and what remains challenging across different settings. With these developments in mind, a global initiative led by Columbia University’s Averting Maternal Death and Disability program, the London School of Hygiene and Tropical Medicine, the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), and World Health Organization (WHO) is updating, improving, and expanding the EmOC framework and indicators to better meet the needs of countries. Malawi participated in the global modified Delphi study and in-depth studies together with Senegal, and Bangladesh to generate insights on what is needed for planning and monitoring implementation.
Objective: The project aimed at learning from national, sub-national and facility level planners, providers and users about their experiences in EmONC services and in using the 2009 EmONC framework and indicators. This paper provides insights for revising the current EmONC indicators and to give feedback on proposed revisions and additions to the framework and indicators.
Methods: Using qualitative approach, applying human-centred design (HCD) methods, Purposive sampling was used to select three (3) districts, and within the districts three hospitals and six BEMONC facilities within their catchment area were selected. Focus group discussions (FGD) using various HCD techniques to generate key insights on provision of EmONC services and/or monitoring performance of EmONC. Homogenous groups comprising of 5 to 7 people from across different districts and facilities will be selected. Overall, 9 FGDs with 45 health system actors were conducted. The HCD methods applied included journey maps, collage systems map, ranking and prototyping.
Results: Six major insights were gleaned from the data that demonstrated challenges: Healthcare workers’ ability to provide timely and effective emergency obstetric and neonatal care is frequently hindered by the dysfunctional referral system, which not only disrupts the continuum of care but also substantially amplifies the distressing rates of maternal and neonatal morbidity and mortality. Health workers often experience delays in providing essential emergency care to women and neonates due to communication hindrances between BEMONC and CEMONC facilities within the referral system, resulting in decreased survival rates and increased stress and anxiety among the women and neonates. Health workers face significant risks and hazards in the referral process, which not only jeopardize the well-being of women, neonates, midwives, and ambulance drivers but also erode confidence in performing critical emergency obstetric and neonatal signal functions. Health workers lack confidence and institutional support to perform signal functions which leads to delays, inappropriate management and unnecessary referrals, as well as fears of punishment in the case of adverse outcomes. Health providers feel fatigued, burned out and their well-being is compromised because of unbalanced staff-patient ratios in BEmONC facilities, affecting their performance and ability to meet professional standards during care of women with complications. Health Care Providers are not able to provide BEmONC and CEmONC functions due to ageing infrastructure, unavailability of equipment, supplies, and medications, and outdated guidelines and protocols resulting in elevated maternal and newborn morbidity and mortality rates.
Conclusion: Providers are affected in many ways by EmONC system weaknesses (policies, staff shortages, competency, working environment, etc.) Poor quality referral systems are experienced as risky and dangerous for all actors involved (women, newborns, providers, drivers, etc.) Paying attention to the needs and experiences of women and their families is essential to building a strong EmONC system.

P91_002056. PATIENTS AND HEALTH CARE WORKERS PERCEIVED CHALLENGES IN MANAGING PREECLAMPSIA, IN MALAWI.
Author(s): Memory M. Ngwira1,2,4, Luis A. Gadama1,2, Renuka Shanmugalingam1,3,5, Angela Makris1,3,4,5 and Annemarie Hennessy1,3,4
Affiliation(s):
1.Western Sydney University, Sydney, Australia
2.Kamuzu University of Health Sciences, Malawi, Africa
3.WHITU, South Western Sydney Local Health District, Sydney, Australia
4.Heart Research Institute, University of Sydney, Sydney, Australia
5.South Western Sydney School of Medicine, University of New South Wales, Sydney, Australia.
Email: moque87@gmail.com

Introduction: Preeclampsia is one of the leading causes of maternal and perinatal mortality worldwide. A diagnosis of preeclampsia could be burdening to both patients and health care workers (HCWs) especially in developing countries such as Malawi. Identifying management challenges from both patients and HCW perspectives would be essential in overcoming issues that could hinder treatment strategies.
Objective: This study investigated challenges faced by patients and health care workers (HCW) in dealing with the diagnosis and management of preeclampsia in Blantyre, Malawi.
Methods: A descriptive cross-sectional formative (qualitative) study using semi-structured In-Depth Interviews (IDI) was conducted at Queen Elizabeth Central Hospital (QECH), Malawi. 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. Patients who developed preeclampsia and maternity HCW (clinicians and midwives) were interviewed for this study.
Results: Twenty four individuals were interviewed across groups of health care workers (n= 13) and patients (n= 11). Diagnosis related stress, lack of information, impact of physical symptoms of preeclampsia and delays in receiving care were identified as the diagnosis related challenges faced by the patients. Late diagnosis, staff burn out, inadequate skills and lack of resources were identified as barriers to provide optimal care by the HCWs
Conclusion: This qualitative study showed that diagnosis of preeclampsia posed various challenges to both patients and HCWs. These challenges need to be addressed at all levels of healthcare in Malawi, Africa in optimizing the management of preeclampsia and improving maternal outcomes.

P92_002116. NEW SIGNAL FUNCTIONS AND LEVELS OF CARE TO DEFINE EMERGENCY OBSTETRIC AND NEWBORN CARE (EMONC): INTEGRATING OBSTETRIC AND SMALL AND SICK NEWBORN CARE
Author(s): Elizabeth Chodzaza1, Martha Kamanga1, Chifundo Zimba1, and Emas Potolani1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: echodzaza@kuhes.ac.mw

Introduction: About 15 percent of women develop complications during pregnancy or after giving birth, leading to the deaths of 303,000 women each year. In addition, 2.7 million newborns die each year, and 2.6 million are stillborn. While most life-threatening complications during pregnancy and childbirth cannot be predicted or prevented, nearly all can be successfully treated with effective, timely emergency obstetric and newborn care (EmONC). Global health experts have identified signal functions for EmONC as representative of the most effective medical intervention for managing direct obstetric complications and improving maternal survival (World Health Organization et al., 2009). But much has changed in the health systems and maternal and child health landscape in the last 30 years. Therefore, the EmONC framework needed to be updated, improved, expanded and include the full integration of newborn care. The Re-Visioning EmONC Project is a new initiative to review, rethink, and revise the framework.
Objective: The aim of the study was to understand how the indicators have been used to monitor and make changes in EmONC systems and services and to ground truth elements of the revised EmONC framework and indicators.
Methods: Qualitative approach using Human Centred Design (HCD) methods were used to guide the study. Through its interdisciplinary and interactive nature, HCD facilitated co-designing with the service providers, local experts and system actors who took an active role in identifying needs, developing solutions, ground truthing them and further refining the interventions to suit the Malawian context. Four focus group discussions with 5-6 participants each were conducted with purposively sample groups of Registered nurse midwives, District Health Management Teams, Clinical officers and national policy team for prototyping the revised framework and indicators. Story boards and sliders were used to gather feedback on the newly proposed levels of care and signal functions were recommended to be performed at various levels of care.
Results: The findings indicated that the previous two levels of care should be maintained: BEmONC and CEmONC. Additionally, a new level of care was introduced: the intensive level of care. Furthermore, appropriate signal functions were advocated to be performed at various appropriate levels of care. At Basic Emergency Care Level, a set of seven key signal functions has been identified: administration of medications to treat PPH, administration of parenteral antibiotics, performance of assisted vaginal deliveries, provision of IV fluid replacement therapy, administration of magnesium sulfate, manual removal of placenta; and a new intervention: Continued clinical care during interfacility transfer. At comprehensive level (CEmOC): Perform cesarean section, perform blood transfusion, provide intensive organ level support, and administration of antenatal corticosteroids was recommended to be maintained at BEmONC facilities; and at a new level of care – Intensive EmONC level: Provide intensive level organ support. A set of key signal functions to basic emergency newborn care: Perform new-born resuscitation with bag and mask, administer oxygen therapy, enable feeding with expressed breast milk, enable kangaroo mother care. At comprehensive level; Provide CPAP, provide phototherapy, Perform Exchange transfusion and Perform mechanical ventilation and at a new level of care – Intensive EmONC level: performing screening and treatment of retinopathy.
Conclusion: This study has contributed to the global Re-Visioning EmONC initiative by producing insights and recommendations on what critical medical interventions should be changed, added and improved.

P93_002122. CAESAREAN SECTION RATES IN NENO DISTRICT HOSPITAL, MALAWI: A CASE AUDIT
Author(s): Mwayi Chunga1, Brown Khongo1 and Listern Tengatenga2
Affiliation(s):
1.Partners in Health
2.Ministry of Health
Email: mchunga@pih.org
Introduction: There has been a continuous rise in caesarean section (C-section) rates worldwide currently at 21%, challenging the established international consensus that an ideal rate falls between 10% and 15%. Overuse of C-sections is a matter of concern when the increase in rates is not accompanied by a decrease in maternal or neonatal morbidity and mortality. We therefore, examined the cases of C-section and their associated characteristics from 2021 to 2022 at Neno District hospital in Malawi.
Objectives: (1) To determine the rates of C-sections in Neno district Hospital. (2)To determine the indications following a C-section.
Methods: We did a retrospective study, collecting C-section data from the theatre register using a CommCare application. This included the age, indications and source of referral and type. Using the data collected, we conducted univariate analysis to determine the rates of C-section and its associated factors.
Results: The data shows a total of 458 C-section cases, accounting for 24.2% of all deliveries. A significant majority (88%) were performed as emergencies, while 11% were elective. The primary indications for emergency C-sections included cephalo-pelvic disproportion (41%) and a previous C-section scar (19%). Elective C-sections were primarily performed for cases with one previous C-section scar (8%). The data revealed that women aged 24 and under were most likely to undergo a C-section (67%), while only 7.7% of C-sections were performed on women aged 35 and over. Most C-sections occurred among women coming directly from home (38%), followed by those from maternal waiting homes (27%).
Conclusion: The rate of C-section at Neno District Hospital is high raising a concern about the appropriateness and indications for the procedures. Further investigation is necessary to understand the factors driving this rise in C-sections and assess the impact on resources, maternal and neonatal outcomes.

P94_002150. PREVALENCE, MORTALITY, AND AETIOLOGY OF PAEDIATRIC SHOCK IN A TERTIARY HOSPITAL IN MALAWI: A COHORT STUDY
Author(s): Mercy Kumwenda1,2, Roxanne Assies1,3,4, Gloria Chathima1, Harriet Khofi1, Job B.M. van Woensel 3,4, Yamikani Chimalizeni 1, Josephine Langton1 and Job C.J. Calis 1,3,4
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Paediatrics and Child Health, Blantyre, Malawi
2.Kamuzu Central Hospital, Department of Paediatrics and Child Health, Lilongwe, Malawi
3.Amsterdam UMC location University of Amsterdam, PICU, Emma Children’s Hospital, Netherlands
4.Amsterdam Reproduction & Development, Amsterdam, the Netherlands
Email: mekumwenda@kuhes.ac.mw

Introduction: Shock is considered one of the most important mechanisms of critical illness in children. However, data on paediatric shock in sub-Saharan Africa is limited, which constrains development of effective treatment strategies.
Objective: We aimed to describe the prevalence, mortality, and aetiology of paediatric shock in a tertiary hospital in Malawi.
Methods: Children aged two months to 16 years presenting with shock (FEAST criteria; respiratory distress and/or impaired consciousness, and at least one sign of impaired circulation; capillary refill>3 seconds, cold extremities, weak pulse, or severe tachycardia) to the emergency department were included and followed-up prospectively using routinely collected data between February 2019 and January 2020. Prevalence, mortality and aetiology of shock were reported for both the FEAST criteria and World Health Organization (WHO) definition. The association between aetiology and mortality was assessed with univariable analysis.
Results: Of all screened admissions (N=12,840), 679 (5.3%) children presented with shock using FEAST criteria and the mortality was 79/663 (11.9%). WHO-defined shock applied to 16/12,840 (0.1%) and the mortality was 9/15 (60.0%). Main diagnoses were viral/reactive airway diseases (40.4%), severe pneumonia (14.3%), gastroenteritis (11.3%) and presumed sepsis (5.7%). Children diagnosed with presumed sepsis and gastroenteritis had the highest odds of dying (OR 11.3; 95%-CI:4.9-25.8 and OR 4.4; 95%-CI:2.4-8.2).
Conclusions: Considering the high mortality, prevalence of paediatric shock (FEAST and WHO definitions) in Malawi is high. Sepsis and gastroenteritis are diagnoses associated with poor outcome in these children. Consensus on a clinical meaningful definition for paediatric shock is essential to boost future studies.

P95_002172. POWER DYNAMICS AMONGST CADRES IN MATERNITY SETTINGS IN MALAWI
Authors: Bianca Kandeya1, Princess Kayira1, Wanangwa Manda1, Patani Mhango1, Effie Chipeta1, Helle Molsted Alvesson2
Affiliation(s):
1.Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre 3, Malawi
2.Karolinska Institutet, Sweden
Email: bkandeya@kuhes.ac.mw

Introduction: Interprofessional teamwork is essential to positive patient, staff, organizational culture and contributes directly to positive maternal outcomes. Midwifery care providers in Malawi manage complicated interpersonal relationships in a difficult environment brought on by an already overworked workforce in maternity settings which reduces job satisfaction.
Objective: The study was conducted to generate insights around interactions amongst midwifery care providers in Malawi.
Methods: A qualitative study was conducted through 38 in-depth interviews, two focus group discussions, 16 observations and co-design workshops in two maternity wards as part of the Action Leveraging Evidence to Reduce Perinatal Mortality and Morbidity in Sub-Saharan Africa study which aims to improve intrapartum care. Women, companions, and midwifery care providers were purposively sampled. Interviews were conducted in the local language and transcribed into English. A reflexive thematic analysis was conducted.
Results: Hierarchical power dynamics were reported by all cadres to hamper quality of maternity care. Obstetricians and Gynaecologists (OBGYNs) and Medical Officers (MO) were perceived to act superior to midwives. Midwives experienced that they were ordered to carry out patient care that the one giving orders could do. OBGYN and MOs’ preferences and personal relationships were directly influencing decisions to refer women in labour to midwives. Task shifting processes were experienced as challenging. When midwives were reluctant to continue monitoring women in prolonged labour, they referred them to OBGYNs and MOs. Lack of motivation to provide care during extended hours and limited support to midwives have increased the acceptability of reliance on interns and nursing students. Limited support to maternity care providers results in work-related frustration that are transferred to patient care.
Conclusion: Power dynamics and poor inter-professional working relationships affect maternity care. Effective leadership and management is needed to improve work environments and behaviour change amongst providers. Co-designing research and interventions may assist in addressing power dynamics.

P97_002197. IMPROVING QUALITY OF SMALL AND SICK NEWBORN CARE IN MALAWI,” A CASE STUDY OF THYOLO DISTRICT HOSPITAL”
Author(s): Loveness Banda1
Affiliation(s):
1.Thyolo District Hospital
Email: lovelanga1@outlook.com

Introduction: Malawi like any other low- income country, continues to face numerous challenges in reducing neonatal mortality rate. Through Every Newborn Action Plan( ENAP) ) and Health Sectors Strategic Plan 3 ( HSSPIII), Malawi is striving to reach the SDG3.2 target by 2023, of having a mortality rate of 12 or fewer deaths per every 1000 live births. One of the challenges at Thyolo District Hospital was management of feeds for newborn care. Objective: To implement and sustain change ideas aimed at improving feed monitoring for small and sick newborn care.
Methods: This was a Quality improvement project implemented in the nursery ward. Change ideas that were tested for improvement include; mentorship in feeding and standards, use of feeding chart and feeds monitoring, and file spot checks and data audits. The nursery work improvement team, a Quality Improvement Support Team Member, and the Unit matron were involved in data analysis and review. The baseline was 20% in May, and the target was 100% by August 2022.
Results: Management of feeds improved from 20% to 75% with a median performance of 74.5 [IQR; 66.5-88.75], from June to August 2022.
Conclusion: If Malawi is to achieve SDG 3.2 by 2023, facilities through QIST and nursery ward WIT need to implement and sustain the small and sick newborn care quality improvement projects.

P98_002207. UTILIZING UPRIGHT BIRTHING POSITIONS FOR MINIMIZING PERINEAL TEARS IN SPONTANEOUS VERTEX DELIVERIES AT LIMBE HEALTH CENTRE, BLANTYRE, MALAWI
Author(s): Miriam Window Shaba1, Patricia Swagart2, Stella Mwangonde3 and Ursula Kafulafula4
Affiliation(s):
1.Kamuzu University of Health Sciences, School of Maternal Neonatal and Reproductive Health
2.Seed Global Health
3.Ministry of Health, Blantyre District Health Office
4.Kamuzu university of Health sciences, School of Maternal Neonatal and Reproductive Health
Email: mwindow@kuhes.ac.mw

Introduction: At Limbe Health Centre, anecdotal evidence indicates a rising incidence of perineal tears in cases of spontaneous vertex deliveries. However, existing evidence supports the advantage of employing Upright Birthing Positions (UBP) in midwifery such as shortened labor duration and reduced perineal laceration severity. The World Health Organization (WHO) advocates for encouragement of low-risk laboring women to assume comfortable positions, including upright postures, during childbirth.
Objectives: (1) Identify causes of perineal tears and develop change ideas at Limbe Health Centre (2) Test change ideas on reducing perineal tears (3) Compare pre and post intervention perineal tears proportion.
Methods: We conducted a quality improvement(QI) project to reducing perineal tears at Midwifery-led ward of Limbe Health Centre from August 2022 to February 2023. Prior to the intervention, we assessed three maternity records from the month of March to August 2022 and conducted 30 labor ward observations to inform the QI project. The intervention included three change ideas: midwife orientation on UBP, bedside mentorship, and educating and demonstrating to laboring mothers on UBP. We used a Plan-Do-Study-Act cycles to test the change ideas and collected and monitored data using run charts. We compared perineal tear proportions before and after implementing these interventions to evaluate the project’s effectiveness.
Results: The proportion of perineal tears following vaginal birth decreased significantly, declining from 61% to 39%, alongside a notable 20% increase in the utilization of upright birthing positions (UBP). Additionally, it was observed that 50% of midwives successfully facilitated deliveries in UBP.
Conclusion: The incidence of perineal tears following vaginal birth decreased with the implementation of UBP intervention through QI measures. Nevertheless, the proportion of mothers opting for UBP during delivery remains low. Further QI activities are necessary to enhance the uptake of UBP among mothers at Limbe Health Centre.

P99_002251. INTEGRATING MATERNAL NEAR MISS CASE REVIEWS WITH THE PRE-EXISTING MATERNAL DEATH SURVEILLANCE AND RESPONSE SYSTEM: LEARNING WITH THREE MALAWIAN HOSPITALS.
Author(s): Luis Aaron Gadama1, Monica Patricia Malata1, Jessie Jane Khaki1, William Peno2, Medrina Mtende2 Effie Kondwani Chipeta1, Patani Mhango1, Fannie Kachale3, Andrew Likaka4, Bertha Maseko4, Chifundo Ndamala5, David Lissauer5, Regina Makuluni5, Emily Peca6, William Stones1 Alisa Jenny7, Dilys Walker7, and Victor Mwapasa1
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi
2.Queen Elizabeth Central Hospital, Blantyre, Malawi
3.Malawi Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
4.Malawi Blood Transfusion Services, Blantyre, Malawi
5.Malawi Liverpool Welcome Trust, Blantyre, Malawi
6.University Research Co. and Center for Human Services
7.University of California San Francisco
Email: lgadama@kuhes.ac.mw

Introduction: The World Health Organization recommends inclusion of maternal near-miss case reviews with the Maternal Death Surveillance and Response System (MDSR) as quality improvement initiatives to improve availability of useful metrics, promote accountability and improve reporting of severe maternal outcomes. This study evaluates the process of integrating maternal near miss case reviews within the pre-existing maternal death and surveillance system in three hospitals in Malawi.
Methods: The study used an implementation science research design piloted in three hospitals in Malawi. Maternal near miss data were collected using an adapted near miss criteria for a period of 9 months. The study also used Likert Scales and in-depth interviews to measure and assess provider perspectives on acceptability, appropriateness, feasibility and sustainability of integrating maternal near-miss case reviews with the MDSR. The study participants were district health managers, service providers and members of hospital MDSR committees.
Findings: Across three health facilities, we recorded 12,253 live births, 236 maternal near-miss cases and 63 maternal deaths representing a maternal near-miss ratio of 19 per 1000 live births and a maternal mortality ratio of 514 per 100,000 live births. Obstetric hemorrhage was the leading cause of both maternal near-miss cases (51.7%) and maternal deaths (20.6%). Hypertensive disorders and obstetric infections were the second and third leading causes of both maternal near-misses and deaths. Obstetric related infections had the highest case fatality ratio (25%), followed by hypertensive disorders (19%) while the ratio for obstetric hemorrhage was 10.7%.
Conclusion: The study found including maternal near-miss reviews to be acceptable by service providers. Midwives welcomed the integration as it shifted the focus from the “blame-game” nature of maternal death reviews to highlighting positive elements of care where lives were saved. However, participants reported increased workload. Sustainability of the surveillance was dependent on the commitment of hospital managers.

P100_001938. DISCOURSE ANALYSIS OF WOMEN CAREGIVERS OF CHILDREN LIVING WITH HIV AND AIDS IN RURAL MALAWI
Authors: Mandayachepa Chriford Nyando1, and Patrick Mapulanga2
Affiliations(s):
1.Adult Health Nursing Department, Kamuzu University of Health Sciences, Lilongwe, Malawi
2.Library Department, Kamuzu University of Health Sciences, Lilongwe, Malawi
Email: cnyando@kuhes.ac.mw

Introduction and objective: This paper examines the invisibility of women caregivers of children living with HIV and AIDS in Malawi and its consequences for their health and the health of their families.
Methods: This paper draws on ethnographic fieldwork experiences in rural Malawi. The paper examines the experiences of women via observation of clinics and wards at a rural hospital. The paper collected data through longitudinal narrative interviews with women (n= 20) caring for a child living with HIV and AIDS.
Results: Women caregivers remain invisible both within the domestic sphere of the home, their community and to healthcare services. They do not have a voice in making decisions about their child’s health or they do not have their own health needs prioritized. Men have controlling attitudes and behavior over women. However, these women demonstrated that they were highly motivated and resilient in caring for their children.
Conclusion: Findings from research conducted in Malawi, have limited generalizability to other settings. The unique social, cultural, and economic factors in this particular context impacted the experiences of women caregivers differently compared to other regions or countries. Exploring the practical implications of the invisible and unrecognized care provided by women caregivers of children living with HIV and AIDS in rural Malawi reveals the need for increased awareness, targeted interventions, strengthened support networks, policy development, training, and empowerment of caregivers. Research on the invisible and unrecognized care of women caregivers of children living with HIV and AIDS in rural Malawi has the potential to create a more inclusive, equitable, and supportive society. By challenging gender norms, reducing stigma, empowering women, strengthening community bonds, and advocating for policy changes, the social landscape can become more conducive to recognizing and supporting the invaluable role of women caregivers.

P101_001976. EXPERIENCES OF USING MISOPROSTOL IN THE MANAGEMENT OF INCOMPLETE ABORTIONS: A VOICE OF HEALTHCARE WORKERS IN CENTRAL MALAWI
Author(s): Bertha Magreta Chakhame 1,2, Elisabeth Darj 1, Mphatso Mwapasa 1,2, Ursula Kalimembe Kafulafula 2, Alfred Maluwa 3, Grace Chiudzu 2, Address Malata 3, Jon Øyvind Odland 1,4 and Maria Lisa Odland 1,5
Affiliation(s):
1.Norwegian University of Science and Technology, Trondheim, Norway
2.Kamuzu University of Health Sciences, Malawi
3.Malawi University of Science and Technology
4.School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa
5.Department of Obstetrics and Gynecology, St. Olav’s Hospital, Trondheim Norway
Email: bchakhame@kuhes.ac.mw

Introduction: Complications after abortion are a major cause of maternal deaths globally. Incomplete abortions are very common, and require treatment with evacuation of the uterus; this can be done surgically, medically, or expectantly. Literature has revealed that surgical management is mostly used in Malawi. Even though the synthetic prostaglandin E1 analogue, misoprostol, is a cheaper and safer option, it is rarely used in the country. To improve post-abortion care, an intervention study was done to increase the use of misoprostol in treating incomplete abortions in Central Malawi.
Objectives: To explore healthcare workers´ perceptions of and experiences with misoprostol in the management of incomplete abortion in central Malawian.
Methods: A descriptive phenomenological study utilising an inductive approach was conducted in three public hospitals in central Malawi. Focus group discussions were conducted with 29 healthcare workers (clinical officers and nurse/midwives) in centres where training on the use of misoprostol in the treatment of incomplete abortions was offered. Purposeful sampling was used to identify participants, and data was analysed using thematic analysis.
Results: Most of the healthcare workers were positive about the use of misoprostol, they knew how to use the drug and were confident in doing so. The staff preferred misoprostol to surgical treatment because they perceived it as safe, effective, easy to use, cost-effective, it had fewer complications, decreased hospital congestion, reduced workload, and saved time. Additionally, misoprostol was also administered by nurses/midwives, and not just physicians; this enhanced task-shifting.
Conclusion: The results showed the acceptability of misoprostol in the management of first-trimester incomplete abortion among healthcare workers in central Malawi, and further implementation of the drug is recommended. Misoprostol will make post-abortion care services accessible to women at a cheaper price. It would reduce waiting time for women and the workload for staff.

P102_002081. SEVERITY OF MENOPAUSE SYMPTOMS AND COPING MECHANISM AMONG WOMEN IN BLANTYRE, MALAWI
Author(s): Thokozani Nyalubwe Kaliati1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: tkaliati2017@gmail.com

Background: Menopause is a key transition point of biological and social development. This period is associated with a wide range of symptoms that can be very distressing and have considerable effects on a woman’s life. Although menopause is inevitable for all women, the experiences are not universal. Therefore, this study was conducted to generate local data on the prevalence, effects, and associated coping mechanisms of menopause symptoms among women in Blantyre, Malawi.
Objectives: The broad objective was to evaluate the severity of menopause symptoms and the associated coping mechanisms among a select population of women in Blantyre, Malawi. The specific objectives were; to determine the prevalence and severity of menopause symptoms, to assess knowledge of menopause among women, to assess coping mechanisms of women with menopause symptoms, and finally to describe the effect of menopause symptoms on health-related quality of life.
Methods: This was a descriptive study using the convergent mixed method. 264 respondents were enrolled for the quantitative arm of the study while 20 women were enrolled for the qualitative arm. Quantitative data was analyzed using STATA while qualitative data was analyzed using Nvivo.
Results: The median age at menopause was 45. Physical symptoms had the highest prevalence at 84.7% followed by psychosocial symptoms at 56.4%. Vasomotor symptoms were reported at 49.2% and sexual symptoms at 41.7%. The severity and effects of menopause symptoms varied across the study respondents. 64% of the respondents reported that they did not have any knowledge of any existing interventions for menopause symptoms.
Conclusion: Menopause symptoms are common among women in Blantyre with varying effects. However, knowledge about menopause and existing medical interventions is very limited. Increased need for community awareness and sensitization on issues about menopause and consider the introduction of mature woman outpatient clinics at national level.

P103_002097. KNOWLEDGE AND EXPERIENCES IN ACCESSING SEXUAL REPRODUCTIVE HEALTH SERVICES FOR PEOPLE WITH SPINAL CORD INJURY IN BLANTYRE, MALAWI
Author(s): Charity Malinda Kafulafula1,2
Affiliation(s):
1.Ministry of Health, Blantyre District Health Office
2.University of the Witwatersrand, Johannesburg South Africa
Email: charitymalinda3@gmail.com

Introduction: Spinal cord injury (SCI) is a devastating life-changing condition. People with spinal cord injury (PWSCI) among other impairments suffer from sexual dysfunctions that disturb their sexual and reproductive life, negatively influencing their quality of life. Management of SCI during physical rehabilitation often excludes issues of sexuality or reproductive health resulting in discharge without a proper solution to the sexual dysfunctions.
Objective: To explore knowledge about sexual and reproductive health services (SRHS), and the experiences in accessing such services among PWSCI in Blantyre, Malawi.
Method: Fifteen face-to-face in-depth interviews were conducted with PWSCI. The participants were clients who had attended physical rehabilitation at Kachere Rehabilitation Center. This data collection was done from November 2022 to December 2022. Data was analyzed thematically using the NVIVO software package.
Results: Six themes emerged from the data:(i) PWSCI have knowledge on SRHS which is sourced from health workers and friends with similar conditions, (ii) positive experiences involved good attitude of health workers, (iii) negative experiences were lack of privacy during treatment sessions, (iv). barriers to access of SRHS included gaps in service delivery of the public clinic like limited resources, (v)facilitators to accessing SRHS included improved psychosocial support by spouse, family, and community, and (vi) improvements to SRHS and physical rehabilitation service can enhance access of SRHS.
Conclusion: People living with spinal cord injury are aware about sexual and reproductive health services. However, they have had bad experiences in accessing such services. To improve the service delivery, there is a need to intensify SRHS educational messaging, improve resource availability and improve the psychosocial support for the PWSCI.

P104_002025. PUBLIC HEALTH PERSPECTIVES ON THE RISE OF COMMERCIAL GAMBLING IN MALAWI
Author(s): Christopher Bunn1 and Junious Sichali2
Affiliation(s):
1.University of Glasgow and Malawi Epidemiology and Intervention Research Unit
2.University of Bath and Malawi Epidemiology and Intervention Research Unit
Email: christopher.bunn@glasgow.ac.uk

Introduction: Globally, commercial gambling is established as a public health concern requiring a public health response. Research has identified gambling-related harms affecting mental health, physical health, financial stability, and relationships, with consequences for gamblers’ families and communities. Malawi has witnessed a rapid growth in commercial gambling since 2015. The sports betting industry has grown at a near exponential rate, with last reported revenues in the region of MK16.6bn (2020-21).
Objectives: To synthesise findings from four studies and to describe health-impacting gambling harms identified in Malawi since 2018.
Methods: We draw on: a qualitative media analysis of 39 Malawian newspaper articles published between 2015 and 2019; an in-depth interview study with 10 regular sports bettors living Lilongwe; a verbal autopsy study of a suicide of a minor living in the Northern region of Malawi; and a participatory, photovoice and co-creative study of youth perceptions of gambling conducted in Lilongwe with 24 young people.
Results: Our studies suggest that commercial gambling in Malawi is connected to a range of harms that industry has contributed to perpetuating. Industry positioned its products as a source of income on launch, enticing Malawians to participate to solve financial problems. Men who became regular sports bettors following the launch described mental health struggles, labelling themselves ‘addicts’, detailed how they re-directed money intended for essential household expenditure, such as food and soap, to their betting habits, and spoke about the common nature of underage gambling. These findings were echoed in our studies of a tragic gambling-related suicide of a minor and in participatory work with young people in Lilongwe.
Conclusion: We establish evidence of gambling harms in Malawi, dangerous under-age gambling and of distal and proximal relationships between gambling practices and negative health-related impacts. As industry continues to grow, public health action is needed to prevent these harms.

P105_002046. FACTORS ASSOCIATED WITH COVID 19 RELATED STIGMA AMONG HEALTH CARE WORKERS: A CASE OF MANGOCHI, MALAWI
Author(s): Mercy Paundi Kulanga1, Ezekiel Kadango1, Patricia Yosiya Ng’ambi1, Lamusi Abudu1, Towera Maureen Maleta2 and Genesis Sungani Chorwe2
Affiliation(s):
1.Ministry of Health, Mangochi District Health Office, Registered Nurse Midwife
2.Kamuzu University of Health Sciences- Genesis Sungani Chorwe”
Email: zekkadango@gmail.com

Introduction: COVID 19 pandemic has overwhelmed the health care landscape such that the health care workers have faced resistance and disrespect by the society. This has led to increased anxiety, public fear, and negative perceptions of stigma which is affecting their psychological wellbeing and performance. The study aimed to identify factors associated with COVID 19 related stigma among heath care workers in the district of Mangochi, Malawi
Methods: A cross sectional quantitative study was carried out among health care workers using a validated self-administered questionnaire. Three level multistage sampling technique was used. The study was conducted in the five zones of the district. The facilities and participants were selected using Simple Random Sampling Technique. The total number of participants were 350. Data was collected from a period of 4 weeks from March 2022 to April,2022. Data was analyzed using Stata version 14.2
Results: 325 health care workers participated in this study. The prevalence of COVID 19 in the population of health care workers was 66.6%(n=218). In multivariable logistic regression analyses, health care workers being sidelined by the community was found to be statistically significant (OR=2.4, 95% CI; 0.41-1.41, P = 0.001¬).
Conclusion: Social stigma prevails among health care workers in Mangochi and is associated with numerous psychological disturbances. These preliminary findings highlights need for specific research and targeted interventions particularly addressing COVID 19 related stigmatization, a need for adequate preparedness within the health sector to support and protect the health care workers and disease awareness strategies for health care workers and the general public for future pandemics.

P106_002054. ESTABLISHING ACCEPTABILITY OF PNEUMOCOCCAL CHALLENGE IN PEOPLE LIVING WITH HIV AND TUBERCULOSIS CHALLENGE IN NEGATIVE VOLUNTEERS: A REPORT OF TWO STAKEHOLDER WORKSHOPS IN BLANTYRE, MALAWI
Author(s): A.E. Chirwa1, K. Doherty1, D. Dula1, T. Chikaonda1, E. Nsomba1, V. Nkhoma1, C. Ngoliwa1,4, S. Sichone1, B. Galafa1, G. Tembo1, M. Chaponda1, N. Toto1, R. Kamng’ona1, L. Makhaza1, A. Muyaya1, F. Thole1, E. Kudowa1, J. Ndaferankhande1, C. Mkandawire1, G. Chiwala1, L. Chimgoneko1, N.P.K. Banda1,3,4, D. Ferreira2,5, K. Jambo1, 2, M.Y.R. Henrion1, 2, S.B. Gordon1, on behalf of the Malawi Accelerated Research in Vaccines, Experimental and Laboratory Systems (MARVELS) consortium
Affiliation(s):
1.Malawi Liverpool Wellcome Programme (MLW)
2.Malawi Accelerated Research in Vaccines by Experimental and Laboratory Systems (MARVELS),
3.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
4.Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
5.School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi,
6.Department of Paediatrics, University of Oxford, Oxford, UK
Email: aechirwa12@gmail.com

Introduction: The effectiveness of pneumococcal conjugate vaccines (PCVs) in Malawi is threatened by low herd effect. People living with HIV (PLHIV) demonstrate high pneumococcal carriage and shedding patterns. There is currently no vaccination strategy for PLHIV in Malawi. Controlled human infection models (CHIMs) are a means to carefully study pathogenesis, correlates of protection and vaccine efficacy in small numbers of appropriate volunteers.
Objective: We aim to establish a patient-and-public-informed framework for CHIMs in at-risk groups especially PLHIV. For the first time we will confirm acceptability of pneumococcal challenge in PLHIV through a formative study.
Methods: Two preliminary stakeholder workshops have been conducted. These led to a patient-and-public involvement and engagement (PPIE) to inform an optimised study design assessing the acceptability of pneumococcal CHIM in PLHIV and tuberculosis challenge in HIV negative individuals. We now have ethics approval to conduct an in-depth qualitative study (Advanced CHIM Acceptability- ACHIMA) through deliberate focus group discussions and key-informant interviews with relevant stakeholders such as PLHIV, community advisory groups, community leaders, health workers, HIV and tuberculosis physician-scientists, and ethics representatives to establish acceptability of human challenge studies in PLHIV and tuberculosis challenge in HIV negatives.
Results: Findings from the two workshops; October 2022 and January 2023, suggest CHIM in PLHIV is can be acceptable in principle, potentially beneficial, and safety concerns require safety netting. There is need for local ownership of CHIMs: (“Why do we have to wait for results from studies done elsewhere? This is a welcome development.”). CHIMs require continuous stakeholder consultation (“The study seems safe but there is need to involve the community throughout the study to clear out myths.”).
Conclusion: A pneumococcal CHIM in PLHIV has the potential to be acceptable and beneficial despite the risks. Stakeholder engagement continues to inform CHIM designs.

P108_002095. OPTIMISATION OF UNDETECTABLE=UNTRANSMITTABLE INFORMATION MATERIALS IN MALAWI
Author(s): Mackwellings Phiri1,2, Owen Mhango1, Anastasia Chikweza2, Rebecca Joppling3, Felix Phuka1, Marriott Nliwasa1, Hussein Twabi1, Tobius Masina4, David Black Kamkwamba5, Liz Corbett6, Augustine Choko2,7, Nicola Desmond7 and Moses Kumwenda1,2
Affiliation(s):
1.Helse Nord TB initiative, Kamuzu University of Health Sciences
2.Malawi Liverpool Wellcome Programme
3.Kings College London
4.Department of HIV, Ministry of Health
5.The Network of Journalists Living with HIV (JONEHA)
6.London School of Hygiene and Tropical Medicine
7.Liverpool School of tropical Medicine
Email: mackwellingsphiri@gmail.com

Introduction: People Living with HIV on effective ART with an undetectable viral load can stay healthy and have almost zero chance of transmitting HIV to their partners through sexual contact. Malawi has a highly successful HIV programme but HIV information communication materials show little emphasis on “Undetectable=Untransmittable” concepts. Thus, most people in Malawi are unaware that effective ART can prevent HIV transmission.
Objectives: To optimize context-relevant “Undetectable=Untransmittable” communication materials intended for application within ANC and ART clinics contexts in Malawi.
Methodology: A qualitative research design was used to optimize the developed “Undetectable=Untransmittable” information materials (i.e. 3 posters, 1 short video and 1 leaflet). We conducted cognitive interviews with nine men and ten women living in mixed-status relationships recruited from Bangwe(N=4), Limbe(N=5), Madziabango(N=5) and Mpemba(N=5) health centres in Blantyre district. Cognitive interviews assessed participant’s comprehension of “Undetectable=Untransmittable” messages within the developed communication materials to garner the required feedback needed to inform the optimization process. Additionally, a stakeholder participatory workshop was done with three policy makers, three implementers and six researchers. Content analysis was used to improve informational materials during the optimization process.
Results: The “Undetectable=Untransmittable” communication tools addressed various topics relating to the role of ART in preventing HIV transmission. Feedback solicited from cognitive interviews demonstrated reasonable lay competency in grasping concepts such as viral load, undetectable viral load, and treatment as prevention. Most participants interpreted messages correctly and were generally satisfied with their clarity. To few, certain phrases were misleading and needed adjusting for optimal comprehension and treatment adherence. For instance, participants felt the term ‘undetectable HIV’ could be misconstrued to mean ‘cure’ potentially precipitating treatment abscondment. Regarding the translation of the concept “”viral load,”” using a phrase “”kuchuluka kwa tizirombo ta HIV m’magazi”” was perceived as derogatory and stigmatising because it implicitly meant ‘a high concentration of HIV.’ Rather, they advocated for nonjudging and neutral translations like “”mulingo wa tizirombo ta HIV”” which means ‘the volume of HIV’. In relation to childbearing, participants felt the message “We can have HIV-negative children if our viral load remains low” made having HIV-negative children the primary goal of viral suppression and failed to reflect other important roles of ART such as a healthy life and ability to fulfil other life ambitions. Policy makers, implementers and researchers alike commended incorporating locally appropriate terminologies to foster comprehension and prevent distorted interpretation. They advised avoiding stigmatizing translations and ensuring that specific target populations intended for the massages were well defined.
Conclusion: Apparent gaps in the availability of “Undetectable=Untransmittable” communication materials in Malawi require contextually relevant information. Cognitive interviews and a participatory workshop allowed us to optimize the developed posters, short video, and leaflets. There is need for great care in selecting appropriate translations and the handling of “Undetectable=Untransmittable” information to ensure comprehension and prevent unintentional consequences resulting from distortion of the intended meaning.

ABSTRACTS FOR ORAL PRESENTATIONS
INFECTIOUS DISEASES (HIV)
031_002164. TRENDS IN HIV DIAGNOSES AND OTHER SELF-REPORTED SEXUALLY TRANSMITTED INFECTIONS IN MALAWI: MALAWI DEMOGRAPHIC HEALTH SURVEY 2004, 2010 AND 2015-2016
Author(s): Evaristar Kudowa1, Maganizo B Chagomerana2,3, James Chirombo1, Mina C Hosseinpour2,3, and Emmanuel Singogo2.
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
2.University of North Carolina Project-Malawi
3.Department of Medicine, University of North Carolina at Chapel Hill
Email: enkudowa@gmail.com

Introduction: HIV and sexually transmitted infections (STIs) pose significant challenges to global health, particularly in sub-Saharan Africa. Malawi, like many other countries in the region, faces a substantial burden of these infections, impacting public health and socioeconomic stability. We explored trends in the prevalence of self-reported STIs and HIV diagnoses in Malawi.
Objective: To estimate prevalence and spatial variation of HIV, STI and HIV/STI co-infections.
Methods: We analyzed data from the 2004, 2010, and 2015-2016 Malawi Demographic Health Surveys for individuals aged between 15 and 49. Descriptive statistics were used to summarise demographic characteristics. We profiled the STI and HIV cases and estimated prevalence and co-infections at district level and utilized geospatial methods to visualize spatial patterns. Sample weights were applied to calculate weighted proportions and their corresponding confidence intervals.
Results: A total of 33,195 individuals (5,150 in 2004; 13,588 in 2010; 14,457 in 2015-2016) were included in HIV analysis, and 66,622 individuals in STI analysis (13,113 in 2004; 25,716 in 2010; 27,793 in 2015-2016). HIV prevalence was 11.8% (95%CI; 11.0%-12.7%) in 2004, 10.6% (95%CI; 10.1%-11.1%) in 2010 and 8.8% (95%CI; 8.3%-9.2%) in 2015-2016. STI prevalence was 7.8% (95%CI; 7.3%-8.3%) in 2004, 10.5% (95%CI; 10.2%-10.9%) in 2010 and 13.6% (95%CI; 13.2%-14.0%) in 2015-2016. Prevalence of HIV/STI co-infections was 14.0% (95%CI; 11.6%-16.7%) in 2004, 17.8% (95%CI; 16.3%-19.3%) in 2010 and 20.2% (95%CI; 18.5%-22.1%) in 2015-2016. We observed a decrease in HIV prevalence over time, and an increase in STI prevalence and HIV/STI co-infections. In all surveys, HIV, STI and HIV/STI prevalence varied across the districts with the southern region having higher prevalence.
Conclusion: While HIV rates decreased, STI prevalence and HIV-STI co-infections increased over time and varied by districts. There is need to strengthen screening and treatment of STIs and HIV, and promote safer sexual practices among the sexually active population.

O32_002176. AN AUDIT OF APPLICATIONS FOR HIVDR TESTING IN THE MALAWI HIV PROGRAM
Author(s): Hope Kanise1, Khumbo Phiri1, Mina Hosseinipour6, Tom Heller3, Bilaal W Matola4, Amos Makwaya1, Sam Phiri1,5, Rose Nyirenda4, Katherine R Simon7, Cecilia Kanyama6, Carrie Cox8 Pachawo Bisani3 and Joep J van Oosterhout1,2
Affiliation(s):

1. Partners in Hope, Malawi
2. University of California Los Angeles, USA
3. The Lighthouse Trust, Malawi
4. Department of HIV and AIDS, Ministry of Health, Malawi
5. Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Malawi
6. UNC Project Malawi,
7. Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi.
8. Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, United States.
   Email: hopekanise@gmail.com

Introduction and objective: Full transition to dolutegravir-based regimens has taken place in Malawi’s HIV program. For persons on dolutegravir- and protease inhibitor (PI)-based regimens, Malawi’s HIV program requires confirmation of HIV drug resistance (HIVDR) before switching to next-line regimens. Approval of applications for HIVDR testing is determined by a national HIVDR committee that also provides individual management recommendations based on HIVDR test results. We audited HIVDR test applications in Malawi’s national ART program.
Methods: We conducted a retrospective review of routinely collected data from individuals of all ages, who had an application for HIVDR testing registered between July 2020 to December 2021. We determined drop-offs at steps of the HIVDR testing cascade: approval, sample collection, sequencing, management recommendation, and implementation of the recommendation. We also assessed the HIV treatment outcomes including the first viral load (VL) result ≥6 months after recommendations from the HIVDR committee.
Results: 228 HIVDR applications were received, while 4869 eligible clients with confirmed virological failure were eligible in the same period. 75% (172/228) of the applications were approved, of these 72% (124/172) had samples sent to the laboratory, and 122 genotyping results were received. 75% (92/122) of the samples were successfully sequenced and 71% (65/92) of these sequences had ≥one major drug resistance-associated mutation. Treatment outcomes were available for 90 clients: 65 Alive on ART, 3 Defaulted, 12 Died, 9 Transferred Out and 1 Stopped ART. VL results were available for 68 clients of which 34 (50%) were suppressed (<1,000 copies/mL).
Conclusion: This audit demonstrates large gaps in the HIVDR testing cascade and moderate clinical outcomes (attrition from care 20%; VL suppression 50%) after recommendations following HIVDR testing. Given considerable effort and costs invested in HIVDR testing, these results suggest that improvement in HIVDR test procedures in the Malawi HIV program is required.

O33_001977. FACTORS ASSOCIATED WITH RETENTION OF HIV EXPOSED INFANTS IN THE EARLY INFANT DIAGNOSIS PROGRAM, IN LILONGWE RURAL, MALAWI
Author(s): Julia Phensere1 and Vincent Jumbe2
Affiliation(s):
1.Nkhoma College of Nursing, Malawi
2.Kamuzu University of Health Sciences, Malawi
Email: juliaphensere@gmail.com

Introduction and Objective: Retention of clients is reported to be the single greatest threat to sustainable HIV response. In Malawi, as of 2022, retention in EID was at 94%, 86% and 89% in the 2 month, 12 month and 24-month age cohorts respectively. Retention of clients in HIV care is a challenge across all age groups including infants. We conducted a study which assessed perceived benefits, threats and socio-cultural factors associated with the retention of HIV-exposed infants in the Early Infant Diagnosis (EID).
Methods: We conducted a descriptive cross-sectional study using barrier analysis in Lilongwe rural health centers/hospitals; Nkhoma Mission Hospital, Mitundu rural hospital, Nathenje and Ntenthera Health Centers in 2021. In 2021, attrition rates in these facilities were 35%, 21%, 22% and 18% respectively. We recruited a total of 90 HIV-exposed infants 0-24 months of age purposively comprising of 45 doers(/active) and 45 non-doers (defaulters/loss to follow). They were identified using the infant’s HIV Care Clinic (HCC) number/card. Data were collected through interviews from mothers of HIV-exposed infants using structured questionnaires.
Results: Distance (RR 0.7; P-001), client’s willingness (RR 3.32; P-0.006), and lack of a life partner (RR 0.236; P-0.004) were statistically significant in influencing the client’s ability to take their infant/child to the clinic for EID services. The attitude of health workers, cultural norms and beliefs did not show any statistical significance.
Conclusion: The findings of this study provide a lever from which more effective social and behavioral change messages, strategies, retention models and supporting activities can be developed to promote retention. Evidence based interventions to retain infants in care are imperative to close the gap. In addition, interventions to improve retention of HIV exposed infants in care should be multi- faceted and may be most effective if health systems factors, behavioral factors as are addressed simultaneously.

O34_002180. EXPLORING THE BURDEN OF HIV AND OTHER STIS AMONG FEMALE SEX WORKERS IN URBAN BLANTYRE USING RESPONDENT-DRIVEN SAMPLING
Author(s): James Chirombo1, Wezzie Lora1, Doreen Sakala1, Wezzie Nyapigoti1, Esnart Sanudi 1, Amr Saidi 1, Sanni Ali1, James Hargreaves 2, Frances Cowan2 and Nicola Desmond3
Affiliation(s):
1.Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2.London School of Hygiene and Tropical Medicine, London, UK
3.Liverpool School of Tropical Medicine, Liverpool, UK
Email: jchirombo@mlw.mw

Introduction: Understanding the burden of sexually transmitted infections among key populations such as female sex workers is important towards control of the HIV/AIDS epidemic. However, obtaining valid population prevalence estimates from FSW populations is a challenge, due to the lack of a sampling frame and privacy concerns. These populations are therefore hidden. In these situations, non-probability sampling methods such as respondent-driven sampling surveys can be used to obtain prevalence estimates. However, specialised analysis methods are needed to perform valid inferences from non-probability samples.
Methods: We conducted an RDS survey to estimate the prevalence of HIV and other sexually transmitted infections among 223 female sex workers (FSW) in urban Blantyre, Malawi. We further calculated the STI prevalence stratified by key variables such as venue of sex work, typology of sex work and age. All prevalence estimates were weighted by the underlying social network of the FSW. We generated recruitment trees to visualize the sex work network structure and other RDS diagnostics to assess the validity of the estimates.
Results: Overall, we found a high prevalence of HIV and syphilis of 70% (57.2 – 82.8%) and 46% (31.2 – 60.0%) respectively. Results further reveal heterogeneity in STI risk across sex work venues in urban Blantyre. Higher HIV prevalence was observed among street-based FSW at 79% (95 CI: 66% – 91%) compared to venue-based FSW at 69% (95% CI: 53 – 85%). The social networks were relatively heterogenous with little homophily effect suggesting good mixing during recruitment.
Conclusion: The heterogeneities in HIV risk shows that there is a need to target various locations with specific interventions to effectively fight HIV among FSW. Our results show the feasibility of using RDS surveys as a quick and relatively low-cost method to estimate the prevalence of STIs in hidden populations compared to population-based prevalence surveys.

O35_002104. THEORETICAL PREFERENCES FOR LONG-ACTING INJECTABLE ART AMONG MOBILE MEN LIVING WITH HIV IN MALAWI: A QUALITATIVE STUDY
Author(s): Marguerite Thorp1, Sam Phiri2, Khumbo Phiri2, Isabella Robson2, Misheck Mphande2, Risa Hoffman1, and Kathryn Dovel1,2
Affiliation(s):

1. University of California Los Angeles
2. Partners in Hope
   Email: mthorp@mednet.ucla.edu

Introduction: Long-acting injectable (LAI) antiretroviral medications may be an ideal treatment option for highly mobile people, including mobile men living with HIV (MLHIV), who experience challenges with ART engagement.
Objectives: We explored mobile MLHIV preferences for a theoretical LAI option.
Methods: We conducted a qualitative sub-study embedded within two trials (ENGAGE and IDEAL) aimed at improving ART outcomes among MLHIV in 24 health facilities. Eligibility criteria were: MLHIV; >15 years; and not actively on ART at time of enrollment. We conducted in-depth interviews with men who self-reported being mobile during the 6-month study period (defined as at least one trip of three nights or more). We used a stratified sampling frame and randomly selected mobile men by study arm, geographic region, and self-reported ART experience during the trial. Interviews included a description of a theoretical, bimonthly LAI and questions about client preference for LAI or oral ART. Interviews were translated, transcribed, coded in Atlas.ti, and analyzed using framework analysis.
Results: We interviewed 29 mobile MLHIV from July to August 2022, median age 36 (IQR:31-41); 34% attended any secondary school; all had previously initiated oral ART. Nearly all participants (26/29) expressed a theoretical preference for LAI over daily oral ART because they believed LAI would reduce the risk of forgetting pills, general pill fatigue, unwanted disclosure, and logistical challenges of traveling with oral ART. Of the three men who preferred oral ART, the most common reason was fear of side effects from a new medication. Most men were not concerned about injection site reactions (19/26); however, some (7/26) said long-lasting pain might change their preference, especially if it prevented them from working.
Conclusion: Mobile MLHIV who experienced treatment interruption expressed strong theoretical preferences for LAI ART. Further research is needed on efficacy and implementation challenges for delivering LAI ART in Malawi.

MENTAL HEALTH
O36_001861. ASSESSMENT OF PREVALENCE AND PREDICTIVE FACTORS OF PERCEIVED STIGMA AMONG CLIENTS WITH MENTAL ILLNESS ATTENDING MENTAL HEALTH CLINICS IN LILONGWE DISTRICT
Author(s): Emma Angasi1, Japhet Myaba2 and Diana J. Jere2
Affiliation(s):

1. Bwaila Hospital, P.O Box 1274
2. Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
   Email: angasi2021emma@kcn.unima.mw

Introduction: Many people with mental illness perceive and experience stigma due to attitudes and behaviour of others. Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves. This type of stigma is known as perceived stigma and can result in reduced access to medical and social services, limited social interaction, and missed employment opportunities. However, the prevalence and predictive factors have not been studied in Malawi. Objective: Our study therefore aimed to assess the prevalence and predictive factors of perceived stigma among clients with mental illness attending mental health clinics in Lilongwe, Malawi.
Method: A quantitative cross-sectional study was conducted through face-to-face interviews in Lilongwe, Malawi. We recruited 261 participants for the study. Data was collected using an adapted perceived devaluation and discrimination scale. We conducted binary and multivariate logistic regressions at a confidence interval of 95% to identify the associated factors to perceived stigma.
Results: The majority 60.5% (n=158) of the participants were male. The mean age of participants was 36.59 years (SD=10.784). Most participants had gone up to secondary level 47.5% (n=124), The prevalence of high perceived stigma was 18%. In the multivariate regression model, age category 36-45 (AOR=0.216, 95% CI: (0.075-0.623), Ngoni (AOR=0.204, 95% CI: 0.046-0.899), Chewa tribe (AOR= 0.126, 95% CI: 0.036-0.445) Lomwe tribe (AOR=0.024, 95% CI: 0.002-0.294), farming (AOR=4.082, 95% CI: 1.404-11.863), withdrawal (AOR=2.401, 95% CI: (1.075-5.363). and number of hospitalizations (AOR=0.289, 95% CI: 0.121-0.,691) were found to be significantly associated with perceived stigma.
Conclusion: Our study shows the prevalence and predictive factors of perceived stigma among clients with mental illness in Lilongwe. This highlights that perceived stigma is a major problem among clients with mental illness attending follow-up care in Lilongwe, hence the need to emphasize awareness of predictive factors for better understanding.

O37_002055. STIGMA AND DISCRIMINATION EXPERIENCED BY PEOPLE WITH PSYCHOSIS IN MALAWI
Author(s): Jack Kramer1, Melissa Stockton2, Brian Pence2, Bradley Gaynes3, Alex Zumazuma5, Griffin Sansbury1, Abigail Morrison4, Harriet Akello Tikhiwa1, Jackson Devadas4, Hillary Mortensen4, and Kazione Kulisewa5
Affiliation(s):
1.UNC Project-Malawi, Lilongwe, Malawi
2.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
3.Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
4.Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
5.Department of Psychiatry and Mental health, Kamuzu University of Health Sciences, Blantyre, Malawi
Email: jskramer@live.unc.edu

Introduction: Psychotic disorders are highly stigmatized in the African context. Understanding stigma is fundamental to optimizing treatment, improving health outcomes, and protecting the human rights of people with psychosis, particularly in resource-limited settings. Yet, little is known about stigma faced by people with psychosis in Malawi.
Objectives: In this qualitative study, we aimed to describe stigma and discrimination faced by people with psychosis in Malawi using the Health Stigma and Discrimination Framework to delineate the stigmatization process including the drivers, manifestations, outcomes, and health and social impacts.
Methods: From March to April 2023, we conducted In-depth interviews with people with lived experience of psychosis (PWLE), caregivers, medical personnel, traditional healers and focus groups with community leaders and religious leaders exploring understanding of psychosis, experience of living with psychosis, perspectives on family and community stigma, and perspectives on treatment/rehabilitation. Thematic analysis was conducted on the coded data to describe the drivers and facilitators, manifestations, outcomes, and health and social impacts of stigma and discrimination.
Results: Key drivers of stigma were rooted in interlocking lack of awareness, negative stereotypes, prejudice and fear. PWLE were labeled as dangerous, violent, incompetent and were considered responsible for their condition due to engaging in substance use and/or witchcraft. The most common manifestations of stigma were gossip, insults, physical violence, avoidance and social exclusion, employment-base discrimination, and being tied up. Participants anticipated stigma upon disclosure in the form of verbal abuse, social alienation, and decreased economic opportunity. Stigma also manifested internally as feelings of shame, low self-esteem, and no longer considering oneself “normal”.
Conclusion: To address psychosis stigma in Malawi, interventions should focus on addressing key drivers of stigma and developing ways for PWLE to contribute to their family and community.

O38_002087. THROUGH THEIR LENS: UNVEILING THE REALITIES OF PEOPLE LIVING WITH PSYCHOSIS AND THEIR CAREGIVERS USING PHOTOVOICE
Author(s): Wakumanya Sibande1, Dennis Chasweka1, Kate Chidzalo1, Demoubly Kokota1,2 Stephen Lawrie2, and Lucinda Manda-Taylor1
Affiliations:
1.Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Division of Psychiatry, University of Edinburgh, United Kingdom
Email: wsibande@kuhes.ac.mw

Introduction: There is a lack of studies in Malawi on the structured involvement of people with lived experience (PWLE) and their caregivers, particularly because mental illnesses like psychosis remain under-researched and underfunded. Photovoice is a participatory action research method of fostering dialogue about personal experiences by sharing and discussing photographs that may improve our understanding of people living with and caring for people with psychosis in Malawi.
Objectives: We aimed to explore the perceptions and experiences of participants by using photographs to draw attention and generate insights into the challenges they face living with and caring for people with psychosis to identify what people want and need based on participants’ perceptions.
Methods: Ten individuals with lived experience (PWLE) and ten caregivers (n=20) were purposefully selected from communities within Chiradzulu and Salima District who received care from the district hospital. The Photovoice data collection procedure involved Training and Consent and individual and Group Discussions using the SHOWeD, culminating in a stakeholder meeting.
Results: Both people living with psychosis and their caregivers expressed the need for love, care, and psychosocial and clinical support. PWLE specifically highlighted the need for the availability of medicines and easy access to medical facilities. Caregivers highlighted the need to combat stigma and discrimination surrounding psychosis within their communities, coupled with a strong aspiration for self-reliance.
Conclusion: Addressing stigma and discrimination, improving access to treatment and care, and providing emotional support for those affected and impacted by psychosis was a clear outcome of the participatory research. The application of photovoice offered an approach to enhance the awareness and insights of researchers, health providers, and community leaders on ways to support people living with psychosis and their caregivers. Our Collaboration with PLWE and their caregivers was pivotal in our efforts to co-produce knowledge to influence our project’s overall objective.

O39_001858. A TRACER STUDY OF PSYCHOSOCIAL COUNSELLING GRADUATES WORKING IN DIFFERENT HEALTHCARE FACILITIES ACROSS MALAWI
Author(s): Teddie Chima1, Esmie Mkwinda2 and Tendai Machaya3
Affiliation(s):
1.Library, Research and Information Resource Centre, Saint John of God College of Health Sciences, Mzuzu, Malawi
2.Nursing Department, Saint John of God College of Health Sciences, Mzuzu, Malawi
3.Psychosocial counselling Department,
Saint John of God College of Health Sciences, Mzuzu, Malawi
Email: teddiechima@gmail.com

Introduction: Graduate Tracer Studies plays a key role in informing higher education institutions worldwide about the effectiveness of their programs and preparing graduates for the job market. The study aimed to trace its psychosocial counselling graduates working in different healthcare facilities across Malawi. Objectives: The following were the specific objectives of this tracer study: to determine graduates’ satisfaction with the provision of the psychosocial counselling programme at Saint John of God College of Health Sciences, to determine the graduate’s utilization of knowledge and skills acquired at the College in their respective workplaces, to assess the graduate’s employment status after graduating at Saint John of God College of Health Sciences, to identify gaps in the delivery of the psychosocial counselling program at the College and to establish improvement areas on the delivery of psychosocial counselling program at the College.
Methods: The tracer study employed a descriptive cross-sectional research design where the quantitative research method, specifically a survey was used.
Results: Out of 123 participants, 72 responded, yielding a response rate of 59%. Of these, there were 40 (55.6%) females and 32 (44.4%) males. Results indicated strong belief among participants that the program provided them with valuable skills. The majority of graduates reported successful employment outcomes, with an impressive 62 (86.1%) securing jobs, often within a short period. Many participants effectively utilized the knowledge and skills acquired. However, some graduates faced challenges in applying their training. Recommendations for program improvement included the addition of courses. The identified key challenges encompassed low staffing levels and limited resources.
Conclusion: The study confirms program effectiveness based on positive outcomes reported by graduates in job relevance, skill development, and knowledge use. Addressing identified gaps and implementing recommended improvements can enhance graduates’ employability, meet market demands, and improve the mental health services (psychosocial counselling) in Malawi.

O40_002050. ADAPTING THE EVIDENCE-BASED RISE COMMUNITY-BASED REHABILITATION (CBR) MODEL TO ADDRESS THE NEEDS OF PEOPLE LIVING WITH PSYCHOSIS: AN APPLICATION OF THE FIRST THREE STEPS OF ADAPT-ITT IN MALAWI
Author(s): Melissa Stockton1, Brian Pence 1, Bradley Gaynes2, Alex Zumazuma3, Saulos Gondwe4, Joshua Chienda3, Isaac Mtonga3, Mwawi Ng’oma4, Jack Kramer5, Anthony Sefasi6, Harriet Akello Tikhiwa4, Griffin Sansbury4, Abigail Morrison1, Hillary Mortensen1, Jackson Devadas1, and Kazione Kulisewa3
Affiliation(s):
1.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
2.Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
3.Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
4.Saint John of God Hospitaller Services, Lilongwe, Malawi
5.UNC Project- Malawi, Lilongwe, Malawi
6.University of Malawi, Zomba, Malawi”
Email: mastockt@email.unc.edu

Introduction: Psychosis causes severe morbidity and mortality in Malawi, where treatment is limited.
Objective: To adapt a CBR model for psychosis developed in Ethiopia for the Malawian context using ADAPT-ITT
Methods: For steps 1-2, Assess Needs and Intervention Decision, we selected CBR due to its home delivery, integration of family, focus on functional goals and social inclusion, and ability to complement existing services focused on acute symptom reduction. We also conducted in-depth interviews with 12 people with lived experiences (PWLE) with psychosis, 12 family members, 6 medical personnel, and 6 traditional healers and 2 focus groups with community and religious leaders from Blantyre, Malawi. Semi-structured interview guides were grounded in constructivist epistemology while inductive and deductive codes were utilized to analyze the data. For step three (adaptation), we are merging the CBR modules, an existing community mental health nursing manual, a recovery-oriented rehabilitation content, and the qualitative findings to generate a preliminary adapted manual for the adapted CBR treatment model.
Results: The adapted CBR manual includes patient and family psychoeducation and counseling on: clinical psychosis, medication, stigma reduction, recovery, problematic/negative symptoms, function, relationships, and goal setting. It will be delivered by psychiatric nurses in the home.
Conclusion: The ADAPT-ITT framework helps ensure the culturally-appropriate adaptation of evidence-based interventions to support health and recovery of people with psychosis in sub-Saharan Africa.

NON-COMMUNICABLE DISEASES
O41_002040. PREVALENCE AND CLUSTERS OF MULTIMORBIDITY AMONG ADULTS ADMITTED TO HOSPITAL IN MALAWI: PRELIMINARY RESULTS FROM THE MultiLink PROSPECTIVE COHORT STUDY
Author(s): Stephen A Spencer1, Jacob Phulusa1, Florence Malowa1, Beatrice Chinoko1, Slyvester Kaimba1, Lucy Keyala1, Peter Mandala1, Mercy Mkandawire1, Matthew Mlongoti1, Bright Mnesa1, Albert Mukatipa1, Paul Dark2, Stephen Gordon1, Mulinda Nyirenda3, Jamie Rylance1, Ben Morton4, and Felix Limbani1 on behalf of the NIHR Multilink Consortium
Affiliation(s):
1.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, UK
2.University of Manchester, UK
3.Kamuzu University of Health Sciences, Blantyre, Malawi
4.Liverpool School of Tropical Medicine, Liverpool, UK
Email: sspencer@mlw.mw

Introduction: In sub-Saharan Africa, multimorbidity (“co-existence of ≥2 chronic diseases”) is increasing due to high burdens of both infectious diseases and non-communicable diseases). Patients often delay seeking healthcare until they are severely ill, meaning hospitals are key to the diagnosis and management of chronic diseases.
Objectives: The objectives of this study are to describe the prevalence and clusters of multimorbidity among hospitalised adults in Malawi.
Methods: This prospective cohort study was conducted in two hospitals in Malawi; 1) Queen Elizabeth Central Hospital (QECH), Blantyre and 2) Chiradzulu District Hospital, Chiradzulu (CDH). Patients were enrolled within 24 hours of admission with an acute medical problem and consecutively recruited. Participants were screened for HIV, hypertension, diabetes and chronic kidney disease using point-of-care tools. We collected data on other chronic conditions using structured case report forms and from medical notes.
Results: We recruited 700 participants (QECH n=400; CDH n=300). The following prevalences were observed: HIV 245/700 (35%); hypertension 235/700 (34%); diabetes 158/700 (23%); CKD 28/700 (4%). Multimorbidity was identified in 236/700 (34%) of all patients. Stratified by condition, we found multimorbidity in 122/245 (50%) of patients with HIV; 170/235 (72%) with hypertension; 118/158 (75%) with diabetes; 26/28 (93%) with CKD.
Conclusion: We identified a high prevalence (34%) of multimorbidity among patients admitted to medical wards in Malawi. Importantly, between 50-92% patients with HIV, hypertension, diabetes or CKD have multimorbidity. Clinical care that focuses on a single presenting disease risks overlooking multimorbidity. Integrated chronic disease care strategies will be vital to develop resilient health systems and improve patient outcomes.

O42_002205. WAIST CIRCUMFERENCE AND GLYCAEMIA ARE STRONG PREDICTORS OF PROGRESSION TO DIABETES IN INDIVIDUALS WITH PREDIABETES IN SUB-SAHARAN AFRICA: 4-YEAR PROSPECTIVE COHORT STUDY IN MALAWI
Author(s): Wisdom P. Nakanga1,2, Amelia C. Crampin2, Joseph Mkandawire2, Louis Banda2, Rob C. Andrews1, Andrew T. Hattersley1, Moffat J. Nyirenda3,4 and Lauren R. Rodgers5
Affiliation(s):
1.National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, UK,
2.Malawi Epidemiology and Intervention Research Unit (MEIRU), Karonga and Lilongwe, Malawi,
3.London School of Hygiene and Tropical Medicine (LSHTM), London, UK
4.Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
5.Institute of Health Research, University of Exeter Medical School, Exeter, UK

Email: wnakanga@ed.ac.uk
Introduction: Sub-Saharan Africa is projected to have the highest increase in the number of people with diabetes worldwide. However, the drivers of diabetes in this region have not been clearly elucidated. The aim of this study was to evaluate the incidence of diabetes and the predictors of progression in a population-based cohort with impaired fasting glucose (IFG) in Malawi.
Methods: We used data from an extensive rural and urban non-communicable disease survey. One hundred seventy-five, of 389 individuals with impaired fasting glucose (IFG) at baseline, age 48 ±15 years and body mass index 27.5 ±5.9 kg/m2 were followed up for a median of 4.2 years (714 person-years). Incidence rates were calculated, and predictors of progression to diabetes were analysed using multivariable logistic regression models, with overall performance determined using receiver operator characteristics (ROC) curves.
Results: The median follow-up was 4.2 (IQR 3.4 – 4.7) years. Forty-five out of 175 (26%) progressed to diabetes. Incidence rates of diabetes were 62.9 per 1000 person-years 95% CI, 47.0-84.3. The predictors of progression were higher; age (odds ratio [OR] 1.48, P=0.046), BMI (OR 1.98, P=0.001), waist circumference (OR 2.50,P<0.001), waist-hip ratio (OR 1.40, P=0.03), systolic blood pressure (OR 1.56, P=0.01), fasting plasma glucose (OR 1.53, P=0.01), cholesterol (OR 1.44, P=0.05) and low-density lipoprotein cholesterol (OR 1.80, P=0.002). A simple model combining fasting plasma glucose and waist circumference was predictive of progression to diabetes (ROC area under the curve=0.79).
Conclusion: The incidence of diabetes in people with IFG is high in Malawi and predictors of progression are like those seen in other populations. Our data also suggests that a simple chart with probabilities of progression to diabetes based on waist circumference and fasting plasma glucose could be used to identify those at risk of progression in clinical settings in sub-Saharan Africa.

O43_002043. HAND GRIP STRENGTH AND MULTIMORBIDITY AMONG MIDDLE-AGED AND OLDER ADULTS IN LILONGWE AND KARONGA: PRELIMINARY FINDINGS FROM LONG-TERM CONDITIONS SURVEY
Author(s): Owen Nkoka1,2, Kondwani Mwandira1, Shekinah Munthali1, Wiseman Scott1, Albert Dube1, Thandile Gondwe1,3, Stuart R Gray1,4, Alison J Price1,3, Amelia C Crampin1,2,3
1.Malawi Epidemiology and Intervention Research Unit, Malawi
2.School of Health & Wellbeing, University of Glasgow, UK.
3.London School of Hygiene & Tropical Medicine, UK
4.School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
Email: onkoka@gmail.com

Introduction: Handgrip strength is a strong indicator of overall health and a predictor of mortality risk. There is a scarcity of research exploring the association between physical multimorbidity, defined as having ≥2 long-term conditions, and handgrip strength in low-income countries. We examined the association between physical health multimorbidity and handgrip strength within community-dwelling middle-aged and older adults.
Methods: We conducted a cross-sectional analysis of individuals aged ≥40 years, using data from an ongoing Long-Term Conditions Survey conducted in Karonga and Lilongwe. We defined multimorbidity as having ≥2 physical health conditions (diabetes, hypertension, asthma, chronic pain, stroke, HIV, epilepsy, heart disease, and disability). Handgrip strength was measured using a Jamar hydraulic dynamometer. We performed multivariable linear regression to examine the association between physical health conditions and grip strength.
Results: The final sample comprised 4033 individuals (mean age in years 53.7±11.7; 58.6% females; and 88.0% rural dwellers). The age-standardized prevalence of multimorbidity was higher in the urban (15.1%, 95% confidence interval (CI): 13.7% – 16.4%) compared to the rural site (12.4%, 95%CI: 11.8% – 13.0%). After adjustment for potential confounders, compared to those with no long-term physical conditions, having 1, 2, and ≥3 physical health conditions were associated decreasing mean grip strength scores: B coefficient -0.81 (95%CI = -1.36, -0.25), B -2.38 (95%CI = -3.03, -1.74), and B -3.27 (95%CI = -4.20, -2.34), respectively, (trend, p<0.001).
Conclusion: There was a notable inverse relationship between the number of long-term physical health conditions and grip strength, highlighting the increasing debility in older Malawians with common conditions. Our findings underscore the clinical significance of grip strength as a physical performance metric in the assessment and management of individuals with multimorbidity. It has potential and could be evaluated as a simple marker of progression and deterioration of overall physical condition in clinical settings in individuals with multiple conditions.

O44_002108. EXPERIENCES OF PATIENTS WITH CHRONIC RESPIRATORY DISEASE BEFORE AND AFTER PULMONARY REHABILITATION AT A TERTIARY HOSPITAL IN MALAWI: A QUALITATIVE STUDY
Author(s): Fanuel M. Bickton1,2*, Talumba Mankhokwe3, Beatrice Chavula3, Emily Chitedze3, Martha Manda3, Cashon Fombe3, Martha Mitengo2, Langsfield Mwahimba3, Moses Isiagi4, Richard N. van Zyl-Smit4, Susan Hanekom5, Martin Heine6, Harriet Shannon7, Jamie Rylance1, Enock Chisati2, Stephen B. Gordon1, and Felix Limbani1
Affiliation(s):
2.Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Post Office Box 30096, Blantyre, Malawi
3.Department of Rehabilitation Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
4.Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
5.Division of Pulmonology and Department of Medicine, University of Cape Town & Groote Schuur Hospital, South Africa
6.Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, , Cape Town, South Africa
7.Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
8.UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
Email: fbickton@mlw.mw

Introduction: Community-based surveys suggest a substantial burden of chronic respiratory disease (CRD) in the Malawian population, causing significant morbidity and loss of economic productivity. Pulmonary rehabilitation (PR) is a highly advocated non-pharmacological intervention. However, there is scarce data on acceptability in this Malawian population.
Objectives: To explore the experiences of patients with CRD before and after PR at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.
Methods: Fourteen adults (57% female) presenting with functionally limiting CRDs to QECH were invited to participate in a six-week PR program. Following program completion, face-to-face semi-structured in-depth interviews with the participants were conducted. Interviews were audio-recorded and transcribed verbatim. The transcripts were anonymized and thematically analysed using both deductive and inductive approaches.
Results: Ten patients (50% female) participated in the PR program. Their documented respiratory diagnoses included chronic obstructive pulmonary disease (COPD), asthma, post-tuberculosis lung disease, and bronchiectasis. Five key themes emerged: (1) negative experiences of living with a CRD, (2) positive experiences of PR, (3) positive feedback on the conduct of the PR program, (4) suggestions to improve the PR program, and (5) program continuation at home. Participants reported experiencing improvements in physical, psychological, and social health associated with PR program participation. The provision of transport was considered a key facilitator for PR program completion. Realising PR benefits, participants were willing to continue exercising at their homes, albeit with potential barriers including a lack of equipment.
Conclusion: The PR program improved the participants’ perceived health status and was well-accepted. Addressing barriers related to transport facilitated immediate implementation while providing a challenge for the scaling and sustainability of PR beyond the project duration. These findings support the drive for shifting chronic care, including rehabilitation, towards primary care and community.

O45_001916. BARRIERS AND FACILITATORS OF RETURN TO WORK AMONG SURVIVORS OF STROKE AT KACHERE REHABILITATION CENTRE; A QUALITATIVE STUDY
Author(s): Kalavina Reuben1, Chidzani Alex1, Cheha Fatch1, Mwanza Ian1, Majoni Chifuniro1 and Mughogho Anderson1
Affiliation(s):
1.Kamuzu University of health sciences (KUHeS), Blantyre, Malawi
Email: rkalavina@kuhes.ac.mw

Introduction: Stroke is the leading causes of disability and death in Malawi. In 2002 alone, it caused 7200 deaths with a 40,1% mortality rate and 47.6% surviving with severe functional impairments. Stroke survivors experience barriers and facilitators of return to work (RTW) which have been minimally explored.
Objective: The aim of the study was, therefore, to explore the barriers and facilitators of RTW after rehabilitation among stroke survivors at Kachere Rehabilitation Center (KRC) in Blantyre, Malawi.
Methods: This was a qualitative exploratory study designed to explore the barriers and facilitators of RTW among stroke survivors at KRC. A sample of 10 participants was recruited using purposive sampling from a population of stroke survivors who had undergone rehabilitation at KRC from January 2012 to December 2014. Semi-structured in-depth interviews were used to collect data which were analyzed using thematic content analysis.
Results: Stroke survivors fail to RTW due to persisting impairments of hand function, cognitive and urinary functions. Lack of disability friendly public transport contributed to failure to RTW. Lack of tailor made rehabilitation services and complex tasks contributed significantly to failure to RTW. However, having a steady income and family support plus the need to provide for the family especially among bread winners facilitated RTW.
Conclusion: This study highlighted some barriers and facilitators of RTW facing stroke survivors at KRC. There is a need for a complete rehabilitation team inclusive of speech and occupational therapists. In addition, rehabilitation workers need to raise awareness among employers of stroke survivors on the need to modify the work environment physically and socially to facilitate RTW. Furthermore, the study has highlighted that introduction of vocational rehabilitation could facilitate RTW. Adoption of multidisciplinary team in rehabilitation services. Future studies to include large samples and explore both Employers’ and stroke survivor’s perspectives of RTW.

MATERNAL AND CHILD HEALTH 2
O46_001812. PREDICTORS OF EARLY BREASTFEEDING INITIATION IN PRETERM BABIES AMONGST POSTNATAL MOTHERS IN SELECTED HEALTH FACILITIES OF MANGOCHI DISTRICT, MALAWI
Author(s): Mercy Paundi Kulanga1, Chimwemwe Selemani2 and Lily Kumbani2
Affiliation(s):
1.Ministry of health, Mangochi District Health Office, Mangochi
2.Kamuzu University of Health Sciences, Malawi
Email: mercykulanga87@gmail.com

Introduction: Early breastfeeding initiation (EBI) is the breastfeed that is received by the baby within the first hour of birth. It is recommended to reduce infant mortality and illnesses. Objective: The study aimed to determine the Predictors of early breastfeeding initiation in preterm babies amongst postnatal mothers in selected health facilities of Mangochi, Malawi.
Methods: A cross sectional quantitative study was carried out amongst mothers with preterm babies using a WHO validated questionnaire. Three level multistage sampling technique was used. The study was conducted in five zones of the district. The facilities and participants were selected using Simple Random Sampling Technique. The total number of participants were 176. Data was collected for a period of six months and was analysed using Stata version 14.2
Results: 176 mothers with preterm babies participated in this study. The prevalence of early breastfeeding initiation in preterm babies was 33.5% (n=66). In simple logistic regression analyses; delivering through ceasarian section (OR=2.56, 95% CI:1.11-5.91, P = 0.020), health care worker support on EBI (AOR=2.59, 95% CI:1.16-5.76, P = 0.020), emphasis on health talk element on EBI (AOR=2.83, 95% CI:1.04-5.46, P = 0.040) were associated with early breastfeeding initiation. Moreover, baby’s condition at birth (AOR=0.05, 95% CI:0.01-0.19, P = 0.000), type of skilled birth attendee at birth (OR=5.14, 95% CI: 1.89-13.98, P = 0.000), mothers’ complication at birth (AOR=0.11, 95% CI:0.42-0.30, P = 0.000) showed a significant correlation.
Conclusion: In this study, only 3 in every 10 babies were breastfeed within one hour of birth. The risk factors were ceasarian section delivery, neonatal and maternal complications. This concludes that interventions targeting an improvement in early breastfeeding initiation must aim at women who deliver through caesarean section, women and neonates with complications.

O47_002137. ASSESSING FACTORS THAT FACILITATE PARTICIPATION OF CAREGIVERS IN THE TREATMENT OF PRETERM NEONATES ON BUBBLE CONTINUOUS POSITIVE AIRWAY PRESSSURE
Authors: Evetta Chisope1, Linda Nyondo Mipando1, and Dominic Nkhoma1
Affiliations:
1.Kamuzu University Health Sciences
Email: echisope@gmail.com

Introduction: More than 60% of all pre-term births globally occur in Africa and Asia. In Sub-Saharan Africa, 12.3% of births are pre-term. Malawi has the highest burden in the world at 18% of its total births. In the 2020 fiscal year, for instance, Mangochi District Hospital (MDH) registered 333 pre-term births against 11,098 births. Many pre-term birth survivors suffer lifetime disabilities, visual and hearing problems. Nevertheless, the participation of caregivers in the care of preterm neonates, as recommended by WHO, can lead to better neonatal outcomes.
Objective: To ascertain factors influencing the participation of caregivers in the treatment of preterm neonates on Bubble Continuous Positive Airway Pressure (bubble CPAP).
Methods: We conducted a cross-sectional study at Mangochi District Hospital Nursery employing a qualitative design. Participants were purposively recruited in the study. We conducted indepth interviews, focus group discussions and non-participant observation to achieve the objective of the study. Ethical approval was sought from College of Medicine Research and Ethics Committee and Mangochi District Hospital Research Committee was also informed of the study.
Results: The study revealed that support from healthcare workers, nursery policies, good prognosis of neonates and cultural factors influenced caregiver participation in care. On the other hand, lack of health education from health care providers and poor attitude among health care providers, nursery policies that facilitated the separation of caregivers from babies and mobility of baby coats limited participation of caregivers in care.
Conclusion: Incorporating caregivers in the treatment of preterm neonates while receiving bubble CPAP in the nursery is an effective and cost-saving intervention that contributes to positive neonatal and parental outcomes. The study highlighted different factors that facilitate caregiver participation and its barriers from their perspective. The results inform of the strategies that health care providers can utilise to promote caregivers’ participation in care.

O48_001820. FACTORS ASSOCIATED WITH TREATMENT OUTCOMES OF SEVERE ACUTE MALNUTRITION AMONG UNDERFIVE CHILDREN ADMITTED AT QUEEN ELIZABETH CENTRAL HOSPITAL (QECH) NUTRITION UNIT: A RETROSPECTIVE CROSS-SECTIONAL STUDY
Author(s): Mirriam Ndhlovu1
Affiliation(s):
1.Department of public health and family medicine, Kamuzu University of health sciences, Blantyre, Malawi
Email: miriamndhlovu7@gmail.com

Introduction: SAM affects 17 million under five children globally of which 4.4million are from Sub-Saharan Africa. About 1 million SAM children die every year. Despite Malawi’s efforts to reduce child mortality, inpatient mortality among SAM children has remained high. Objective: This study was aimed to assess factors associated with treatment outcomes among SAM children aged 1 to 59 months admitted at QECH.
Methods: This was a retrospective cross-sectional study. The study population was all malnourished children aged 1 to 59 months admitted at QECH NRU from 2017 to 2020. Systematic random sampling was done from admissions between 2017 to 2020 with equal numbers amongst those that died and those discharged alive.
Results: About 21% SAM children died, 77% were transferred to OTP and 2% defaulted. Characteristics associated with mortality were stopping breastfeeding [ARRR 3.2, (95% CI: 1.1-9.4), Pneumonia [ARRR 3.2,(95% CI: 1.2 – 8.5)], dehydration [ ARRR 6.9,( 95% CI:2.1 -23)], sepsis [ ARRR 2.9,( 95% CI: 1.2-7.1)], unknown breastfeeding status [ ARRR 14.4, (95%CI: 2.3-88.7)] and unknown hypoglycemia status in the ward [ARRR 0.04, (95% CI: 0.01-0.1)]. Characteristics associated with default were oedema[ ARRR 13.5,( 95% CI: 1.6-113)] and dehydration ARRR 12.3, (95% CI: 1.2 – 130)]. Predictors of mortality were unknown hypoglycemia status in the ward [AHR 0.18,( 95% CI: 0.09-0.35)], unknown HIV status [ AHR 6.7,(95% CI 1.1- 41.8)], Hypothermia [ AHR 2.9, (95% CI:1.4 -6.25)], stopping breastfeeding [ AHR 2.2, (95% CI:1.03-4.5)], unknown breastfeeding status [AHR5.9, (95% CI: 2.5 -14.3)], poor appetite on admission [ AHR 1.9, [95% CI: 1.1-3.3)] , and TB[ AHR 0.5,(95% CI: 0.3-0.97)].
Conclusion: Mortality was high among SAM children admitted at QECH NRU. Early detection of life threatening conditions, timely management of associated medical comorbidities and adhering to WHO SAM inpatient management protocols might be effective in reducing SAM case fatality estimates.

O49_002215. REDUCING RISK OF DEHYDRATION FROM DIARRHEA (DRINK): COMPARING TREATMENT OUTCOMES OF A FLAVORED LOW OSMOLALITY ORS WITH THE CURRENT WHO STANDARD IN CHILDREN UNDER FIVE
Author(s): Towela Maleta1, Jobiba Chinkhumba1, and MacPherson Mallewa1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: toweramaleta@gmail.com

Introduction: Oral rehydration solution, an effective and safe therapy for diarrhoea and dehydration has been reformulated a few times since its adoption 1978. Yet diarrhea persistently ranks among the three leading causes of deaths among children under five globally. This study purposed to assess non inferiority of Drip Drop ORS which has a lower osmolality and a taste comparable to fruit juices to the current WHO ORS. The goal was to enhance compliance.
Objectives: Compare treatment success, rehydration efficiency and ease of uptake.
Methods: Open labelled randomized controlled trial. Children were assigned to intervention or control using random codes. Children without dehydration were given sachets amounting to 2 liters ORS and returned for review 48 hours later. Children with some dehydrations were treated and monitored hourly till discharge at 4 hours if satisfactory. Caregivers rated ease of uptake on a scale.
Results: All children without dehydration and most (92%) with some dehydration from both arms recovered well. Treatment failure was comparable (p value 0.913). All children in the intervention group had calmed down at the 1st hour compared to the control where 19% were still restless (p value 0.087). The number of children with poor skin turgor also declined by 7 percentage points from 13% on admission to 5.88% compared to 1.3 percentage points from 7% to 5.66% in the control, p value 0.036. In addition, 83% of children in the intervention group were classified as improved compared to 69% in the control. Up to 77% caregivers felt their children took ORS easily compared to 64% among the control group.
Conclusion: Treatment success was comparable between the two ORSs concluding that drip drop ORS is not inferior the current WHO ORS standard. It also seemed to easier to take and restored hydration more efficiently. This may improve compliance and caregiver attitudes.”

O50_002086. DEVELOPING A MICRONISED NASAL SUSPENSION OF PHENOBARBITAL FOR USE IN EPILEPTIC PAEDIATRICS.
Author(s): Wyson Gostino1, and Peter Kumpalume1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: pkumpalume@kuhes.ac.mw

Introduction: Epilepsy is one of the most common neurological disorders affecting over 50 million people worldwide, 80% of which live in Low and Middle Income countries (LMICs) including Malawi. The vast majority of cases are children and in 65% are below 18 years of age. The main medication is phenobarbital which is mostly available as a 30mg tablet. With the The recommended dose being 2.5-5mg/kg, administration to children as the guardian is expected to break the tablet to administer the medicine at home. Since the vast majority of the population is semi-literate, effective administration of phenobarbital is a challenge. Thus a child friendly formulation is required.
Objectives: Our objective was to create a stable, micronized nasal-suspension of phenobarbital with desirable physcochemical characteristics and capable of delivering a dose conveniently suitable for children.
Methods: Phenobarbital API was isolated using solvent-solvent extraction methods and formulated into a suspension GRAS components (Generally Regarded As Safe). Internally developed formulation was selected to maximise absorption via nasal administration. The concentration of the API in the suspension was 25mg/ml. The suspensions were then dispensed into a spray bottle. The volume of the spray and the amount of API in each spray was measured using an analytical balance and HPLC respectively.
Results: We have created a micronized nasal suspension with desirable characteristics. The suspension does not cake and once suspended remains fully suspended for over a minute, giving the operator enough time to draw a dose. A single spray (a puff) delivers 100 microliters of the suspension. Based on the concentration each spray was designed to deliver 2.5mg of the API. HPLC analysis of the samples showed each spray delivered 2.4-2.7 mg of API. With this formulation it is possible to deliver conveniently a dose of phenobarbital to paediatrics without flooding the nose.
Conclusion: Conduct PK/PD experiments to confirm bioavailability and bioequivalence. There is need to optmise concentration and decide on the final bottle configuration to optmise dose in each puff.

NEGRECTED TROPICAL DISEASES
O51_002029. PREVALENCE OF SCHISTOSOME HYBRIDS IN SAMAMA, MANGOCHI AND MTHAWIRA, NSANJE COMMUNITIES.
Author(s): David Lally1, Priscilla Chammudzi1, Donales Kapira1, Gladys Namacha1, Alexandra Juhasz2, Sam Jones2, Sekeleghe Kayuni1,2, Peter Makaula1, Janelisa Musaya1, and Russell Stothard2
Affiliation(s):
1.Malawi Liverpool Wellcome Research Programme
2.Liverpool School of Tropical Medicine
Email: dlally@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 drag administration targeting humans. However, for the first time in Malawi 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 schistosome hybrids in human hosts and to isolate parasites of medical importance.
Objectives: To determine prevalence of urogenital schistosomiasis and assess if the proportion of S. haematobium hybrids are uniform across the two communities of Nsanje and Mangochi districts.
Methods: Urine samples were collected from study participants and analysed to determine schistosomiasis infection by filtration of 10ml urine and viewed under microscope to visualize eggs. Filters from positives samples were then placed in water to facilitate hatching of the eggs, with the miracidia collected onto FTA paper for sequencing using novel qPCR assay.
Results: Prevalence of schistosomiasis was found to be 41.3% (n=2271) in 2022 and 44.2% (n=2006) in 2023. The overall prevalence of hybrid infections in 2022 was 7% (n=938), with Mangochi accounting for 5.2% and Nsanje 1.8%. Preliminary results from analysis of 2023 samples are projecting prevalence levels of hybrid infections.
Conclusions: Our findings suggest a possibility of hybrids originating in humans of zoonotic spill over 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.

O52_002203. DISTRIBUTION OF SCHISTOSOME HYBRIDS IN SNAIL VECTORS AND ANIMAL RESERVOIRS IN SOUTHERN MALAWI
Author(s): Priscilla Chammudzi1, Donales Kapira1, David Lally1, Gladys Namacha1, Alexandra Juhasz2, Sam Jones2, Sekeleghe Kayuni1,2, Peter Makaula1, Janelisa Musaya1,3, and Russell Stothard2
Affiliation(s):
1.Malawi Liverpool Wellcome Research Programme
2.Liverpool School of Tropical Medicine
3.Kamuzu University of Health Sciences
Email: pchammudzi@mlw.mw
Introduction: The hybridization in urogenital schistosomiasis (HUGS) is a longitudinal population study aiming to investigate transmission biology and epidemiological impact of Schistosoma haematobium-hybrids in Malawi. About 80% of 17 million Malawian population are at-risk of schistosomiasis. Schistosoma haematobium is dominant in humans while S. matthei and S. bovis are animal infecting species. We carried out surveys on intermediate snail hosts and animals (cattle and goats) to investigate the environmental transmission dynamics of schistosome hybrids in Mangochi and Nsanje.
Objectives: To investigate the environmental factors for the intermediate hosts of Schistosoma spp. To conduct periodic surveillance in livestocks (cattle and goats) to determine prevalence of hybrid infections.
Methods: Environmental snail surveys were conducted at 12 sites in Mangochi (7), Chikwawa (2) and Nsanje (3). Collected snails were screened for shedding cercariae. Cercariae shed from Bulinus were screened for evidence of introgressive hybridisation using a novel real-time PCR High Resolution Melt (HRM). For animal survey, we collected postmortem samples to check for adult worms in veins and hatching of miracidia from fecal material from livestock.
Results: Bulinus and Biomphalaria snails were found at 11 (91.7%) of the 12 sites in Mangochi and Nsanje. S. haematobium cercariae found to be shed at two sites, one at lakeshore in Mangochi, and one on Shire River. Schistosoma mattheei found in shedding snails from two sites, one the same lakeshore site where S. haematobium was found, and at another in a lagoon next to lake with small stream feeding into lake. Bovine schistosomiasis is common (Mangochi 67% n=120, Nsanje 28% n=120). Goat schistosomiasis less common (Mangochi 33% n=80, Nsanje 0% n=40). DNA tests show 2 of 403 samples from 102 cattle show likely hybrids.
Conclusions: Our preliminary findings suggest a possibility of hybrids originating in humans of zoonotic spillover from livestock populations, where schistosomiasis is co-endemic.”

O53_001845. BURDEN OF GENITAL SCHISTOSOME HYBRID INFECTIONS AND ASSOCIATED DISEASES IN NSANJE AND MANGOCHI DISTRICTS. A CASE REPORT ON 33-YEAR-OLD FGS PARTICIPANT.
Author(s): Sekeleghe Kayuni1,2, Dingase Kumwenda1,2, Bright Mainga1, David Lally Jnr1, Priscilla Chammudzi1, Donales Kapira1, Gladys Namacha1, Alice Chisale1, Tereza Nchembe1, Luis Kinley1,3, Ephraim Chibwana1,3, Alexandra Juhasz2, Sam Jones2, Peter Makaula1, Janelisa Musaya1,4, Russell Stothard2
Affiliation(s):
1.Malawi Liverpool Wellcome Programme,
2.Liverpool School of Tropical Medicine
3.Queen Elizabeth Central Hospital
4.Kamuzu University of Health Sciences
Email: skayuni@mlw.mw

Introduction: Genital schistosomiasis remains an often-overlooked chronic consequence of urogenital schistosomiasis in the genital system of afflicted men and women. Moreover, this has not been fully described in hybrid infection, an emerging public health concern in endemic areas. As part of a 2-year longitudinal study on Hybridization of UroGenital Schistosomiasis (HUGS), we conducted a sub-study to describe the morbidity associated schistosome hybrid infections in the male and female genital systems.
Objectives: To assess the prevalence of male and female genital schistosomiasis (MGS and FGS) associated with schistosome hybrids and co-infections among adults in two communities of Nsanje and Mangochi districts. Also, the study described the history, diagnosis and management of the infected participants.
Methods: Urine, cervicovaginal fluid and swabs, as well as semen samples were collected from study participants and analysed to determine schistosome infection by filtration and microscopy of the 10ml urine and microscopy of the sediments from the centrifuged cervicovaginal lavage and semen, to visualise the Schistosoma eggs. Samples also underwent molecular analysis using novel qPCR assay. Portable colposcopy and histopathology were also conducted. FINDINGS: 23 men and 87 women were recruited into the MGS-FGS sub-study. In Nsanje, 44.4% men (n=9) and 65.5% women (n=29) had MGS and FGS on qPCR respectively while in Mangochi, 85.7% men (n=14) and 48.3% women (n=58) had MGS and FGS respectively. Among the women, 2 in Nsanje and 7 in Mangochi were co-infected with an STI, Trichomonas vaginalis. A 33-year-old lady, FGS positive on colposcopy, microscopy and histopathology, was negative on qPCR.
Conclusions: Our findings indicate that genital consequences of schistosomiasis are prevalent which could pose a further challenge in control interventions being implemented by the National Control Program in the Ministry of Health. In addition, it could increase the risk of other infections like STIs and HIV in the country.

O54_001995. FIRST REPORT OF THE INTERMEDIATE HOST SNAIL FOR SCHISTOSOMA MANSONI, BIOMPHALARIA PFEIFFERI, IN THE LOWER SHIRE, SOUTHERN MALAWI
Author(s): Clinton Nkolokosa1, Rex Mbewe1,2, James Chirombo2, Michelle Stanton2, Christopher M. Jones2, Peter Makaula1, Gladys Namacha1, Blessings Chiepa1, Patrick Ken Kalonde1,2, Chifuniro Baluwa1, Kennedy Zembere1, Aisha Kambewa1,2, Chikumbusko Chiziwa Kaonga3, John Archer2, Alexandra Juhaz2, Lucas Cunningham2, Julie-Anne Akiko Tangena2, and Russell Stothard2
Affiliation(s):
2.Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
3.Liverpool School of Tropical Medicine, Liverpool, UK
4.Malawi University of Business and Applied Science, Blantyre, Malawi
Email: cnkolokosa@mlw.mw

Introduction: Biomphalaria pfeifferi (Gastropoda: Planorbidae) is a freshwater snail of medical importance. The Biomphalaria snails serve as the intermediate host of Schistosoma mansoni, blood flukes that cause intestinal schistosomiasis in humans.
Methods: A time-based malacological survey was conducted in Chikwawa and Nsanje districts of lower Shire. Data on occurrence and abundance of Biomphalaria pfeifferi snails, conductivity, pH, temperature and total dissolved solids (TDS) of water and elevation were obtained across 45 sampled semi-aquatic habitats. Subsequently, B. pfeifferi presence or absence was predicted using the physicochemical and environmental conditions in a random forest classification to determine the abiotic factors associated with their occurrence. Furthermore, the rDNA sequences of the detected B. pfeifferi were obtained for further identification.
Results: We established the presence of B. pfeifferi populations in Chikwawa. Primary finding from the Templeton Crandall and Sing network is that the Chikwawa District haplotype is identical to one haplotype also found in Mangochi District (GenBank Accession number: OQ216746) as well as Zimbabwe (GenBank Accession number: MG780180). This suggests introduction into Chikwawa may have come from either Mangochi District or Zimbabwe. Primary finding from molecular xenomonitoring screen suggests that S. mansoni may be being transmitted in this area, however larger-scale assessment is needed. Among the explanatory variables, conductivity and TDS of water and elevation were more important in increasing accuracy of the prediction model.
Conclusion: The results suggest that B. pfeifferi spatial presence across lower Shire is influenced strongly by conductivity, TDS of water, and elevation. Temperature and pH of water play a slightly less significant role in mediating the occurrence of B. pfeifferi occurrence in the lower Shire. Ascertaining the whereabouts and understanding the environmental determinants of B. pfeifferi occurrence in the lower Shire are critical steps in the implementation or redesign of appropriate and effective focal intestinal schistosomiasis control strategies.

O55_002249. TRANSCRIPTOME PROFILES OF T.B. RHODESIENSE IN MALAWI REVEAL FOCUS SPECIFIC GENE EXPRESSION PROFILES ASSOCIATED WITH PATHOLOGY.
Author(s): Peter Nambala1,2, Harry Noyes3, Joyce Namulondo4, Oscar Nyangiri4, Enock Matovu4, Vincent Pius Alibu4, Barbara Nerima1, Annette MacLeod5, Janelisa Musaya2 and Julius Mulindwa1 on behalf of the TrypanoGEN+ Research Group as Members of the H3Africa Consortium.
Affiliation(s):
1.Department of Biochemistry and Sports Sciences, College of Natural Sciences, Makerere University, Kampala, Uganda.
2.Kamuzu University of Health Sciences, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
3.Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom.
4.Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
5.Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom.”
Email: pnambala@mlw.mw

Background: Sleeping sickness caused by T.b. rhodesiense is a fatal disease and endemic in Southern and Eastern Africa. There is an urgent need to develop novel diagnostic and control tools in order to achieve elimination of rhodesiense sleeping sickness which might be achieved through a better understanding of trypanosome gene expression and genetics using endemic isolates. Here, we describe transcriptome profiles and population structure of endemic T. b. rhodesiense isolates in human blood in Malawi.
Methodology: Blood samples of r-HAT cases from Nkhotakota and Rumphi foci were collected in PaxGene tubes for RNA extraction before initiation of r-HAT treatment. 100 million reads were obtained per sample, reads were initially mapped to the human genome reference GRCh38 using HiSat2 and then the unmapped reads were mapped against Trypanosoma brucei reference transcriptome (TriTrypDB54_TbruceiTREU927) using HiSat2. Differential gene expression analysis was done using the DeSeq2 package in R. SNPs calling from reads that were mapped to the T. brucei genome was done using GATK in order to identify T.b. rhodesiense population structure.
Results: 24 samples were collected from r-HAT cases of which 8 were from Rumphi and 16 from Nkhotakota foci. The isolates from Nkhotakota were enriched with transcripts for cell cycle arrest and stumpy form markers, whereas isolates in Rumphi focus were enriched with transcripts for folate biosynthesis and antigenic variation pathways. These parasite focus-specific transcriptome profiles are consistent with the more virulent disease observed in Rumphi and a more silent disease in Nkhotakota associated with the non-dividing stumpy form. Interestingly, the Malawi T.b. rhodesiense isolates expressed genes enriched for reduced cell proliferation compared to the Uganda T.b. rhodesiense isolates. PCA analysis using SNPs called from the RNAseq data showed that T. b. rhodesiense parasites from Nkhotakota are genetically distinct from those collected in Rumphi.
Conclusion: Our results have added new insights on how clinical phenotypes of r-HAT in Malawi might be associated with differences in gene expression profiles and population structure of T. b. rhodesiense from its two major endemic foci of Rumphi and Nkhotakota.

VACCINES
O56_001836. MEASURING THE EFFECTIVENESS AND IMPACT OF TYPHOID CONJUGATE VACCINE IN MALAWI
Author(S): Priyanka D. Patel1, Latif Ndeketa1,2, Amanda J. Driscoll3, Theresa Misiri1, Felistas Mwakiseghile1, Richard Wachepa1, Happy Banda1, Yuanyuan Liang3, Marc Henrion1,4, Shrimati Datta3, Neil French2, Kathleen M. Neuzil3 and Melita A. Gordon1,2
Affiliation(s):
1.Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
2.University of Liverpool, United Kingdom
3.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
4.Liverpool School of Tropical Medicine, Liverpool, UK
Email: ppatel@mlw.mw

Introduction and objective: Typhoid Conjugate Vaccine (TCV) has demonstrated robust efficacy in randomized controlled trials in low- and middle-income countries (LMICs), including Malawi. Liberia and Zimbabwe became the first sub-Saharan African countries to introduce TCV (Typbar-TCV) in April and May of 2021, respectively. In May 2023, Malawi became the third African country to introduce TCV and the first to use TyphiBev in Africa. We aim to measure the effectiveness and impact of TCV after introduction in a typhoid-endemic sub-Saharan African setting to demonstrate the safety and effectiveness of TCV are consistent with the clinical trial results, and to inform policy decisions across Africa.
Methods: We are conducting passive surveillance in Ndirande and Zingwangwa townships. Children and adults aged 9 months to 45 years presenting with febrile illness (subjective fever for ≥72 hours, axillary temperature ≥38°C, or hospitalization with a history of fever), have blood collected for culture. Vaccine effectiveness will be measured using a test-negative study design, and impact assessed using an analysis of incidence before and after the vaccine campaign.
Results: Between 18 April 2022 and 31 May 2023, 121,864 participants were screened during passive surveillance, 3646 were enrolled, and 3603 blood cultures taken. The results showed 148 cases of Salmonella Typhi and 11 cases of Salmonella Typhimurium. Among the cases, 99% were multidrug-resistant, 2.03% were fluoroquinolone-resistant, and only 1% were fully susceptible to first-line antibiotics. A total of 61% of these cases occurred in children eligible for the national vaccine campaign (09 months to 15 years), which occurred in May 2023; the rest occurred in non-vaccine-eligible older individuals. This study data includes one year of surveillance before the campaign, alongside multi-year baseline surveillance data from the Malawi Liverpool Wellcome Programme, the Strategic Alliance Across Africa and Asia (STRATAA) and the Typhoid Vaccine trial in Malawi.
Conclusion: This study will demonstrate real-life effectiveness and impact of TCV in an endemic setting. Pre-campaign baseline data consistently suggests ongoing high incidence and transmission. Surveillance continues after the TCV campaign, and current data will be reported. Vaccine effectiveness and impact in Malawi will provide important information across Africa.

O57_002006. AN EVALUATION OF ADVERSE EVENTS FOLLOWING IMMUNIZATION FOLLOWING AN INTEGRATED IMMUNIZATION CAMPAIGN WITH TYPHOID CONJUGATE, BIVALENT POLIO, AND MEASLES RUBELLA VACCINES IN MALAWI
Author(s): Kondwani Mmanga1, Lapani Chisi Ngala1, Rhoda Chado2, Brenda Mhone2 and Mike Chisema2
Affiliation(s):
1.African Field Epidemiology Network, Malawi
2.Ministry of Health, Expanded Program on Immunisation
Email: kondmmanga@gmail.com

Introduction: In May 2023, Malawi conducted an integrated vaccination campaign (IVC) with Typhoid Conjugate (newly introduced), bivalent Polio, and Measles Rubella vaccines targeting 9 million children aged 0 months to 15 years. Despite, vaccines being safe and effective, during mass campaigns, due to increased number of doses administered over a short time and vaccination of an older, wider age group, there is a perception of increased Adverse Events Following Immunisation (AEFI) reports. This may be due to large number of doses used, requirements for large number of healthcare workers, and chances of usage of untrained personnel as well as vaccination in non-ideal settings. Therefore, EPI requested an evaluation of AEFIs following IVC.
Objective: This article describes Malawi’s experience on AEFI reporting during IVC.
Methods: We reviewed various materials, which included AEFI reporting forms, AEFI investigation forms, AEFI line listing forms, and Google sheets data, which was used to report coverage data for the IVC.
Results: Passive surveillance detected 48 suspected cases of AEFIs from all 29 districts during IVC. Most frequent events were body rash (17.0%) and Fever (14.9%). Overall, 88.3% reported AEFIs, were non-serious, with all cases fully resolved without long-term sequelae. Majority (75.0%) of serious AEFIs were investigated within 7 days of being reported. Most suspected AEFIs were among those who received TCV only (50.0%). The national incidence of suspected AEFI per 100,000 vaccinated children was 0.66.
Conclusion: Adequate AEFI reporting, Investigation, and management remain important in managing risk of disruption of mass campaigns. Most reported AEFIs were conditions that commonly occur after other childhood vaccinations or independently of vaccination, and in regard to careful monitoring for serious AEFI, there is need for timely causality assessment. In general, these results support the good safety profile of the vaccines provided during IVC and provide reassuring data as TCV’s use expands.

O58_002216. OFF-TARGET EFFECTS OF NEONATAL LIVE-ATTENUATED ROTAVIRUS (RV3-BB) VACCINATION ON INNATE IMMUNE RESPONSES: IMPLICATIONS FOR INFANT PROTECTION AGAINST HETEROLOGOUS PATHOGENS
Author(s): Prisca Benedicto-Matambo1,2,3, Julie Bines7,8, Iain Robertson4, Amanda Handley7,8, Ann Turner3, Jonathan Mandolo2, James Chirombo2, Chikondi Malamba-Banda1,2,3, Desiree Witte1, Kondwani.C. Jambo1,2,9, Nigel.A. Cunliffe1,3, Miren Iturriza-Gomara3, Katie.L. Flanagan4,5,6, and Khuzwayo.C. Jere1,2,3
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Medical Laboratory Sciences, Blantyre, Malawi
2.Malawi-Liverpool Wellcome Research Programme, Blantyre, Malawi
3.University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
4.University of Tasmania, Tasmania, Australia
5.RMIT University, Melbourne, Australia
6.Tasmanian Vaccine Trial Centre, Launceston, Tasmania
7.Murdoch Children’s Research Institute, Melbourne, Australia
8.University of Melbourne, Melbourne, Australia
9.Liverpool School of Tropical Medicine, Liverpool, UK”
Email: pmatambo@kuhes.ac.mw

Introduction: Traditionally, vaccines are designed to induce specific immunity against their targets. In the recent years, however, this paradigm has shifted. Live vaccines appear to be able to induce non-specific effects (off-target effects) beyond their intended targets through modulation of innate immune system. This results in altered cytokine responsiveness upon stimulation with unrelated antigens.
Objective: We examined whether administration of a neonatal live-attenuated rotavirus vaccine (RV3-BB) would influence changes in natural killer cell proportions and modulate cytokine responsiveness to heterologous and toll-like receptor agonists.
Methods: 250 participants comprising of vaccine naïve (58) and RV3-BB vaccinated neonates (192) from Blantyre, Malawi were recruited into the study. We conducted 20hr stimulation assays on cordblood(baseline) and whole blood (Week 6) with heterologous(non-specific) pathogens (Streptococcus pneumoniae, Staphylococcus aureus, heat killed monocytogenes=HKLM) and toll-like receptor agonists (lipopolyssacharide=LPS and CLO75). We measured 6 cytokines (IFN-g, TNF-A, IL-1B, IL-6, IL-12(p70) and IL-10) using customised multiplex kit. Natural killer cells (CD56BrightCD16-, CD56Bright-CD16dim, CD56DimCD16-, CD56DimCD16+) were measured using flow cytometry. Analysis was performed using graphpad, R and stata.
Results: RV3-BB vaccinated infants showed greater IL-1B response to S. pneumoniae(p=0.024), and CLO75(p=0.010) relative to vaccine naïve infants. Additionally, RV3-BB vaccination was associated with enhanced IFN-g response to HKLM(p=0.043), LPS(p=0.004) and CLO75(0.043). Reactivity to S.aureus also induced higher IL-6 (p=0.041) and TNF-A(p=0.022) in the vaccinated cohort. Notably, IL-10 was enhanced in response to S. pneumoniae(p=0.024) and LPS(p=0.033). Flow cytometry analysis identified elevated CD56brightCD16dim NK population (dominant cytokine producing NK cells) in RV3-BB vaccinated group(p=0.047).
Conclusion: We report RV3-BB associated off-target effects as demonstrated by enhanced pro-inflammatory cytokine responsiveness (IFN-g, IL-1B, TNF-A, IL-6) to heterologous antigens along with increased CD56brightCD16dim cells. The simultaneously enhanced IL-10 reactivity in RV3-BB recipients would potentially allow for better control of the inflammatory response. This study is the first to demonstrate heterologous innate immunomodulatory effects following rotavirus vaccination in any human population.

059_002034. EFFECT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE ON EXPERIMENTAL CARRIAGE OF STREPTOCOCCUS PNEUMONIAE SEROTYPE-6B IN BLANTYRE, MALAWI: A RANDOMISED CONTROLLED TRIAL AND CONTROLLED HUMAN INFECTION STUDY
Author(s): A.E. Chirwa1†, D. Dula1, B. Morton1,2,3, T. Chikaonda1, E. Nsomba1, V. Nkhoma1, C. Ngoliwa1,4, S. Sichone1, B. Galafa1, G. Tembo1, M. Chaponda1, N. Toto1, R. Kamng’ona1, L. Makhaza1, A. Muyaya1, F. Thole1, E. Kudowa1, A. Howard2, T.K. Nyazika2, J. Ndaferankhande1, C. Mkandawire1, G. Chiwala1, L. Chimgoneko1, N.P.K. Banda1,4,5, J. Rylance1, D. Ferreira2,6, K. Jambo1,2, M.Y.R. Henrion1,2, S.B. Gordon1,2 , on behalf of the Malawi Accelerated Research in Vaccines, Experimental and Laboratory Systems (MARVELS) consortium
Affiliation(s):
1.Malawi Liverpool Wellcome Programme (MLW) Malawi Accelerated Research in Vaccines by Experimental and Laboratory Systems (MARVELS)
2.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
3.Critical Care Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
4.Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
5.School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
6.Department of Paediatrics, University of Oxford, Oxford, UK
Email: aechirwa1@gmail.com

Introduction: Effectiveness of PCV-13 in Malawi is threatened by high persistent vaccine-type pneumococcal carriage. Pneumococcal carriage is a precursor for disease and transmission. There is need to re-appraise vaccination strategies in endemic settings using acceptable and efficient methods to enhance vaccine relevance. For the first time in Africa, PCV-13 efficacy against experimental pneumococcal carriage has been demonstrated in a controlled human infection model (CHIM) (https://doi.org/10.1016/S2666-5247(23)00178-7).
Methods: 204 participants were inoculated with serotype 6B one-month post PCV-13 vaccination. Participants were monitored for safety. Nasal wash was collected on days 2, 7 and 14 post-inoculation. Experimental carriage was determined by culture. Immunological correlates of protection against carriage in nasal and systemic milieu were explored.
Results: 204 participants completed the study; 98 PCV-13, 106 placebo. Carriage rates were lower in vaccine group at all three inoculation doses (0 of 21 vs 2 [11%] of 19 at 20000 CFUs; 6 [18%] of 33 vs 12 [29%] of 41 at 80 000 CFUs, and 4 [9%] of 44 vs 16 [35%] of 46 at 160 000 CFUs. The overall carriage rate was lower in vaccine compared with placebo group (10 [10%] of 98 vs 30 [28%] of 106; unadjusted p-value=0·0013). Vaccine efficacy against carriage was estimated at 62%, 95% confidence interval [28%, 80%]. There were no severe adverse events related to vaccination or inoculation.
Conclusion: PCV-13 is protective against experimental pneumococcal carriage providing reassurance for potential herd immunity. Compared to similar work, such as the Liverpool experimental human pneumococcal carriage model, the vaccine efficacy was lower in Malawi than in Liverpool (62% versus 78%). Reasons for this, including correlates of protection can now be explored.

O60_001914. EXPERIMENTAL HUMAN PNEUMOCOCCAL CARRIAGE IN PEOPLE LIVING WITH HIV (PLHIV); RECRUITMENT LESSONS, EXPERIENCES AND PRELIMINARY FINDINGS FROM THE FIRST CONTROLLED HUMAN INFECTION MODEL IN PLHIV
Author(s): A.E. Chirwa1, K. Doherty1, D. Dula1, T. Chikaonda1, E. Nsomba1, V. Nkhoma1, C. Ngoliwa1,4, S. Sichone1, B. Galafa1, G. Tembo1, M. Chaponda1, N. Toto1, R. Kamng’ona1, L. Makhaza1, A. Muyaya1, F. Thole1, E. Kudowa1, J. Ndaferankhande1, C. Mkandawire1, G. Chiwala1, L. Chimgoneko1, N.P.K. Banda1,3,4, D. Ferreira2,5, K. Jambo1, 2, M.Y.R. Henrion1, 2 and S.B. Gordon1, 2
Affiliation(s):
1.Malawi Liverpool Wellcome Programme (MLW), Malawi Accelerated Research in Vaccines by Experimental and Laboratory Systems (MARVELS)
2.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
3.Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
4.School of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
5.Department of Paediatrics, University of Oxford, Oxford, UK
Email: achirwa@mlw.mw

Introduction and Objective: Childhood immunisation with pneumococcal conjugate vaccines (PCVs), including PCV-13 has not conferred optimal herd immunity in Malawi. People living with HIV (PLHIV) are a significant reservoir of pneumococcal disease with pneumococcal carriage rates and shedding higher than their counterparts even when optimally managed with antiretroviral therapy. There is currently no vaccination strategy for PLHIV in Malawi. After careful community consultation, we are conducting a pneumococcal controlled human infection model (CHIM)in PLHIV in order to determine correlates of protection, carriage dynamics, and in future evaluate vaccine efficacy against carriage.
Methods: The study sample size is 150 participants; 75 PLHIV, 75 HIV-negatives, inoculated with Streptococcus pneumoniae serotype-6B in a dose-ranging study at 20,000-CFU, 80,000-CFU and 160,000-CFU per naris until 50% carriage is established. Serum, nasal fluid and nasal microbiopsy samples will be collected to evaluate factors associated with protection from carriage and the mucosal immune response to inoculation
.
ABSTRACTS FOR POSTER PRESENATIONS
INFECTIOUS DISEASES (COVID)
P109_001829. CHEST X-RAY PATTERNS AND CLINICAL OUTCOMES OF COVID-2019 PATIENTS AT QUEEN ELIZABETH CENTRAL HOSPITAL, MALAWI
Author(s): Blessed Kondowe1, Ankunda Racheal1 and Suzgo Mzumara2
Affiliation(s):
1.ECUREI University
2.Kamuzu Central Hospital, Lilongwe, Malawi
Email: blessed.kondowe@yahoo.com

Introduction: Chest X-ray (CXR) is a low radiation dose, cheap, and widely available baseline imaging test with a mobile option currently being used in COVID-19 patients’ prognosis and monitoring but the use of findings to predict treatment outcomes has not been evaluated. Computed Tomography (CT) is the gold standard but costly with high radiation doses. Objective: To describe CXR patterns and relate them to clinical outcomes of COVID-19 patients admitted to Queen Elizabeth Central Hospital (QECH) isolation ward in Malawi.
Methods: This cross-sectional study included 216 CXR images and files of COVID-19 patients aged 18 and above admitted to the QECH COVID-19 isolation ward from June to August 2021. Images were reviewed by two qualified image readers blinded from each other and findings were recorded in a predesigned questionnaire by the researchers. A tiebreaker was involved where the two reports disagreed. Data analysis was done using STATA version 13.
Results: Out of 216 CXR images analyzed, 81.9% had abnormal patterns with total Brixia scores of 1-18 while 18.1% had normal CXR patterns with a Brixia score of 0. The prevalence of discharge was 62% less among patients with Ground Glass Opacities (GGO) (P<0.001) and almost half among patients with consolidations compared to patients with normal CXR patterns (p<0.001). Similarly, the prevalence of discharge among patients with severe Brixia scores was almost 50% compared to patients with normal Brixia scores (p<0.001).
Conclusion: The study found most COVID-19 patients with COVID-19-related CXR patterns and abnormal Brixia scores. GGO and consolidations were the most common patterns with many patients having severe Brixia scores. The abnormal patterns and severe Brixia score were associated with hospital death. The Brixia score should be incorporated into a prognostic model and treatment monitoring for COVID-19 patients.

P111_002008. KNOWLEDGE, ATTITUDES AND PRACTICES OF COVID 19 PREVENTIVE MEASURES AMONG HYPERTENSION PATIENTS AT MONKEY BAY COMMUNITY HOSPITAL
Author(s): Gaily G. Lungu1, Victor Kumfunda2, Dorothy M. Chizimba3, Gideon Mwanamanga2, Gladys Msiska1 and Richard M’madi1
Affiliations:
1.Kamuzu University of Health Sciences
2.Mangochi District Health and Social Services
3.Nurses and Midwives Council of Malawi
Email: gglungu@kuhes.ac.mw

Introduction: Covid-19 is an acute respiratory disease declared a pandemic by World Health Organization in March 2020. Worldwide, about 133 million people have been infected with the disease with 2.89 million deaths. Hypertension was identified as one of the comorbidities and risk factors for severity and adverse outcomes for patients with COVID-19. As such hypertensive patients need extra caution to avoid contracting the disease.
Objectives: Main – This study assessed knowledge, attitudes, and practices of COVID-19 Preventive Measures among Hypertensive Patients at Monkey Bay Community Hospital. Specific (1) To determine participants’ awareness of the COVID-19 preventive measures (2)To explore participants’ attitudes towards COVID-19 prevention (3) To identify preventive measures for participants in response to COVID-19.
Methods: A validated tool adopted from a KAP survey by Ngwewondo et. al was used. A sample of 65 clients with hypertension reporting for noncommunicable diseases were enrolled through simple random sampling. Quantitative study design was employed. Data were analysed using a Statistical Package for Social Sciences version 20.0.
Results: The study established that respondents heard about COVID-19 (98.5%, n=64) via different channels like radio (92.3%, n=60) and friends (4.6%, n=3). About 83.1% (n≥54) were aware of symptoms like dry cough, fever, and sore throat. They reported ways of preventing the infection as frequent hand washing, use of face masks, and avoiding handshakes. Most respondents, (83.1%, n=54) reported that COVID -19 vaccine can prevent the infection and (16.1%, n=11) reported that it is not a preventative measure for COVID-19.
Conclusion: The study findings suggest that the knowledge towards COVID-19 prevention is high among hypertensive patients at Monkey Bay Community Hospital. However, their practices are not consistent with the level of knowledge. There is a need to enhance awareness campaigns on prevention, infection, and care in order to prevent the at-risk group from contracting the disease.

P113_002084. FACTORS INFLUENCING UPTAKE OF COVID-19 POLICY UPTAKE BY FRONTLINE HEALTH CARE WORKERS IN MALAWI.
Author(s): Olive Mbekwani-Kalata1, Linda Nyondo-Mipando2, Esnart Chiwanda1, Josephine Tenthani1, Kondwani Jambo1,3, and Rhona Mijumbi-Deve1,3
Affiliation(s):
1.Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2.Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi.
3.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
Email: ombekwani@mlw.mw

Background: Frontline healthcare workers (FLHCWs) were disproportionately affected by COVID-19 globally despite access to effective COVID-19 policies. Evidence suggests that low uptake of COVID-19 policies at the peak of the epidemic may have contributed to such high risk of infection in this population.
Objective: To determine factors that affected the uptake of COVID-19 policies by FLHCWs during the 4 epidemic waves in Malawi.
Methods: The study took a qualitative cross-sectional design and enrolled consenting FLHCWs who reported to have cared for COVID-19 patients during either of the 4 epidemic waves at a central hospital (QECH), a district hospital (Chikwawa DHO) or health centers (Zingwangwa and Lirangwe). COVID-19 policy was defined as any COVID-19 prevention guidelines such as use of personal protective equipment (PPE), hand and facility hygiene, lockdown, and vaccination guidelines. Qualitative data were collected from June to July 2023 through focus group discussions (FGD) and in-depth interviews (IDI) and analyzed using Dedoose software.
Results: Of the 20 participants interviewed, 40% and 25% were working at QECH and Chikwawa DHO respectively, and 70% were clinicians/nurses. FLHCWs reported to have followed COVID-19 policy guidance more closely when (1) clear guidance on COVID-19 prevention and PPE were available; (2) peer FLHCWs were adhering to the policies; (3) a prominent leader or a close relative dies of COVID-19; (4) and when they themselves were diagnosed with COVID-19. FLHCWs found it difficult to adhere to policy when (1) there were extreme hot/cold weather conditions; (2) misinformed about COVID-19 and vaccines by religious leaders/social media (3) when leaders mishandled COVID-19 funds; (4) and when there was no PPE.
Conclusion: Efforts to improve uptake of COVID-19 policy among FLHCWs during outbreaks/epidemics are likely to be effective if the guidance is clear, there is commitment from leadership, resources are available and social barriers are addressed.

P114_002184. PREVALENCE OF CO-INFECTION WITH OTHER RESPIRATORY PATHOGENS IN COVID-19 PATIENTS IN BLANTYRE, MALAWI: A RETROSPECTIVE LONGITUDINAL STUDY
Authors: Annociata Chisale1, Harry Meleke1, Margaret Nkhonjera1, Lyson Samikwa1, Vincent Samuel Phiri2, Samuel Mpinganjira2, David Chaima1, Kondwani Jambo3,4, Khuzwayo Jere3,5,6, Victor Mwapasa2, and Tonney S. Nyirenda1
Affiliation(s):
1.Pathology Department, Kamuzu University of Health Sciences, Blantyre Malawi
2.Community Health Department, Kamuzu University of Health Sciences, Blantyre Malawi
3.Malawi Liverpool Wellcome Trust Program, Blantyre Malawi
4.Liverpool School of Tropical Medicine, Liverpool UK
5.Medical Laboratory Sciences Department, Kamuzu University of Health Sciences, Blantyre Malawi
6.University of Liverpool, Liverpool UK
Email: achisale@kuhes.ac.mw

Introduction: Research shows that COVID-19 patients are more likely to be co-infected with other respiratory pathogens. Co-infection of COVID-19 with other respiratory pathogens has been observed with varying outcomes. In our population it is not known if SAR-CoV-2 coinfection with other respiratory pathogens is associated with poor clinical outcomes.
Objectives: (1) To investigate the prevalence of other respiratory pathogens in COVID-19 patients. (2) To determine if SARS-CoV-2 co-infection with other respiratory pathogens is associate with increased disease severity.
Methods: We conducted a longitudinal study, where we recruited 110 participants SAR-COv-2 infected participants (index) and household contacts and followed them up at day 1, 14 and 28. Respiratory infections were investigated using Siemens Healthineers multiplex real-time PCR targeting 31 respiratory pathogens: bacteria, viruses and fungi.
Results: A total of 100 participants tested positive for at least one of the 21 respiratory pathogens detected. Bordetella species, Klebsiella pneumoniae, and Staphylococcus aureus were the most prevalent pathogens detected, accounting for 30%, 24%, and 15% of the 336 positive results, respectively. Ten participants had no co-infection. Most frequent other respiratory pathogens were considered for further analysis. Among the 80 participants with COVID-19, 75 tested positive for one or more of the top three pathogens comprising of 23 (31%) with one co-infection, 36 (48%) had two co-infections, and 16 (21%) had three infections. Among them, 22 had no symptoms and 50 had mild symptoms, and had 3 severe symptoms. In the 5 COVID-19 patients without co-infection, 1 had no symptoms and 4 had mild symptoms. There was no association of co-infection with increased disease severity of COVID-19 (p-value = 0.7924).
Conclusion: Most COVID-19 patients were co-infected with other respiratory pathogens but this was not associated with increased disease severity. Detection of other respiratory pathogens may help to explain increased disease severity in other populations with COVID-19.

P115_002262. RATES AND PREDICTORS OF COVID-19 TRANSMISSION TO HOUSEHOLD CONTACTS OF A COVID-19 LABORATORY CONFIRMED CASE IN BLANTYRE MALAWI
Author(s): Samuel Mpinganjira1, Vincent Phiri1, Tonney Nyirenda2, David Chaima2, Kondwani Jambo3,6, Khuzwayo Jere4,5,,Arox Kamng’ona4, Ralphael Kamng’ona2, Chisomo Msefula2, Kamija Phiri1, and Victor Mwapasa1
Affiliation(s):
1.Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Pathology, Kamuzu University of Health Sciences 3Immunology Group,
2.Malawi-Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi;
3.Department of Bio-Medical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi; University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom,
4.Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Email: slmpinganjira@kuhes.ac.mw

Introduction: During the COVID-19 pandemic, projections for disease transmission intensity and risk factors were largely based on estimates derived from developed countries whose social and environment contexts are different from low-income countries, including Malawi.
Objectives: To determine rate of transmission and predictors of COVID-19 transmission amongst household contacts of laboratory confirmed cases in Blantyre
Methods: We conducted a prospective cohort household-based study in Blantyre urban and rural areas in Malawi from December 2020 to October 2021. We enrolled individuals with confirmed positive COVID-19 results, as index cases, and their household contacts and followed them up at weekly intervals for 28 days. Nasopharyngeal samples were collected for COVID-19 PCR test, while blood samples were collected for HIV, malaria, and serology tests. Proportions were used to determine the secondary spread i.e. households with at least one contact testing positive. Chi Square was used to test for significance. Cox regression models were fitted to assess predictors of infection.
Results: 171 index cases and 410 household contacts were enrolled. In comparison with the index cases, the contacts were generally younger [31 (7-86) vs 41 (7-79)]; unmarried (58% vs 26%); and unemployed (40% vs 18%). From the 120 index cases that tested positive on enrolment in our study, 70% (84) had at least one household contact who tested positive during the 28 day follow up. Proportions of secondary transmission were not different across rural (67%, n=36), urban high density (73%, n=41), and urban low-density settings (70%, n=43) respectively (P value: 0.834, 95%CI). Proportions of secondary transmission were higher in the third wave (83%, n=53) than second wave (60%, n=67) (P value=<0.05, 95%CI). Households with running tap water were less likely to have COVID-19 household transmission than those without (Adjusted Hazard Ratio: 95% CI 2.154 (1.218, 3.806), P value: <0.05). Age, sex, education, HIV status, location, size of the house, size of household and BMI were not significantly associated with household COVID-19 transmission.
Conclusion: Our results suggest that COVID-19 household transmission in the Malawian setting was influenced by the virus variant and sub-optimal water supply. Improvement of water supply to households may reduce the intensity of COVID-19 transmission.

INFECTIOUS DISEASES (HIV/TB)
P116_001815. MOLECULAR INVESTIGATION OF THE AETIOLOGY OF TUBERCULOSIS-LIKE CLINICAL SYNDROMES IN ADULTS PRESENTING FOR PRIMARY HEALTH CARE AT LIMBE AND NDIRANDE HEALTH CENTRES
Author(s): Alice Chimwemwe Mnyanga1, Marriott Nliwasa1, and Titus Divala1
Affiliation(s):
1.Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences
Email: amnyanga@kuhes.ac.mw

Introduction: Respiratory infections are a common cause of morbidity and mortality globally. The bacterial and viral aetiology of respiratory symptoms is not fully understood, especially in low and middle-income countries, posing a major limitation for the development of effective prevention and clinical management strategies.
Objective: To investigate the aetiology of respiratory pathogens and associated factors of symptom improvement.
Methods: A case-control study that recruited Malawian adults (aged ≥18 years) attending primary care at Limbe and Ndirande health centres in Blantyre, who reported being unwell for at least 14 days (including cough) was conducted. Nasopharyngeal swab samples were collected from cases and controls and then screened for viral and bacterial respiratory pathogens. Prevalence of respiratory pathogens was assessed and compared in both groups using logistic regression analysis to measure the association between patient characteristics and symptom improvement.
Results: The most detected viruses were Influenza (A, B, C) (11/123) [8.9%] in controls vs 0/79 [0%] in cases and Human respiratory syncytial virus (5/123 [4.1%] vs 1/79 [1.3%]). Streptococcus pneumoniae (7/123 [5.7%] vs 11/79 [13.9%] and Klebsiella (5/123[4.1%] vs 7/79 [8.9%] were the most detected respiratory bacteria. No atypical bacteria were detected. Viral or bacterial presence was not individually significantly associated with symptom improvement. Patients treated with antibiotics had reduced chances of improving symptoms (OR:0.04 95% CI 0.01-0.22). Patients who reported weight loss (OR: 3.20 95% CI 1.55-6.60) were more likely to improve their symptoms. Patients infected with TB (OR: 0.13 95% CI 0.05-0.33) had reduced chances of improving their respiratory symptoms.
Conclusion: Respiratory pathogens in Malawi were uncommon in adults with prolonged cough seeking primary care. The use of antibiotics has no benefit in the improvement of respiratory symptoms. Further work using untargeted sequencing and quantitative diagnostics should help elucidate causative pathogens and drivers of respiratory syndromes in Malawian outpatients.

P117_001824. PATIENT CHARACTERISTICS ASSOCIATED WITH CARDIO-RESPIRATORY FUNCTION IN POST- TUBERCULOSIS PATIENTS WITH KNOWN HIV STATUS UNDER-GOING PULMONARY REHABILITATION IN MALAWI: A RETROSPECTIVE COHORT STUDY
Author(s): Precious Tadala Gwelema1, Takondwa Msosa2, Adamson Muula1 and Marriott Nliwasa2
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi
2.Kamuzu University of Health Sciences, Blantyre, Malawi, Helse Nord Tuberculosis Initiative, University of Amsterdam
Email: tadala199@gmail.com

Introduction: The prevalence of Chronic Lung Diseases is high in Human Immunodeficiency Virus (HIV) positive (HIV+) and HIV negative (HIV–) adult patients undergoing Tuberculosis (TB) screening. Currently, there is more emphasis on proper TB detection and treatment than on rehabilitation after TB diagnosis which leaves patients with poor lung function and diminished Quality of Life (QoL). To prevent progressive loss of pulmonary function, interventions that are tailored based on the HIV status of the patients need to be employed.
Objective: This study aimed at assessing patient characteristics associated with cardio-respiratory function in post-TB patients with known HIV status under-going 12 weeks of Pulmonary Rehabilitation (PR).
Methods: A retrospective cohort study that used registry data collected by The Paradiso TB Patients Trust was carried out in Malawi among 205 patients with post-TB lung disease. The outcomes were mean difference (MD) in exercise tolerance scores, respiratory symptoms proportions and change in QoL. A paired T-test was used to compare exercise tolerance and QoL scores. In addition, the proportion of participants experiencing respiratory symptoms were aggregated and logistic regression was done.
Results: Improvements in respiratory symptoms measures were seen, at baseline, respiratory symptoms were reported in 153 (93.87%) HIV– and 35 (83.33%) HIV+ participants, but in only 40 (24.54%) HIV– and 18 (42.86%) HIV+ participants at endline. An improvement was observed in QoL scores, but there was no significant difference in the change in mean values between the two groups, for example in the physical domain, (HIV–: 9.26 vs HIV+: 9.29, MD: -0.03, CI: -8.62 to 8.56, p=0.9949).
Conclusion: Our study showed improvement in cardio-respiratory function in both patient groups but there was no difference in PR treatment response between them. The study outcomes provide motivation for the integration of PR in Pulmonary TB management of both patient groups to improve health outcomes.

P118_001838. WOMEN’S PERCEPTIONS OF DMPA-SC SELF-INJECTION IN MALAWI
Author(s): Mandayachepa Chriford. Nyando1, Lauren Suchman5, Innocencia Mtalimanja2, Address Malata2, Alfred Maluwa2, Tamanda Jumbe2, Emas Potolani2, Martha Kamanga1, Peter Waiswa3 and Zachary Kwena4.
Affiliations:
1.Kamuzu University of Health Sciences, Lilongwe Campus(KUHeS)
2.Malawi University of Science and Technology (MUST)
3.Makerere University
4.Kenya Research Institute (KEMRI)
5.University of California San Francisco (UCSF)
Email: cnyando@kuhes.ac.mw

Introduction: The abstract describes a qualitative cross sectional research study conducted in Malawi between March and May 2021 to explore women’s perceptions of the Subcutaneous Depot Medroxyprogesterone Acetate Self-Injection (DMPA-SC-SI) as a contraceptive method. Objective: The study aimed to understand how these perceptions influenced their decisions and attitudes toward adopting this method. Specifically, the study 1). Examined women’s perceptions and feelings towards self-injection; 2). Understanding the factors influencing women’s decision regarding self-injection and 3). Identified enablers and barriers for self-injection among women of child bearing age in the age band of 15 to 45 years.
Methods: In-depth Interviews (IDIs) using an In-depth Interview semi-structured guides with 60 women were conducted in Mulanje and Ntchisi Districts. Thematic analysis was employed to analyse the qualitative data. Data were coded using Dedoose qualitative analysis software and analysed using an iterative thematic approach.
Results: The study’s results highlight several important themes: Meeting Contraceptive Needs and Self-Efficacy; Privacy and Autonomy; Convenience and Access; Trust in Information Sources; Perceived Threats and Challenges; Covert Use and Decision-Making Power; Perceived Benefits of Using Self-Injection and Women’s Perceived Power in Contraceptive Decisions.
Conclusion: The study’s implications include the importance of comprehensive counselling, strengthening supply chains, empowering women, engaging communities, and conducting long-term acceptability studies to promote positive perceptions and sustained adoption of self-injection methods. Integrating these findings into family planning programs can enhance women’s overall well-being and contribute to the success of self-administered contraceptive methods.

P119_001849. PREVALENCE AND PREDICTORS OF ALCOHOL USE AMONG MALAWIAN ADOLESCENTS LIVING WITH HIV ATTENDING SELECTED ANTI-RETROVIRAL TREATMENT CLINICS IN BLANTYRE, MALAWI
Author(s): John Kuyokwa1, Claire van der Westhuizen1, Katherine Sorsdahl1, Chiwoza Bandawe2
Affiliation(s):
1.Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
2.Department of Psychiatry and Mental Health Kamuzu University of Health Sciences, Blantyre
E-mail: johnkuyokwa@gmail.com

Introduction and Objective: The study aimed to determine prevalence and predictors of alcohol use among Malawian adolescents living with HIV (ALHIV) attending Anti-Retroviral Treatment clinics (ART) in Blantyre, Malawi.
Methods: A cross-sectional study design was used on 376 ALHIV attending ART clinics. They were asked about their lifetime alcohol use and other psychosocial issues.
Results: The study found that overall prevalence of lifetime alcohol use was 17.8%. Other psychosocial factors were: depressive symptoms (27.7%), anxiety symptoms (23.7%), traumatic event experience (70.5%) and symptoms of Post Traumatic Syndrome Disorder (PTSD) (31.7%). Being male increased odds of reporting any lifetime alcohol use compared to being female (OR=1.98, 95% CI 1.14, 3.43). As age increased, lifetime alcohol use risk decreased (OR=0.87, 95% CI 0.76, 0.98). Secondary school completion decreased odds of any lifetime alcohol use compared to primary school completion only (OR=0.50, 95% CI 0.29, 0.86). ALHIVs with PTSD symptoms had decreased risk of any lifetime alcohol use (OR=0.54, 95% CI 0.32, 0.93), while participants reporting more social support from a significant other (OR=1.15, 95% CI 1.02, 1.30), family (OR=1.20, 95% CI 1.04, 1.40) or friends (OR=1.20, 95% CI 1.04, 1.39) were more likely to report any lifetime alcohol use. In the adjusted model, gender remained significantly associated with any lifetime alcohol use, whereby females were more likely to use alcohol than males (OR=1.90, 95% CI 1.08, 3.33).
Conclusion: Alcohol use among ALHIV is prevalent and relevant interventions are required. Therefore, there is need to investigate variables linked to lower risks of lifetime alcohol consumption among ALHIV, those that completed secondary education, have social support, and PTSD symptoms, a larger study with a mixed-methods design would be important to inform policy.

P120_001899. UNCONTROLLED HIV INFECTION ALTERS CD4+ T CELL SUBSETS IN THE NASAL MUCOSA
Author(s): Gloria Luhanga1,2, Joseph Phiri1,2, Thokozani Kayembe1, Lusako Sibale1,2, Edwin Lisimba1, Precious Chigamba1, Lukerensia Mlongoti1, Ndaona Mitole1, Janet Zambezi1, Alice Kusakala1, Mercy Khwiya1, Chisomo Jasi Jowati1 and Kondwani Jambo1,2,3
Affiliation(s):
1.Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2.Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
3.Kamuzu University of Health Sciences, Blantyre, Malawi
Email: glorialuhanga14@gmail.com

Introduction: The nasal mucosa is a major portal of entry for respiratory pathogens and a critical site for transmission. HIV infection is associated with extensive disruption of CD4+ T cells in different mucosal sites, but the impact of HIV in the nasal mucosa remains underexplored. Objective: To assess the impact of HIV infection on the nasal CD4+ T cell compartment.
Methods: In a prospective cohort study, we recruited otherwise healthy and asymptomatic age- and sex-matched adults into three groups (42 HIV-uninfected adults, 42 PLHIV on ART <3 months (uncontrolled HIV) and 42 PLHIV on ART >1 Year (controlled HIV)). We collected nasal scrapes and used flow cytometry-based immunophenotyping to examine the CD4+ T cell compartment.
Results: The proportion of CD4+ T cells in the nasal mucosa was lower in individuals with uncontrolled HIV compared to HIV-uninfected adult controls (25.9% vs 19.35%, p=0.017). Furthermore, the proportion of CXCR3- and CCR6-expressing CD4+ T cells in the nasal mucosa of individuals with uncontrolled HIV was lower than those with controlled HIV (16.5% vs 23.1%, p=0.035) and HIV-uninfected adults (16.5% vs 25.6%, p=0.031). In contrast, the proportion of CD25+CD4+ T cells in the nasal mucosa of individuals with uncontrolled HIV was higher than those with controlled HIV (18.20% vs 6.9%, p=0.0001) and HIV-uninfected adults (18.20% vs 7.41%, p=0.0001).
Conclusion: Our findings demonstrate HIV-associated disruption in the CD4+ T cell compartment in the nasal mucosa of adults with uncontrolled HIV infection. Impaired nasal mucosa immunity could contribute to the persistence of bacterial and viral respiratory pathogens.

P121_001926. FACILITATORS AND BARRIERS TO HIV PRE-EXPOSURE PROPHYLAXIS (PREP) AMONG ADOLESCENT GIRLS AND YOUNG WOMEN IN KAWALE, LILONGWE, MALAWI
Author(s): Simon Nicholas1,2, Maureen Matewere2, Mercy Tsidya2, Mina Hosseinipour2, and Alinane Linda Nyondo Mipando1,3
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Health Systems and Policy
2.University of North Carolina Project Malawi
3.Department of Womens’ and Childrens’ Health, University of Liverpool
Email: snicholas@unclilongwe.org

Introduction: Seventy percent of all newly acquired HIV infections in Malawi among young people aged 15-24 occur in Adolescent Girls and Young Women (AGYW). The Ministry of Health (MoH) has rolled out an Oral Pre-Exposure Prophylaxis (PrEP) prevention program targeting high-risk groups/populations including AGYW. Since PrEP roll-out in 2021, there has been limited research exploring the factors that influence uptake of PrEP among AGYW. This study explored the barriers and facilitators to the uptake of Oral Pre-Exposure Prophylaxis among HIV High Risk Adolescents Girls and Young Women.
Methods: This exploratory qualitative study employed a phenomenological design and was done at Kawale Health Center in Lilongwe, Malawi in February 2023. Data were collected using semi-structured in-depth interviews and vignettes from purposively sampled 20 AGYW and 10 health care workers based on their PrEP status and involvement in PrEP provision respectively. The data were digitally recorded, transcribed, managed using NVivo® 12.6 software and analysed using a thematic approach guided by the Consolidated Framework for Implementation Research (CFIR).
Results: Facilitators to PrEP uptake included knowledge of PrEP, AGYW’s perceived vulnerability, perceived HIV risk, attitude of Health Care Workers (HCW), and availability of resources. The barriers were PrEP side effects, burden of work, limited information about PrEP, lack of privacy, limited resources, stigma, and lack of transport.
Conclusion: To unlock the full potential of PrEP as an effective HIV prevention tool among AGYW, a comprehensive strategy is needed that is tailored to their unique needs, addresses structural barriers, and ensures access to quality services. Demand creation is necessary at this stage where most AGYW are unaware of PrEP.

P122_001971. SPATIAL DISTRIBUTION OF CLIENTS WITH LATE CLINIC ATTENDANCE AND FACTORS ASSOCIATED WITH MISSED APPOINTMENTS AT LARGEST ART CLINIC IN LILONGWE, MALAWI: A RETROSPECTIVE COHORT STUDY
Authors: Petros Tembo1,2, Emmanuel Singogo2, Maganizo Chagomerana3, and Victor Mwapasa1
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Lighthouse Trust, Malawi
3.University of North Carolina Chapel Hill-Malawi Project
Emails: ptembo@lighthouse.org.mw

Introduction: Non-attendance to scheduled clinic appointments in healthcare systems have several unfavorable consequences, including congestion, long client queues, increased waiting times for patients and workload for healthcare workers. It is essential to understand the extent, key areas, and contributing factors related to missed clinic appointments for ART.
Objective: To identify the magnitude and hotspot with missed clinic appointments and the associated factors
Method: This was retrospective cohort study, conducted at Bwaila-Martin Preuss Centre, the largest public ART clinic in Lilongwe, Malawi. Data was extracted from the electronic medical records system between January 2019 and December 2022 and matched with geographical coordinates for the cluster Traditional authorities dataset where study clients live by location variable.
Results: A total of 3832 clients were included for analysis. 61% (2323) females mean age was 32±11 years. Clients distribution by ART start year 1223(32%) in 2019, 996(26%) in 2020, 865(22%) in 2021 and 748(20%) in 2022. Overall, late reporting for clinic appointments was 60%(2303) with 20%(772) missed-once, 14%(523) missed-twice, 8%(311) missed-3times, 6%(231) missed-4times, 4%(157) missed-5times and 8%(309) missed-6+times. Clients aged (25-39) years had more missed visits (1282(56%)). The magnitude missed clinic appointments by duration on ART was frequent among clients ≤ 6months (476 (21%)) and ≥36months (538(23%)) on ART. Factors associated with missed clinic appointments were being pregnant OR=1.7(95%CI:1.3-2.3; p=0.001); breastfeeding OR=2.1 (95%CI:1.2-3.7; p=0.014); poor ART adherence OR=2.0(95%CI:1.7-2.3; p=0.001); un-suppressed viral load OR=2.6 (95%CI:1.4-4.9; p=0.002); ≥36months on ART OR=4.8 (95%CI:3.8-6.2; p=0.001) and were all statistically significant. The cluster areas with the highest number of clients with late clinic attendance were Area24 with 18%(403), Area 36 with 15% (340) plus Area 56 with 11%(241).
Conclusions: The findings indicate that factors like pregnancy, breastfeeding, poor ART adherence, unsuppressed viral load, and longer ART duration are predictors of late clinic attendance. Patients with poor drug adherence and unsuppressed viral load require tailored interventions to understand their adherence to clinic appointments.

P123_001994. HIV TESTING SERVICES AMONG ADOLESCENT GIRLS AND YOUNG WOMEN AGED 16-24 IN MALAWI AND SOUTH AFRICA
Author(s): W. Phiri1, T. Tchereni1, F. Birhanu1, A. Gunda1, R. Nyirenda2, S. Ngoma2, S. Rosen3,4, I. Mokhele3, N Mutanda3, S. Pascoe3 and A. Huber3
Affiliation(s):
1.Clinton Health Access Initiative, Lilongwe, Malawi
2.Malawi Ministry of Health, Directorate of HIV/AIDS and Viral Hepatitis, Lilongwe, Malawi
3.Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
4.Boston University School of Public Health, Boston, MA, USA
Email: wphiri@clintonhealthaccess.org

Introduction: HIV incidence remains disproportionately high among adolescent girls and young women (AGYW) in sub-Saharan Africa. HIV testing is the gateway to achieving incidence reduction. There is limited understanding of access to HIV testing services (HTS) among AGYW. We surveyed clients accessing HTS in Malawi and South Africa (SA) to understand current testing practices.
Objective: To compare HTS offerings to AGYW between Malawi and South Africa
Methods: From 09/2022-04/2023, we conducted a cross-sectional survey of clients testing for HIV at 12 health facilities in Malawi and 18 in SA. Up to 40 clients testing for HIV were recruited (20 testing positive; 20 negative) per facility. A questionnaire was used to collect information on demographic characteristics, reason for visit, and services received. Descriptive results for female participants 16-24 years in Malawi and 18-24 years in SA are presented.
Results: Among 809 participants (Malawi 335, SA 464), 223 (28%) were AGYW (77 Malawi; 146 SA). Of those testing positive (19% Malawi vs. 14% SA), 33% were first-time testers; all were offered ART; and 93% from Malawi and 100% from SA were linked to care. Among those testing negative, 31% in Malawi and 14% in SA were offered family planning services; 10% in Malawi and 5% in SA screened for STIs; 29% in Malawi and 50% in SA were offered PrEP. Condoms were offered to 23% of participants. TB screening was reported by only one of those testing in Malawi and by 10 (8%) in SA. None reported being screened for gender-based violence (GBV) in either country.
Conclusion: While linkage from a positive HIV test to ART was nearly universal, linkage to prevention and other health services was generally low among those AGYW testing. Improving availability and accessibility of these services is critical to reducing incidence among this vulnerable group.

P124_002002. HIV PREVENTION GAPS AMONG INDIVIDUALS RECRUITED FROM CLINICS AND SOCIAL VENUES IN BLANTYRE DISTRICT, MALAWI: A CROSS-SECTIONAL SURVEY USING A PLACE METHODOLOGY.
Author(s): Confidence Banda1, Sarah Bourdin2, Emmanuel Singogo1, Evaristar Kudowa1, Maganizo Chagomerana1, John Chapola1, Harriet Jones2, Thomas Hartney2, Jessie K. Edwards3, Andreas Jahn4, Gift Kawalazira5, Yohane Kamgwira5, Lucy Platt2, Brian Rice6, James R. Hargreaves2, Mina C. Hosseinipour1,3, Sharon S. Weir3
Affiliation(s):
1.University of North Carolina Project Malawi, Lilongwe, Malawi
2.Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, England
3.Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
4.Department of HIV & AIDS, Ministry of Health, Lilongwe, Malawi
5.Blantyre District Health Office, Ministry of Health, Blantyre, Malawi
6.School of Medicine and Population Health, University of Sheffield, Sheffield, England
Email: bandac@kuhes.ac.mw

Introduction: Despite expanded HIV programs, gaps in access to HIV prevention services still exist. We used HIV prevention cascades to identify gaps in access to and utilization of condoms, PrEP, and HIV testing among HIV negative individuals recruited from clinics and social venues in Blantyre, Malawi.
Methods: We used data from a cross-sectional bio-behavioural survey of participants with a non-reactive HIV test in the Clinic vs Venue study (CLOVE) from January to March 2022. 2,225 patients from government clinics providing HIV testing and STI treatment services, and 1,634 patrons in social venues were used. We developed prevention cascades focusing on need, perceived access and effective use of condoms, HIV testing, and PrEP use to identify prevention gaps among sub-groups of participants at higher risk of HIV acquisition (engaging in transactional sex, multiple partners, aged 15-24 or 30+).
Results: 3,861 participants were included in the study; 1,502 females and 725 men in clinic, and 303 women and 1,326 men in venues. Of 3,861 participants, 35.0% reported an HIV test in the past 6 months, 24.4% reported consistent condom use in the past 6 months, and 1.9% reported current PrEP use. Access to PrEP among current users was high (70.2%). Access to condoms and HIV testing was high in both clinic and venue (79.5% vs 85.1%). Among female sub-groups, reported use of prevention methods was higher in venues than in clinics. Among male sub-groups, reported use of prevention methods was relatively similar between venues and clinics except for condom use in men 30+ (13.4% at clinics vs. 20.5% at venues).
Conclusions: Although access to condoms, HIV education, PrEP, and HIV testing is high, use is low. Barriers that lead to suboptimal use of prevention services, such as negative attitudes towards condom use, gender power dynamics and other structural factors, need to be further explored.

P125_002068. ARE HIV TESTING AND COUNSELLING (HTC) PROVIDERS IN BLANTYRE DISTRICT COMPETENT IN PROVIDING HIV TESTING SERVICES (HTS) TO ADOLESCENT BOYS AND YOUNG MEN?
Author(s): Rose Sakala1, Themba Mzembe1, Henderson Mitomoni1 and Victor Mwapasa1
Affiliation(s):
1.KUHES College of Medicine
Email: rosesakalas@gmail.com

Introduction: Despite the high HIV/AIDS risk among the youth, and the scale-up of Youth-friendly Sexual and Reproductive Health Services (YFHS) by the Ministry of Health (MoH), a higher proportion (62.9%) of adolescent boys and young men (ABYM) in Malawi are unaware of their HIV status compared to adolescent girls and young women (44.7%). This study aimed to (1) describe the competency of HIV testing and counselling (HTC) providers to provide services to ABYMs; (2) assess facility adherence to MoH HTC guidelines; and (3) explore ABYMs’ perceptions regarding the quality of HTC services.
Methods: This was a cross-sectional study with a mixed methods approach, involving HTC providers working at 11 health facilities in Blantyre district, and ABYMs who had accessed HTC services in the previous 12 months. HTC providers’ competence and facility infrastructure were assessed through structured observations during HTC sessions with ABYMs. Focus group discussions (FGDs) and in-depth interviews (IDI) were conducted to explore ABYMs’ perceptions. Binary logistic regression was used to explore factors associated with provider competence, thematic analysis was used to explore ABYMs’ perceptions.
Results: Overall, 105 HTC providers were interviewed, and 42 ABYMs participated in five FGDs and two IDIs.
Only 25% of the HTC providers reported receiving specialized training on HTC for ABYMs, and 18% demonstrated competence in conducting HTC with ABYMs. The providers with training on HTC for ABYMs were more likely to demonstrate competency compared to those without (Odds Ratio: 3.65; 95% Confidence Interval: 1.28 – 10.39).
Overall, 9 (82%) facilities had excellent adherence to MoH’s HIV testing guidelines. However, all the ABYMs mentioned that the judgmental attitude of the providers, lack of privacy and safe space for the youth within facilities were major barriers to accessing HTC services.
Conclusion: To increase HTC uptake among ABYMs, the MoH needs to invest in ABYM-friendly training of HTC providers and restructuring the facilities to guarantee privacy and confidentiality.

P127_002112. CHARACTERIZING MISSED APPOINTMENTS AMONG ART PATIENTS AT A LARGEST ART CLINIC IN LILONGWE, MALAWI: A RETROSPECTIVE COHORT STUDY.
Author(s): Petros P.M Tembo1,2, Emmanuel Singogo3, Maganizo B. Chagomerana3,4 and Victor Mwapasa5
Affiliation(s):
1.Lighthouse Trust, Malawi
2.Kamuzu University of Health Sciences
3.University of North Carolina Malawi Project
4.Department of Medicine, University of North Carolina at Chapel Hill.
5.Kamuzu University of Health Sciences
Email: ptembo45@gmail.com

Introduction: Non-attendance to scheduled clinic appointments in healthcare is often attributed to clinic congestion, long client queues, increased waiting times for patients, and high workload for healthcare workers. However, the magnitude of missed clinic appointments and hotspots with clients who missed clinic appointments at HIV clinics are not well characterized.
Objective: To identify the magnitude of missed clinic appointments, hotspots with clients who missed clinic appointments, and factors associated with missed appointments.
Method: We conducted a retrospective cohort study at Bwaila-Martin Preuss Centre in Lilongwe, Malawi. Data for ART clients between January 2019 and December 2022 were extracted from electronic medical records including locations of study clients. We analyzed location data at an aggregated traditional authority level.
Results: A total of 3,832 clients were included for analysis, mean age was 32±11 years and (n=2323 (61%)) were females. ART initiations varied by year: (n=1223(32%)) in 2019, (n=996(26%)) in 2020, (n=865(22%)) in 2021 and (n=748(20%)) in 2022. Overall, 2303 (60%) clients missed clinic appointments: 772 (20%) missed once, 523 (14%) missed twice, 311(8%) missed 3 times, 231(6%) missed 4 times, 157(4%) missed 5 times, and 309(8%) missed ≥6 times. Clients aged 25-39 years had more missed appointments (n=1282 (56%)).
Factors associated with missed clinic appointments were starting ART when pregnant (OR=1.7, 95%CI:1.3-2.3), starting ART when breastfeeding (OR=2.1,95%CI:1.2-3.7), poor ART adherence (drug consumption<95%) (OR=2.0, 95%CI:1.7-2.3), viral load ≥1000 copies/ml (OR=2.6, 95%CI:1.4-4.9), being on ART ≥36 months (OR=4.8, 95%CI:3.8-6.2). Clients with missed clinic appointments were more clustered in Area24 (n=403 (26%)), Area 36 (n=340 (22%)), and Area 56 (n=241 (15%)).
Conclusion: Missed clinical appointments was common among clients who had been on ART for more than two years. ART clients should be sensitized on differentiated care services available at the facility and have one-on-one health talks on the importance of adhering to clinical appointments.

P129_002218. FACTORS ASSOCIATED WITH RECEIVING A REPEAT HIV TESTING IN THE THIRD TRIMESTER AMONG PREGNANT WOMEN IN BLANTYRE.
Author(s): Martha Patience Kaula1, Maria Chifuniro Chikalipo2, Alinane Linda Nyondo-Mipando2 and Victor Mwapasa2
Affiliation(s):
1.International Organization of Migration,
2.Kamuzu University of Health Sciences, Blantyre, Malawi
Email: mwkaula@gmail.com

Introduction: Regular HIV testing in pregnancy is crucial for identifying new maternal HIV cases and reducing the risk of mother-to-child HIV transmission. While guidelines support retesting initially HIV-negative pregnant women, there’s limited data on how this is put into practice.
Objectives: To determine the prevalence and associated factors of repeat HTC in third trimester
Methods: A mixed-method study using a convergent parallel approach. The quantitative approach used retrospective review of antenatal records from July 2019 to June 2020, while qualitative data was collected from purposively selected pregnant women and midwives through focus group discussions in-depth and key informant interviews.
Results: Analysis of 369 antenatal care records, spanning ages 18 to 42, with 302 from Ndirande and 67 from Lirangwe, revealed that only 30 (8.13%) participants received a repeat HIV test in the third trimester from both facilities. Factors influencing repeat HIV testing were intricate, with age, gravidity, and parity in isolation not significantly impacting retesting. Key factors influencing the decision to undergo repeat HIV testing included a lack of knowledge, fear of a positive result, delays in initiating antenatal care, perceived low risk, financial constraints, distance to healthcare facilities, shortages of HIV testing and counseling (HTC) providers, and separation of HTC and antenatal care services. In contrast, marital status, a welcoming environment, clinic operations, resource availability, and improved neonatal outcomes were motivating factors for repeat HTC in the third trimester. Retrospective antenatal records indicated that increasing age reduced the likelihood of accessing repeat HIV testing in the third trimester compared to younger women (OR = 0.43; 95% CI: 0.05 – 3.86).
Conclusion: maternal retesting in the third trimester remains suboptimal due to a complex interplay of factors. Strategies aimed at enhancing retesting coverage and identifying women with new maternal HIV infections are imperative for effective prevention of MTCT.

P130_002222. GENDER DISPARITY IN HIV DIAGNOSES CLASSIFIED AS LONG-TERM INFECTIONS IN RECENT INFECTION SURVEILLANCE IN MALAWI
Author(s): Joe Theu1, Misheck Luhanga2, Davie Chalira1, Alex Ernst4, Ireen Namakhoma1, Alinune Kabaghe2, Melissa Arons3, Harriet Mfungwe1 and Chikumbutso Lapken1
Affiliation(s):
1.University of Washington, I-TECH Malawi;
2.Centers for Disease Control and Prevention, Malawi;
3.Centers for Disease Control and Prevention, Atlanta, US;
4.University of California, San Francisco (UCSF), California, US.
Email: npatson@itech-malawi.org

Background: Recent infection surveillance aims to classify HIV infections of persons receiving an HIV positive test result as either recent (acquired approximately within the last 12 months) or long-term (acquired >12 months prior) to identify areas and populations with potential elevated HIV acquisition. This data is triangulated with program data, including sex and age disparity analyses.
Methods: Malawi`s rapid tests for recent infection (RTRI) are conducted after a new HIV diagnosis to classify the infection as recent or long-term followed by viral load testing. Viral load results <1000 copies/mL can identify individuals previously diagnosed and on ART and reclassify them as long-term. We used RITA results from Malawi recent infection surveillance data from March 1,2022 to March 1, 2023. We used descriptive statistics to characterize the proportions of men and women by age-specific gender disaggregation and both sexes combined, among all with RITA status results. and evaluated using a Chi-square.
Results: The current analysis had 43,174 observations. Participants who did not consent (n=143), had age missing (n=4), were not categorized as new HIV-positives (n=3,050), were not categorized as either RTRI recent or long-term (n=57), reported having ever been on ART (n=481) or revealed they were known to be HIV-positive (n=14) were dropped from the analysis, resulting in an analysis dataset of 39,425 observations. The proportion of men with long-term infections using RITA (14,741/15,027) was greater than the proportion of women (23,517/24,398), a difference of 1.7% (p<0.00001). A similar trend was found for each age group with the exception of the age group 65 and older, where more women had long-term infections compared to men. The men aged 50-64registeredgreatest proportion of long-term infections. (1,662/1,673).
Conclusion: Almost 2.0% more men compared to women were classified as long-term HIV infections, suggesting that the undiagnosed long-term infections with HIV may be gender-biased.

P131_002229. TRENDS IN KNOWLEDGE ABOUT HIV AMONG YOUNG MEN AND WOMEN IN MALAWI: AN ANALYSIS OF CROSS-SECTIONAL DATA FROM MULTIPLE DEMOGRAPHIC HEALTH SURVEYS
Author(s): Lindizgani Ndovie1, Emmanuel Singogo2, and Maganizo Chagomerana2
Affiliation(s):
1.LCQM, MOH
2.UNCP
Email: lindizganindovie@gmail.com

Introduction: HIV/AIDS remains a pressing health concern globally. In Malawi, a significant disparity exists in HIV prevalence among young women (15-24 years) at 4.9% versus young men of the same age bracket at 1%. Knowledge about HIV, its transmission, and prevention is paramount to curb its spread and improve health outcomes. There’s a notable gap in research focusing on the trends in HIV knowledge among Malawi’s youth.
Objectives: This study aims to: Characterize the demographics of those with limited HIV understanding. Assess the association of various socio-demographic and behavioral factors with HIV knowledge. Evaluate regional and district differences in understanding HIV transmission and prevention.
Methods: Data from the Malawi Demographic Health Survey (MDHS) conducted in 2004, 2010, and 2015 were utilized. The focus was on adolescents and young adults aged 15-24. The outcome variable was based on responses to a set of 10 critical questions related to HIV and it was classified into “”low”” or “”high”” knowledge based on these responses.
Results: Of the 32,461 participants, 12,101 exhibited low knowledge, while 20,360 demonstrated high knowledge. There was a significant rise in high knowledge, from 13.72% in 2004 to 45.18% in 2015-2016. Participants aged 15-19 displayed a 48.22% high knowledge rate, just under the 20-24 age bracket’s 51.78%. Gender showed comparable levels of understanding. Factors such as education, urban versus rural dwelling, region, and wealth quintile showed discernible disparities in HIV knowledge. Media exposure positively correlated with higher knowledge.
Conclusion: The study reveals a progressive improvement in HIV knowledge among Malawi’s youth from 2004 to 2015-2016. Although gender disparities were minimal, differences based on education, residence, and wealth was evident. Media exposure proved beneficial for HIV awareness. The data, while not exhaustive, offers valuable insights for tailored interventions to enhance HIV education and prevention strategies for Malawi’s youth.

P132_002259. ACCESS TO PREVENTIVE, TESTING, TREATMENT SERVICES AND RETENTION IN CARE FOR HIV KEY POPULATIONS GROUPS IN MALAWI (PERSUADE-II CONSORTIUM)
Author(s): Jane Mallewa1, Tsirizani Kaombe1, and Jupiter Simbeye2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.University of Malawi
Email: janemallewa@yahoo.com

Introduction: HIV remains an important public health disease in Sub-Saharan-Africa and Malawi (prevalence 8.2% in adults, 5.1% overall, incidence 0.17% (Naomi-Model2021)). Epidemic control was achieved in Malawi in 2020 through ART scale-up, on track to eliminate HIV as an important public health disease by 2030. HIV and STI prevalences are highest in key populations (KPs). In 2020, Female-sex-workers (FSW) had HIV/STI rates of 49% and 32.6%; men-having-sex-with-men and Transgender-people(MSM/TG) had 12.8% and 9% (Malawi-BBSS-Report2020). As part of a Global-Fund-sponsored PERSuADE-II-consortium initiative, we conducted a data-base analysis exercise on KP services by NGOs and MOH facilities.
Objectives: To describe access to preventive, testing, treatment services and retention in care for HIV/STIs in KPs in Malawi
Methods: PERSuADE-Malawi engaged NGOs and MOH facilities providing HIV services for secondary data on HIV/STI preventive, diagnostic and treatment services accessed by KPs (FSWs and their clients, MSM/TGs and prisoners). Reporting Period: October 2020-September 2022. Analyses done in STATA version-15.
Results: Three NGOs provided data: Pakachere(FSW+clients), CEDEP(MSM/TG), Elizabeth-Glazer-Paediatric-AIDS-Foundation (Prisoners) offering services in high prevalence districts in all regions. HIV Testing/linkage to care (LTC) services were available to FSWs, MSM/TGs and prisoners with HIV rates of 25%, 10.2% and 36.6% respectively with >90% LTC for all groups in 2021. The HIV rates improved for FSWs in 2022 (22.7%) and prisoners (27.5%). But the rate increased in MSM/TGs (18.4%). There was scale up of services for FSWs and MSM between 2021 and 2022: HIV self-testing kit distributions up to 500%, PrEP provision >75%. These services were not available to prisoners. STI treatment was >90% of those diagnosed for all three groups.
Conclusions: HIV services are reaching some KPs via NGOs with excellent linkage to care, these need to be extended to MOH facilities. The HIV rate is dropping in some KPs especially FSWs.

P133_002266. SINGLE-CELL RNA SEQUENCING ANALYSIS REVEALS SIGNIFICANT HIV-DRIVEN ALTERATIONS IN THE NASAL IMMUNE CELL LANDSCAPE
Author(s): Joseph Phiri1,2, Gloria Luhanga1,2, Precious Chigamba1, Robert Nyirenda1, Lukrensia Mlongoti1, Thokozani Kayembe1, Alice Kusakala1, Mercy Khwiya1, Ndaona Mitole1,3, Lusako Sibale1,2, James Nyirenda1, Benjamin Kumwenda1,3,4, Daniela Ferreira1,2,4, Chris Moxon1,6, and Kondwani Jambo1,2
Affiliate(s):
1.Malawi Liverpool Wellcome Programme, P.O. Box 30096, Blantyre 3
2.Liverpool School of Tropical Medicine, Pembroke Place, L35QA
3.Kamuzu University of Health Sciences, P/Bag 360, Blantyre 3
4.University of Liverpool, L6972X
5.Department of paediatrics, University of oxford, OX39DU
6.College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow
Email: jphiri@mlw.mw

Introduction: The nasal mucosa is an important site for pathogen entry and colonisation, a source of HIV-associated opportunistic infections. However, our understanding of the immune cell landscape in the nasal mucosa during HIV infection remains unclear.
Objective: To analysed the single-cell transcriptome of nasal mucosal cells in African adults living with or without HIV.
Methods: We recruited 3 HIV-uninfected adults, 3 people living with HIV (PLHIV) on anti-retroviral therapy (ART)<3 months and 3 PLHIV on ART>1 year and collected nasal cells using a nasal curette, a device that samples the inferior turbinate of the nasal mucosa. Single-cell sequencing libraries were generated using 10x Genomics Chromium Next GEM Single Cell 5′ Reagent Kits v2.
Results: The abundance of immune cells in the nasal mucosa was significantly altered in HIV infection, with neutrophil clusters over-represented and T cell clusters depleted in PLHIV compared to HIV-uninfected adults. Differential gene expression analysis showed higher expression of genes in PLHIV on ART<3 months than HIV-uninfected adults, including PRF1, GZMB, GZMA, GZMK, GNLY, LAG3, PDCP1, ISG15, RUNX3, NR4A1 and CCL4L2. While, higher gene expression of AQP5, NEU1, JUP, MDK and SLC31A1 was observed in PLHIV on ART>1 year than in HIV-uninfected adults. Co-expression Modules Identification analysis revealed an overrepresentation of modules containing pathways associated with T cell cytotoxicity and immune exhaustion in PLHIV on ART<3 months, and pathways associated with innate immunity in PLHIV on ART>1 year.
Conclusion: Overall, the nasal mucosa landscape shows significant HIV-driven alterations in cell distribution and gene expression in both innate and adaptive immunity, even during suppressive ART.

MENTAL HEALTH
P134_001799. THE ORGANIZATIONAL FEATURES AND ENVIRONMENT OF A PRIVATE MENTAL HEALTH PROVIDER IN KIGALI, RWANDA, A CASE STUDY OF SOLID MINDS.
Author(s): Theodora Khofi1, Jamilu Wa’alamu Yunusa1, Ezer Kang2,3, Belize Uwurukundo4, Jemma Hogwood5, Rose Nyiraneza5, Justine Mukamwezi5 and Sam Munderere5
Affiliation(s):
1.University of Global Health Equity, Institute of Global Health Research
2.University of Global Health Equity, Community Health and Social Medicine
3.Howard University, Department of Psychology
4.King Faisal Hospital Rwanda
5.Solid Minds Rwanda
Email: theodora.khofi@gmail.com

Introduction: Research on private mental health providers within sub-Saharan Africa and the role they potentially play in decreasing the mental health service divide is limited. To address this gap, this qualitative descriptive study will examine the organizational features and environment of Solid Minds, a private mental health clinic in Kigali, Rwanda. Objectives: To describe how providers at Solid Minds perceive organizational values and how those values influence the physical and social environment, ultimately shaping the delivery of mental health services.
Methods: In-depth interviews were conducted with 17 staff members at Solid Minds. Participants included nine clinical staff and eight non-clinical staff, followed by a member-checking focus group to discuss findings with the wider staff team. Thematic analysis was conducted to identify perceived organizational values and practices that foster client engagement and satisfaction.
Results: Three themes emerged: (1) upholding the confidentiality and privacy of clients, (2) fostering a supportive environment for clients and staff; and (3) promoting inclusive, accessible, and convenient mental healthcare. These values informed the creation of the physical environment of the clinic, clinician and non-clinician behaviour.
Conclusion: Consistent with previous research, Solid Minds demonstrated person-centred values that align with the domains of quality of care in mental healthcare. However, variations were observed in how these values were embodied and prioritized, highlighting the importance of tailoring mental health settings to meet the specific needs of the clientele. Government and not-for-profit organizations should explore collaborations with private mental health agencies, leveraging public-private partnerships to broaden the reach of mental health services. Additionally, training programs for non-clinical staff are recommended to enhance customer service and improve clients’ experiences, reducing barriers to regularly accessing mental healthcare.
P135_001870. HEALTH STIGMA & DISCRIMINATION EXPERIENCED BY ADOLESCENTS LIVING WITH HIV AND COMORBID DEPRESSION IN MALAWI
Author(s): Maria Faidas1, Melissa Stockton1, Nivedita Bhushan2, Brian Pence1, Steve Mphonda3, Haley Hedrick2, Griffin Sansbury1, Twambilile Phanga4, Laura Ruegsegger1 and Jackson Devadas1
Affiliation(s):
1.University of North Carolina, Chapel Hill
2.RTI International
3.UNC Project Malawi
4.Twambilile Phanga- UNC Project Malawi
Email: maria_faidas@med.unc.edu

Introduction: Among 65,000 adolescents living with HIV (ALWH) in Malawi, nearly 19% also suffer from depression. Not only is HIV stigma a major contributor to depression, but it also adversely impacts engagement with HIV care, particularly adherence to antiretroviral therapy (ART) and appointment attendance. ALWH in Malawi experience HIV stigma as stereotyping, social exclusion, low social support, and abuse; and these experiences are associated with poor mental health. Despite recognition of the deleterious effects of HIV stigma and discrimination in this population, we have limited knowledge of how stigma is experienced by ALWH. Objective: In this analysis, we use the Health Stigma and Discrimination framework to describe stigma faced by depressed ALWH in Malawi, and its impact on health and social wellbeing.
Methods: As part of our formative work adapting the Friendship Bench, a counselling intervention, for ALWH, we recruited 25 ALWH from ART clinics in Lilongwe for in-depth interviews, social support mapping sessions, and a focus group discussion.
Results: Analyses identified the major drivers of HIV stigma as fear of HIV transmission, and stereotyping ALWH as weak and unhealthy. The most common manifestations of HIV stigma were gossip, overt mockery, and physical and social distancing. Decreased adherence to antiretroviral therapy was a commonly cited outcome of HIV stigma. Broader impacts of HIV stigma include social exclusion, decreased quality of life, substance use, and worsened mental health.
Conclusion: This study is the first to specifically describe the stigma and discrimination faced by depressed ALWH in Malawi. It verifies our prior knowledge that stigma is a significant barrier to healthcare and negatively impacts quality of life. Further studies specifically focused on stigma are needed to better characterize this process, identify potential solutions, and develop stigma reduction interventions for depressed ALWH in Malawi.

P136_001948. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES AMONG CHILDREN AND ADOLESCENTS ATTENDING “ART TEEN CLUBS” IN MZUZU CITY IN NORTHERN MALAWI: A CROSS-SECTIONAL STUDY
Authors: Paul Uchizi Kaseka1*, Maggie Zgambo2, Balwani Chingatichifwe Mbakaya3,4, Mathews Lazarus5, Obed Nkhata6, and Fatch W. Kalambo2
Affiliation(s):
2.Paediatric Department, Zomba Central Hospital, Zomba, Malawi
3.School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
4.Public Health, University of Livingstonia, Mzuzu, Malawi
5.Nursing and Midwifery Department, Mzuzu University, Mzuzu, Malawi
6.Basic Department, Kamuzu University of Health Sciences, Lilongwe, Malawi
7.Investigations Department, Nurses and Midwives Council of Malawi, Mzuzu, Malawi
Email: kasekapaul2016@gmail.com

Introduction: While triple anti-retroviral therapy (ART) has improved HIV-infected children surviving into adolescence and adulthood, these children remain vulnerable to HIV-related psychological disturbance due to both the direct HIV infection effects on the brain and indirect effects related to coping with a range of medical, psychological and social stresses associated with HIV, which makes it vital to identify their mental health needs.
Objectives: The study was conducted to determine the prevalence of emotional and behavioural problems among children and adolescents attending “ART teen club” in Mzuzu City and to identify demographic and clinical factors that were associated with emotional and behavioural problems among this population.
Methods: This was a cross-sectional descriptive study design involving participants aged 10 to 19 years using a Chichewa version of the Strengths and Difficulties Questionnaire. Data were analyzed using descriptive analysis and logistic regression.
Results: Based on the four-band categorization of the SDQ, higher scores for total difficulties score were observed in 72.9% of the children. Children had higher scores in peer problems (62.8%), emotional (68.2%), conduct (68.6%) and prosocial (57.8%) subscales while lower scores were identified in the hyperactivity (16.6%) subscale. Multivariate binary logistic regression indicate that children who do not have a single parent (AOR 3.404; 95% CI:1.563-7.416, p=0.002) had 3.404 odds of having abnormal mental health status unlike those children with a single parent and children who were in WHO HIV clinical stage 2 (AOR 2.536; 95% CI:1.005-6.395, p=0.049) or 3 and 4 (AOR 8.459; 95% CI:1.5.820-10.544, p<0.001) had more odds of having the mental disorder as compared with those in WHO HIV clinical stage 1.
Conclusion: Addressing mental health needs like the provision of culturally appropriate screening guidelines, having a good viral load monitoring schedule and allocating mental health staff in the ART teen clubs may improve mental health among these children.

P137_001965. CAN A SHORT EDUCATIONAL VIDEO BE USED TO REDUCE STIGMA AND INCREASE KNOWLEDGE OF POSTPARTUM PSYCHOSIS AMONG HEALTHCARE WORKERS IN THYOLO, MALAWI?
Authors: Gloria Kalolo1, Emily Garman2, Dalitso Ndaferankhande3, Robert C Stewart4, and Carrie Brooke-Sumner5
Affiliation(s):

1. Kamuzu University of Health Sciences
2. University of Cape Town
3. African Alliance for Maternal Mental Health
4. University of Edinburgh
5. South African Medical Research Council

Email: gkalolo@kuhes.ac.mw
Introduction: Postpartum psychosis (PP) is a severe mental illness affecting 1-2 per 1000 women soon after delivery. Late diagnosis and treatment carry risk of harm to both the mother and her infant. Lack of knowledge and stigmatizing attitudes amongst health workers may lead to late identification and initiation of treatment.
Objective: To assess whether a short video-based educational tool changes in knowledge and attitudes towards postpartum psychosis among healthcare workers in Thyolo District.
Methods: A 10-minute video-based educational tool about PP in Malawi was developed that included interviews with people with lived experience (PWLE) of PP and mental health experts. Using convenience sampling, 20 health centers were selected where all healthcare workers were invited to participate. A total of 126 participants were recruited and 96 completed both pre and post-training assessments. Pre- and post-training quantitative assessment of knowledge and skills was conducted using the Mental Health Knowledge Schedule (MAKS) and Mental Illness Clinicians’ Attitudes Scale (MICA).
Results: 54% of the participants were clinicians and 46% nurses. 56% were female and mean age was 33. The unadjusted paired sample t-tests showed significantly higher MAKS scores in post-test (mean = 23.1, SD = 2.5) compared to pre-test (mean = 21.9, SD= 2.9), with a mean difference from pre to post MAKS score of 1.2 (95% CI 1.91 to 0.53). The MICA scores were significantly lower in MICA post-test (mean = 37.9, SD = 8.5) than pre-test (mean = 40.5, SD = 8.17), with a mean difference of -2.6 (95% CI -0.56 to -4.46).
Conclusion: There was an improvement in knowledge about and attitudes towards PP among health workers after exposure to the video. This adds to the literature that combining social contact and education reduces stigma. This tool could be used to reduce stigma and improve management of PP in Malawi.

P138_002013. ASSESSING LEVELS OF DISABILITY AMONG PERINATAL WOMEN WITH MAJOR DEPRESSIVE DISORDER IN NENO DISTRICT, MALAWI.
Author(s): Stellar Chibvunde1, Amruta Houde2, Moses Banda1, Kondwani Mpinga1, Myrah Kamwiyo1, Michael Harawa1 and Fabien Munyaneza1
Affiliation(s):
1.Partners in Health/Abwenzi Pa Za Umoyo
2.Partners in Health- Boston
Email: schibvunde@pih.org

Introduction: Depression is one of the leading causes of disability worldwide. Disability, as defined by WHODAS, refers to the challenges and limitations individuals face in carrying out activities and participating in various life domains due to impairments, health conditions, or functional restrictions. Globally, depression accounts for 5% of disability. Among perinatal women, the estimated prevalence of depression is 27.4%, while in Malawi, the prevalence is estimated at 18.9%. We examined the levels of disability among perinatal women in Neno District, Malawi. The analysis will ultimately contribute to guiding more effective interventions for this vulnerable population.
Objective: To assess the levels of disability among perinatal women in Neno District, Malawi
Methods: As part of Many Voices Initiative to treat major depressive disorder among perinatal women in Neno District, Malawi, 161 perinatal women were screened for disability using the WHODAS. We conducted univariate analysis to determine the levels of depression behavior, as well as multivariable linear regression analyses to investigate predictive sociodemographic characteristics of overall disability.
Results: We found high overall disability with 73% reporting above average disability across all the 12 items of disability among perinatal women. This included a prevalence of 69% for any perinatal women who had difficulties in joining in community activities in the same way as anyone else can, 59% prevalence for those who had difficulties in Concentrating on doing things for ten minutes and 55% for those that had difficulties Standing for long periods such as 30 minutes. Increased depression symptomology was associated with high disability (B = 0.771, P <0.00) controlling for age and gestation age.
Conclusion: Disability is elevated among perinatal women in Malawi. Timely interventions targeting depression and other causes of disability should be implemented to address this problem in Neno District and beyond.

P139_002033. ADAPTATION AND VALIDATION OF CHICHEWA AND CHITUMBUKA VERSIONS OF A SCREENING MEASURE FOR GENERALISED ANXIETY DISORDER, THE GAD-7.
Author(s): Jullita Kenala Malava1, Rebecca Nzawa-Soko1, Japhet Myaba2, Andrew Matchado2, Madalitso Makhalira3, Manson Msiska4, Tommy Mthepheya3, Joseph Mkandawire2, Innocent Nyanjagha1, Eric Umar2, and Robert C. Stewart 1, 5
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit (MEIRU)
2.Kamuzu University of Health Sciences (KUHeS)
3.Ministry of Health, Government of Malawi
4.Saint John of God Hospitaller Services, Malawi
5.University of Edinburgh, UK
Email: alavajkenala@gmail.com

Introduction: Large population-based epidemiological studies that include mental health conditions (such as the Generation Malawi and Health Lives Malawi cohorts) require valid mental health screening tools.
Objectives: We set out to translate, adapt and validate the GAD7, a 7-item screening measure for generalised anxiety disorder, for use in Chichewa and Chitumbuka speaking populations in Malawi.
Methods: We undertook a rigorous process of translation, adaptation, expert review, cognitive interviewing, and piloting of the GAD7. The final versions were administered by trained fieldworkers to convenience samples of women and men in rural southern Karonga district and urban Lilongwe Area 25. A weighted random sub-sample of participants were interviewed by mental health clinicians (blind to GAD7 scores) to determine “gold-standard” diagnosis of generalised anxiety disorder using the Structured Clinical Interview for DSM-5 (SCID). We calculated a measure of internal consistency (Cronbach’s alpha) and evaluated criterion validity by plotting Receiver Operating Characteristic (ROC) curves and calculating weighted area under the curve (AUC) estimates.
Results: The adapted measures demonstrated face and construct validity. Adaptations included changing the items from self-response to question format, and the use of a visual response aid. In the Karonga site, 392 participants were screened with the GAD7 (using mainly the Chitumbuka version) of whom 297 had a SCID interview. In Lilongwe Area 25, 458 participants were screened (using only the Chichewa version) of whom 251 had a SCID interview. The internal consistency (Cronbach’s alpha) was 0.883 in Karonga and 0.804 in Lilongwe. AUC was 0.731 (95%CI 0.696-0.751) in Karonga and 0.833 (95%CI 0.783-0.841) in Lilongwe.
Conclusion: The Chichewa and Chitumbuka versions of the GAD7 showed utility as brief screening measures for detection of generalised anxiety disorder in population cohort studies in urban and rural Malawi. Identified limitations were issues of fieldworker training and the cultural appropriateness of the visual aid.

P140_002035. PREVALENCE AND FACTORS ASSOCIATED WITH DEPRESSION AMONG WOMEN SEEKING POST-ABORTION CARE SERVICES AT KAWEMPE NATIONAL REFERRAL HOSPITAL
Author(s): Kamlongera Deborah Modie1,4, Keesiga Annette2, Abbo Catherine3, and Barageine Justus Kafunjo4
Affiliation(s):
1.Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University
2.Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
3.Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University
4.Kamuzu Central Hospital, Lilongwe, Malawi
Email: dkamlongera93@gmail.com

Introduction: Literature has shown that women experiencing an abortion have psychological distress and some are diagnosed with affective disorders including depression. However, despite the many women with abortions seen at Kawempe National Referral Hospital (KNRH), the prevalence of depression in this population is not known.
Objectives: This study aimed at determining the prevalence and factors associated with depression among women seeking post-abortion care (PAC) services at KNRH.
Methods: A cross-sectional study was conducted from 6th April to 7th July 2023 among 345 women seeking PAC at KNRH. Beck’s depression inventory (BDI-II) was used to assess depression and an interviewer-administered questionnaire for potential associated factors. Data was entered using KoboToolBox, cleaned and exported to STATA version16.0 for analysis. The prevalence was calculated as a ratio with the number of those screening positive for depression as the numerator and the number of all participants as the denominator. Logistical regression was used to analyze the potential associated factors with p<0.05 considered significant at multivariate analysis.
Results: The prevalence of depression was 11%, with 7.8% having mild, 2.3% moderate, and 0.9% severe forms of depression. Significant associated factors were being a housewife (AOR 3.72, 95% CI: 1.34-10.32; p = 0.011), being employed (AOR 3.01, 95% CI: 1.06-8.93; p = 0.039), having a monthly income of <100,000 Ugandan Shilling (AOR 3.73, 95% CI: 1.24-6.91; p = 0.014), a prior abortion(s) (AOR 2.57, 95% CI: 1.23-5.39; p = 0.012), and having a complication following the recent abortion (AOR 4.51, 95% CI: 1.90-10.67; p = <0.001).
Conclusion: Grief counselling should be routine when offering PAC services. Screening for depression should be part of follow-up care and linkage to psychiatric care done where needed. A similar study should be replicated in Malawi to determine if depression in this population is as prevalent.

P141_002039. ADAPTATION AND VALIDATION OF CHITUMBUKA AND CHICHEWA VERSIONS OF THE PHQ 9, A SCREENING MEASURE FOR DEPRESSION, FOR USE IN POPULATION-BASED EPIDEMIOLOGICAL STUDIES IN MALAWI.
Author(s): Japhet Myaba1, Julitta Kenala Malava2, Rebecca Nzawa-Soko2, Andrew Matchado1, Madalitso Makhalira3, Manson Msiska4, Tommy Mthepheya3, Joseph Mkandawire1, Innocent Nyanjagha2, Eric Umar1, and Robert C. Stewart1,5
Affiliation(s):
1.Kamuzu University of Health Sciences (KUHeS)
2.Malawi Epidemiology and Intervention Research Unit (MEIRU)
3.Ministry of Health, Government of Malawi
4.Saint John of God Hospitaller Services, Malawi
5.University of Edinburgh, UK
Email: jmyaba@kuhes.ac.mw

Background: The PHQ-9 is a screening measure for depressive disorder. Although a validated Chichewa version of the PHQ-9 exists but there is no Chitumbuka version.
Objectives: We set out to translate, adapt and validate a Chitumbuka version of the PHQ-9 for use in Karonga district as well as a revised Chichewa version to allow comparable data to be collected in in Lilongwe.
Methods: We undertook a rigorous process of translation, adaptation, expert review, cognitive interviewing, and piloting. The final versions were administered by fieldworkers to convenience samples of women and men. A weighted random sub-sample of participants were interviewed by mental health clinicians (blind to PHQ-9 scores) to determine “gold-standard” diagnosis of Depressive disorder using the Structured Clinical Interview for DSM-5 (SCID). We calculated a measure of internal consistency (Cronbach’s alpha) and evaluated criterion validity by plotting Receiver Operating Characteristic (ROC) curves and calculating weighted area under the curve (AUC) estimates.
Results: The adapted measures demonstrated face and construct validity. Adaptations included splitting the psychomotor activity item into 2 items. In the Karonga site, 392 participants were screened (using mainly the Chitumbuka version) of whom 297 had a SCID interview. In Lilongwe Area 25, 458 participants were screened (using only the Chichewa version) of whom 251 had a SCID. Internal consistency (Cronbach’s alpha) was 0.859 in Karonga and 0.749 in Lilongwe. AUC for detecting minor-or-major depression was 0.739 (95%CI 0.709-0.755) in Karonga and 0.762 (95%CI 0.732-0.778) in Lilongwe. The AUC for detecting major depression was 0.646 (95%CI 0.596-0.674) in Karonga and 0.81 (95%CI 0.767-0.818) in Lilongwe.
Conclusion: The Chitumbuka/Chichewa versions of the PHQ-9 showed utility as screening measures for detection of depression although accuracy in identifying major depression was only moderate for the Chitumbuka version. Identified limitations were issues of fieldworker training and the cultural appropriateness of the visual aid.

P142_002079. THE PREVALENCE AND ASSOCIATED FACTORS OF MENTAL HEALTH DISORDERS AMONGST FRONTLINE HEALTH CARE WORKERS DURING THE COVID-19 PANDEMIC IN MALAWI: A CROSS SECTIONAL STUDY
Author(s): Clara Sambani1,2, Gloria Kalolo3, Mzee Chalira4, McClear Masambuka1, Victor Chikwapulo2, Clement Seven2, Regina Mankhamba2, Dzinkambani Kambalame2, Collins Mitambo2, Evelyn Chitsa Banda2, and Micheal Udedi5
Affiliation(s):
1.Malawi Ministry of Health Kasungu District Hospital
2.Public Health Institute of Malawi
3.Kamuzu University of Health Sciences
4.Malawi Ministry of Health Kamuzu Central Hospital
5.Malawi Ministry of Health Directorate of Curative and Medical Rehabilitation Services
Email: cmsambani@gmail.com

Background: The COVID-19 pandemic intensified the demand for healthcare services especially in resource strained settings like Malawi. Healthcare workers (HCWs) worked longer shifts with shortages of medical supplies. The impact of COVID-19 on mental health of frontline HCWs has not been adequately studied in Malawi.
Objective: To assess the prevalence and associated factors of mental health disorders amongst frontline HCWs during the COVID-19 pandemic.
Methods: We conducted a cross-sectional study in districts with high and low burden COVID-19 in Malawi. The study was conducted in October, 2022 and 270 frontline HCWs were interviewed. Data was collected on symptoms of anxiety, depression and Post-Traumatic Stress Disorder (PTSD) during the peak of COVID-19 and off-peak and compared the prevalence between the sites and peaks. We used both descriptive and inferential statistics for analysis.
Results: Almost 80% of the participants were between 25 and 35 years. Majority (53.3%) were males. The prevalence of anxiety and depression increased during the peak of COVID-19 (7.04% to 22.96% and 12.96% to 34.81 respectively) and PTSD was at 10%. The high burdened districts had higher risk for anxiety (OR 9.67) and depression (OR 1.17). The HCWs who were placed in isolation and with extended families were likely to get anxiety (OR 2.16 and 2.38 respectively). HCWs who attended tertiary education (OR 2.30), whose family members had chronic diseases (OR 2.95) and having a family history of mental illness (OR 2.03) had a higher risk of depression. The HCWs having family members with chronic diseases and those who worked beyond 7 days at treatment centres were 4 times more likely to develop PTSD.
Conclusion: The HCWs suffered from mental health disorders during the COVID-19 pandemic. There is need to establish and strengthen transparent systems to support the HCWs at risk of developing mental health disorders during pandemics.

P143_002092. CULTURAL AND SOCIAL FACTORS ASSOCIATED WITH GENERAL ANXIETY DISORDER AMONG ADOLESCENT MOTHERS DURING THE POSTPARTUM PERIOD IN MALAWI: A CROSS SECTIONAL SURVEY.
Author(s): Chimwemwe Tembo1, Linda Portsmouth 2 and Sharyn Burns 2
Affiliation(s):
1.St John of God Malawi
2.Curtin University Perth Australia
Email: chimweptembo@yahoo.co.uk

Introduction: The postnatal period is an important time for adolescent mothers to regain their health as they adjust to life with their infants. However, it is also a time when mothers are vulnerable to mental health problems. General Anxiety Disorders (GADs) are among the common mental disorders that can impact mothers. Anxiety disorders can have adverse effects on the child’s cognitive development. However, there is scarcity of studies pertaining to anxiety disorders among adolescent mums in Malawi.
Objective: The main aim was to establish the prevalence of GAD among adolescent mothers and identify the cultural and social factors that influence anxiety in this population.
Methods: A cross-sectional survey was conducted among adolescent postnatal mothers aged 19 and below. Two stage random sampling method was used to select participants. The General Anxiety Disorder (GAD) Scale was used to assess anxiety. Adolescent mothers were recruited from Mitundu Rural hospital catchment area in Lilongwe district, Malawi.
Results: A total of 395 adolescent mothers participated in the study. The response rate was 99.5%. Thirty-four per cent were between the age of 14-17. The prevalence of probable GAD (GAD -7 ≥ 10) was 31.9%. Experiencing Intimate Partner Violence (IPV) increased the likelihood of experiencing GAD (OR 5.1, p=0.02, CI; 1.36 – 19.89), while those who had a contact with a health worker postnatally were less likely to report GAD (OR 0.4, p=0.03, CI; 0.21-0.88) and those who were ‘not prayerful’ were less likely to present GAD (OR, 0.02, P= 0.02, CI; 0.23-0.89). Participants whose family were not involved in decisions regarding their care were 2.3 times more likely to present symptoms of GAD (OR 2.3, p =0.03, CI; 1.04 -5.21).
Conclusion: The prevalence of probable GAD among adolescent mothers is higher compared to older women in this population. We, therefore, recommend policies and guidelines that will prioritize the maternal mental health of adolescent mothers in Malawi. There is a need for targeted and universal culturally appropriate interventions.

P144_002126. INFORMAL CAREGIVER’S BURDEN FOR ADOLESCENTS WITH MENTAL HEALTH DISORDER AND HIV/AIDS AND MENTAL HEALTH DISORDER CO-MORBIDITIES IN LILONGWE, MALAWI
Author(s): Esther C. Chakani1,2 and Eric Umar 1
Affiliation(s):
1.Kamuzu University of Health Sciences
2.Saint John of God Hospitaller Service- Lilongwe
Email: escchakani@gmail.com

Introduction: Adolescents living with HIV (ALHIV) are more likely to experience mental health problems and disorders including mood disorders, psychosis and suicidality. Caring for people with such comorbidities is arduous. This is even more burdensome for informal caregivers in low-income context.
Objectives: The study set out to explored the burden and challenges that informal caregiver of adolescents living with HIV/AIDS and Mental Health Disorder co-morbidities experienced. The study also established the roles of informal caregivers, identified the experiences of caregivers and explored how the challenges experienced could be addressed.
Methods: An in-depth qualitative study employing thematic analysis was conducted in to explore the burden and challenges experienced by informal caregivers, thus lay people who provide care to a sick family member. A total of 20 informal caregivers of adolescent patients with HIV/AIDS and mental disorder co-morbidities who received services at two specialist mental health facilities in Lilongwe, Malawi participated in this study. The study was guided by the Burden of Treatment Theory.
Results: Three themes emerged from this analysis. In term of burden for informal care giving, include 1) anxiety doing roles without training, 2) emotional distress, and 3) economic burden. Informal caregivers take up some roles of care that health care workers or the hospital in general is supposed to provide without being trained, hence experience anxiety in undertaking such activities. Informal caregivers experience emotional distress as they provide care. A majority of the informal caregivers suffer major economic burden as caring for an individual with mental health illness limits their economic activities.
Conclusion: Informal care providers to sick family members with co-morbidities that include mental health could particularly experience profound caregiving burden. These care providers may need adequate support for them to provide proper care to the patients as well as nurture their own health during the process.

P145_002155. THE RELATIONSHIP BETWEEN SOCIAL SUPPORT AND PSYCHOLOGICAL DISTRESS AMONG FAMILY CAREGIVERS OF PALLIATIVE PATIENTS
Author(s): Ian Matandika 1, 2, Modai Mnenula 1, & Prosper Lutala 1
Affiliation(s):
1.Department of Family Medicine, Kamuzu University of Health Sciences
2.Nsanje District Hospital, Ministry of Health, Malawi
Email: ismatandika@gmail.com

Introduction: Caring for palliative patients offers a significant burden because the caregiver must provide physical, psychological, social, and spiritual support. Finding ways to support informal caregivers is important to improve their quality of life and that of the palliative patients.
Objective: The aim of the study was to assess social support and its association with psychological distress among family caregivers of patients attending palliative care services at Nkhoma mission hospital and Neno district hospital in a rural setting in Malawi.
Methods: 308 adult caregivers of palliative patients attending palliative care services at Nkhoma mission hospital and Neno district hospital in Malawi were recruited. Data was collected between November 2022 and February 2023 using the Self Reporting Questionnaire (SRQ) and Multidimensional Scale of Perceived Social Support (MPSS). All categorical data was analyzed and presented in percentages and frequencies and continuous data was summarized as mean and standard deviation. Significant associations were established using logistic regression.
Results: Out of 308 participants, only 176(57.1%) participants reported receiving social support with 129(41.9%) participants reporting psychological distress. Participants in Nkhoma were more than six times likely to receive social support (risk ratio [RR] 6.69; 95% CI 3.11-14.37, p<0.001) than Neno and overall, female caregivers were more than twice likely to receive social support (RR 2.23 95% CI 1.17-4.38, p<0.016). Psychological distress was more likely to develop among care givers who reported social support from a friend (RR 2.21 95% CI 0.67-2.07, p<0.004) or significant other (RR 1.94 95% CI 1.10-3.43, p<0.023) compared to those who received social support from family (RR 1.18 95% CI 0.67-2.07, p<0.562).
Conclusion: Informal caregivers of palliative patients were more likely to develop psychological distress and this risk increased when the social support was not coming from family. We recommend further studies to explore other causes of psychological distress and interventions other than social support to prevent development of psychological distress among informal caregivers of palliative patients.

P146_002189. QUALITATIVE FEEDBACK ON IDEAS FOR HOPE, A BRIEF TELEHEALTH COUNSELLING INTERVENTION ADDRESSING SUICIDALITY FOR PEOPLE LIVING WITH HIV IN URBAN SETTING, NORTHERN TANZANIA
Author(s): Theodora Khofi1, Paul Ngangula2, Ismail Amiri2, Elizabeth F. Msoka2,3,4, Kim Madundo4,5, Clotilda S. Tarimo3, Victor Katiti3,5, Louise Joel4, Jackline Rwakilomba4, Blandina T. Mmbaga2,3,4,5, Michael V. Relf2,6, David B. Goldston7, and Brandon A. Knettel2,6
Affiliate(s):
1.University of Global Health Equity, Butaro, Rwanda
2.Duke Global Health Institute, Durham, NC, USA
3.Kilimanjaro Clinical Research Institute, Moshi, Tanzania
4.Kilimanjaro Christian Medical Centre, Moshi, Tanzania
5.Kilimanjaro Christian Medical University College, Moshi, Tanzania
6.Duke University School of Nursing, Durham, NC, USA
7.Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
Email: theo.khofi@gmail.com

Background: People living with HIV (PLWH) face an elevated risk of mental health challenges, including suicidality. However, there is a gap in interventions addressing suicidality in this population, especially in Africa.
Objectives: This qualitative study aimed to assess the quality and feasibility of a brief telehealth counseling intervention designed to address suicidal ideation among PLWH in Moshi, Tanzania.
Method: The IDEAS for Hope intervention combines (1) suicide screening, (2) HIV education, (3) HIV treatment adherence strategies and stigma reduction, and (4) problem-solving regarding underlying social challenges, with a goal of fostering hope among PLWH in Tanzania. We conducted a pilot randomized controlled trial involving 60 PLWH attending routine HIV appointments in two urban clinics. Participants were randomly assigned to the comparison group (a single brief safety-planning session) or the intervention group (the three-session IDEAS for Hope program). Telehealth sessions were administered by two trained telehealth nurse-counselors based at a referral consultant hospital. Three months post-enrollment, participants completed a follow-up survey to evaluate intervention feasibility and acceptability. Open-ended responses from this survey were thematically analyzed.
Results: Participants were nearly universal in considering the IDEAS for Hope sessions helpful in reducing suicidal thoughts and increasing hope. Participants described several mechanisms for positive changes in their mental health, including enhanced ability to cope with stigma and increased seeking of social support. Self-reported HIV-related outcomes were also positive, including improved clinic attendance and medication adherence. Participants described enhanced problem-solving leading to improved economic empowerment; however, some encountered persisting socioeconomic challenges.
Conclusions: Initial findings suggest that brief telehealth interventions like IDEAS for Hope are feasible and acceptable for PLWH experiencing suicidal ideation regionally. While such interventions show promise in helping individuals cope with ideation, persistent socioeconomic challenges remain unaddressed by counseling alone. Future interventions should further address economic empowerment with more intensive, practical support.

NON-COMMUNICABLE DISEASES
P147_001818. THE ROLE OF METFORMIN IN LIVER LIPID METABOLISM IN TYPE 2 DIABETES
Author(s): Symon Fidelis Nayupe1,2; Gopika K Suresh1, Abhirami S1, Mani Sebastian1, Maya G Pillai1 and Helen Antony1
Affiliation(s):
1.Department of Biochemistry, University of Kerala – Kariavattom Campus, Thiruvananthapuram, Kerala, India
2.University Private Clinic, Kamuzu University of Health Sciences – Mahatma Gandhi Campus, Blantyre, Malawi
Email: snayupe@kuhes.ac.mw

Introduction: Diabetes mellitus, a metabolic condition characterised by elevated blood glucose levels resulting from immune-mediated processes and metabolic stress-induced β-cell destruction or dysfunction, is a global health concern, with type 2 diabetes being more prevalent than type 1. It significantly contributes to morbidity and mortality due to complications, including dysregulated lipid metabolism (dyslipidaemia) linked to an increased risk of cardiovascular issues. Experiments in some animal and cell culture models have shown
the potential benefits of metformin on lipid metabolism in type 2 diabetes.
Objective: The main objective was to investigate metformin’s role in liver tissue lipid metabolism. Specifically, its effects lipogenic enzymes, namely, HMG-CoA reductase, glucose-6-PO4 dehydrogenase, and malic enzyme, its effect on apolipoprotein metabolism and the overall effect on lipid profiles.
Methods: Sprague Dawley rats were grouped into three groups: Normal (Group I), Diabetic (Group II) and Diabetic metformin-treated (Group III). Group I was on a regular diet, while a high-fat diet was given to Group II and III rats to induce obesity, followed by inducing diabetes by intraperitoneal streptozotocin administration (25mg/kg). Group III rats were treated with oral metformin (150mg/kg/rat/day) for 28 days. Lipid profile analysis was done using UV-Vis spectrophotometry, enzyme activities were analysed using enzyme kinetic methods, and enzyme-linked immunosorbent assay (ELISA) was used to analyse apolipoprotein concentration.
Results: There was a significant reduction in liver tissue concentration of cholesterol, triglycerides, free fatty acids, and phospholipids among metformin-treated diabetic rats compared to untreated rats. Metformin treatment significantly decreased HMG-CoA reductase, glucose-6-PO4 dehydrogenase, and malic enzyme activities. There was no significant difference in Apo-A concentration in all groups, but Apo-B was significantly reduced in treated rats.
Conclusion: This study demonstrated metformin’s ameliorating effects on liver lipid metabolism. This suggests that, besides its anti-glycaemic use, metformin has therapeutic potential for managing lipid-related complications, particularly in the liver.

P148_001823. MANAGEMENT PRACTICES FOR THE CARE OF PATIENTS WITH HYPERTENSION IN THE BLANTYRE DISTRICT OF MALAWI: A QUANTITATIVE CROSS-SECTIONAL DESIGN
Author(s): Nesto Tarimo1 and Julie Phillips2
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Rehabilitation Sciences, Blantyre, Malawi
2.University of the Western Cape, Department of Physiotherapy, South Africa
Email: ntarimo@kuhes.ac.mw

Introduction: Hypertension (HTN) is a global health issue, especially in low-income countries like Malawi. Management practices that combine drug therapy and lifestyle change are considered effective in treating and controlling HTN.
Objective: To assess HTN management practices among healthcare professionals (HCPs) in Blantyre, Malawi.
Methods: A quantitative cross-sectional design using a self-administered questionnaire was employed. A convenient sample of 67 HCPs was obtained from health centres. The data was analyzed using STATA 14.2. Socio-demographic characteristics were summarized using descriptive statistics, and Chi-square tests at the 0.05 alpha level tested the relationships between categorical variables. Ethics requirements were sought and followed.
Results: Over half (55.2%) of the sample were female, 42 (62.7%) were between 25 and 34 years old, and 33 (49.3%) had a diploma as a high qualification (p = 0.358). Most HCPs, 32 (47.8%), had less than 5 years of experience (p = 0.514). HTN management training was lacking in 57 (86%) of HCPs. In particular, nearly 70% of HCPs had trouble diagnosing HTN, and 36 (59.0%) did not follow treatment guidelines. Lifestyle counseling is mostly focused on diet 59 (90.8%) and smoking cessation 54 (81.5%). Most HCPs, 41 (62.1%), provided physical activity counseling and its benefits, but 38 (59.4%) did not make a plan or educate patients about proper exercise. Just 28 (42.4%) reported “”occasionally”” discussing treatment goals with patients.
Conclusion: The results show a lapse in the management practices for HTN in the Blantyre district of Malawi. A lack of knowledge about HTN management and treating without guidelines makes diagnosis and treatment difficult. Providing HCPs with HTN management knowledge and the utilization of treatment guidelines during care is essential.

P149_001826. SHORT-TERM HYPOXIA ATTENUATES ANGII AND MIR-6315 INDUCED SUPPRESSION OF MAS1 AND CARDIAC INJURY TO ENHANCE CARDIOMYOCYTE SURVIVAL
Author(s): Shang-Yeh Lu1,2,3, Wei-Wen Kuo4, Chia-Hua Kuo5,6, Pei-Ying Pai1, Tzu-Ching Shih2, Michael Yu-Chih Chen7, Kuan-Ho Lin2,8, Dennis Jine-Yuan Hsieh9,10, Thomas Gabriel Mhone3, Chih-Yang Huang3,11,12,13,14
Affiliation(s):
1.Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
2.College of Medicine, China Medical University, Taichung, Taiwan
3.Graduate Institute of Medical Science, China Medical University, Taiwan, ROC.
4.Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan
5.Laboratory of Exercise Biochemistry, University of Taipei, Taipei, Taiwan
6.Department of Kinesiology and Health Science, College of William and Mary, Williamsburg, VA, USA
7.Department of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
8.Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
9.School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
10.Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
11.Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
12.Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
13.Department of Biotechnology, Asia University, Taichung, Taiwan
14.Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Taiwan
Email: thommhone@gmail.com

Introduction: Mas1 G protein-coupled receptor (MAS1) vasodilative and proliferative effects are important for counteracting Angiotensin II (ANGII) hypertensive effects and therefore, rendering cardioprotective effects. Thus, targeting MAS1 activation may be a cardioprotective strategy in the management of hypertension-induced ischemic heart disease and reduce the risk of heart failure. HIF1a activation and miRNAs regulation are amongst essential hypoxia adaptive responses to cope with oxygen unavailability and ensuring cardiac tissue perfusion restoration. Objective: Aimed at investigating the cardioprotective role of MAS1 and HIF1a activation and miR-6315 downregulation in cardiomyocytes exposed to ANGII and short-term hypoxia.
Methods: To investigate the cardioprotective role of short-term hypoxia we performed miRNAs Profiling with Microarray in cardiomyocytes exposed to short-term hypoxia, followed by RT-qPCR, Western blot analysis, Immunofluorescence, co-immunoprecipitation, immunohistochemistry and miRNA transfection assays.
Results: Our miR array revealed a significant differential downregulation of miR-6315 in cardiomyocytes exposed to short-term hypoxia. Bioinformatic computations predicted MAS1 as possible target for miR-6315 regulation. Our data demonstrated that short-term hypoxia remarkably elevated HIF1a and MAS1expression levels, and reduced the expression levels of miR-6315 to inhibit apoptosis in H9c2 cardiomyocytes. Importantly, our results revealed that ANGII and miR-6315-mimic induced apoptosis was alleviated by short-term hypoxia and miR-6315 inhibitor. Interestingly, our data demonstrated a cardioprotective colocalization and interaction of MAS1 and HIF1a in cardiomyocytes exposed to short-term hypoxia. Finally, MAS1 expression levels were shown to be reduced with increasing age in Wistar-Kyoto rat and spontaneously hypertensive rat hearts animal model, supporting notion of increased risk of hypertension with increasing age.
Conclusion: Overall, our findings suggests that, therapeutic targeting of MAS1 activation and miR-6315 inhibition might mimic the cardioprotective effects of hypoxic preconditioning reducing the risk ischemic heart disease and myocardial infarction.

P150_001859. A QUALITY IMPROVEMENT PROJECT ON PATIENT FLOW IN A DIABETIC CLINIC IN CENTRAL MALAWI
Author(s): McDonald W. Nyalapa1, Francis Mkwenembera2, Belinda T. Gombachika1, Ellen Chirwa3 and Cath Conn4
Affiliation(s)
1.School of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Medical Outpatient Department, Kamuzu Central Hospital, Lilongwe, Malawi
3.School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
4.Auckland University of Technology Child and Youth Health Research Centre, Aotearoa, New Zealand.
Email: mnyalapa@kuhes.ac.mw

Introduction: Diabetes, a complex chronic noncommunicable disease, is a leading cause of morbidity and mortality in developing countries. This is largely attributed to poor quality of care for people living with diabetes. However, evidence suggests that quality improvement strategies have the potential for transforming diabetes care in such countries. A baseline assessment in a diabetic clinic at Kamuzu Central Hospital illuminated a lack of clear, consistent and accurate information among patients with diabetes on where to get services on diabetic clinic days. This resulted in unnecessary delays and complications as some patients were constantly being sent back for skipping a step.
Objective: To increase awareness of patients with diabetes on where to go and get services on diabetic clinic days in order to reduce patient delays and complications.
Methods: A baseline assessment was conducted using rapid surveys and observations. This was followed by the formation of an improvement team. Subsequently, a root cause analysis was conducted using the 5-Whys and Fishbone diagram. Change ideas were developed and tested using PDSA cycles. Monitoring and evaluation were done and documented in a quality improvement journal.
Results: Baseline awareness level on where to get services on clinic days was at 43%. A patient flow chart was developed and pasted on the walls of the diabetic clinic in the Medical Outpatient Department. Clinical team members were oriented to the project through a capacity building meeting. They were also constantly reminded to encourage patients to refer to the flow chart. Final evaluation demonstrated a 100% patient awareness on where to get services on diabetic clinic days.
Conclusion: The quality improvement project had a significant impact on the improvement of patient flow at the diabetic clinic. However, our initiative did not measure the waiting time; thus, opening the door for further quality improvement projects and research.

P152_001921. HIGH RATES OF UNCONTROLLED HYPERTENSION AMONG ADULTS RECEIVING INTEGRATED HIV AND HYPERTENSION CARE WITH ALIGNED MULTI-MONTH DISPENSING IN MALAWI
Authors: H. Whitehead1, K. Phiri2, P. Kalande2, J.J van Oosterhout1,2, S. Phiri1, C. Moucheraud3, A. Moses2, and R. Hoffman1
Affiliation(s):
1.University of California Los Angeles, School of Medicine, Los Angeles, United States
2.Partners in Hope, Lilongwe, Malawi
3.New York University School of Public Health
Email: khumbo@pihmalawi.com

Background: Integrated care with aligned multi-month dispensing (MMD) of antiretroviral therapy (ART) and antihypertensive medications may reduce burden of care for people living with HIV, but actual alignment of dispensing and impact on blood pressure (BP) control are not well understood.
Methods: We surveyed adults (≥18 years) on ART and antihypertensives receiving integrated care for both conditions at 8 healthcare facilities in Central and Southern Malawi from July 2021 to April 2022. Respondents were asked about frequency of visits for care and antihypertensive medication refills. We characterized dispensing and alignment of ART and antihypertensive medications, and used descriptive and bivariate analyses to explore associations with uncontrolled hypertension. A random subset of participants with uncontrolled hypertension were selected for collection and analysis of medical chart data on antihypertensive medication adjustments over the prior year.
Results: We surveyed 464 people receiving integrated HIV-hypertension care (median age 54 years [IQR 48-60], 58% female), all but five (1%) of whom reported aligned dispensing of medications. Most (63%) of those with aligned dispensing had 3-month dispensing (3MD), 31% had 4MD or 6MD, and 6% had1MD or 2MD. Among the 362 individuals with ≥2 BP readings in the prior year, 77% (n=278) had uncontrolled hypertension, and this was associated with shorter refill intervals: 81% of those with 3MD or shorter had uncontrolled hypertension, versus 67% of those with 4MD or longer (p=0.007). Of 149 participants with uncontrolled hypertension who had detailed chart reviews, only 10% (n=15) had antihypertensive medications added, discontinued, and/or switched over the past year.
Conclusion: Uncontrolled hypertension was common among Malawian adults receiving integrated HIV and hypertension care with aligned MMD, and was associated with shorter refill intervals, but very few medication changes. In Malawi and similar settings, integrated care with aligned multi-month dispensing is promising for chronic comorbidity care.”

P153_001931. IMPLEMENTING A FRIENDSHIP BENCH PROGRAM IN NON-COMMUNICABLE DISEASE CLINICS IN MALAWI. EXPERIENCES, CHALLENGES AND LESSONS LEARNED FROM SHARP STUDY
Authors: Steve Mphonda1, Kazione Kulisewa2, Mina Hosseinpour3, Brian W. Pence3, and Bradley N. Gaynes3
Affiliation(s):
1.UNC Project , Lilongwe Malawi
2.Kamuzu University of Health Sciences
3.University of North Carolina, Chapel Hill
Email: stvnmpho@yahoo.co.uk

Introduction: Depression and non-communicable diseases (NCDS) are the major contributors to the global burden of disease in terms of mortality, morbidity and disability. Despite the high burden of comorbidity, NCD patients with comorbid depression seldom access care. The SHARP project provided depression treatment using a psychosocial counselling intervention, the Friendship Bench (FB), to treat mild depression in NCD patients.
Objectives: The objective of the study was to determine successes and challenges in implementing FB evidence-based depression treatment in NCD clinics in Malawi.
Methods: The SHARP Trial integrated depression screening and treatment into routine NCD clinic care. We assessed counselor availability, sessions completed, cost, and ability to achieve quality counseling.
Results: We trained 65 peer patients from 10 district hospitals as FB counselors. Over 29 months, 1,095 patients started FB and completed 2,993 sessions (mean 2.7 sessions per patient); 10.5% of patients completed >=6 sessions. Of 69 randomly selected sessions assessed for fidelity, only 29% met the fidelity threshold. The mean symptom severity score was reduced by 51% at session 6 compared to session 1. Using peer counselors ensured counselor availability and was cost effective since they received a per diem rather than salary. Use of peer patients who were people with lived experience promoted a patient-centered care approach. The key challenge was that peer counselors required much attention and ongoing supervision to achieve quality counseling.
Conclusions: Depression co-morbid with physical NCDs worsens clinical outcomes for all conditions. There is a treatment gap in low and middle-income countries for detection and management of co-morbid depression with NCDs. The Friendship Bench, delivered by trained and supervised peer patients is a promising intervention for patients with depression and comorbid NCDs. FB can be a culturally acceptable and cost effective intervention in countries with similar mental health treatment gap in NCD care as Malawi.”

P155_001963. ORAL HYGIENE PRACTICES, KNOWLEDGE, AND SELF-REPORTED DENTAL AND GINGIVAL PROBLEMS WITH RURAL-URBAN DISPARITIES AMONG PRIMARY SCHOOL CHILDREN IN LILONGWE, MALAWI
Authors: F. Mlenga1, E G Mumghamba2
Affiliation(s):
1.ABC Community Clinic, Lilongwe
2.Muhimbili University of Health and Allied Sciences, Tanzania.
Email: mulengafransisco@yahoo.com

Introduction: Dental caries and periodontal disease are among the commonest diseases that affect the oral cavity.
Objective: To determine oral hygiene practices, knowledge, and experience of dental caries and gingival problems among urban and rural primary schoolchildren in Lilongwe District, Malawi.
Methods: This was an analytical and quantitative descriptive cross-sectional study. Four urban and four rural primary schools were conveniently sampled. Pupils aged 11-14 years (n = 409) were recruited using self-administered structured questionnaire. Data were analyzed using SPSS program v20.0.
Results: Out of 409 pupils, most of them had knowledge that dental caries is caused by consumption of sugary foodstuffs (91.4%), toothache is a symptom of dental caries (77.6%), gingivitis is caused by ineffective tooth brushing (92.7%), and gingival bleeding is a sign of gingivitis (85.3%). Most pupils experienced toothache (30.8%); many of them had parents with secondary education and above (35.0%) compared to those with primary education (23.5%). 24.4% experienced gingival bleeding with higher percentages from urban (30.1%) than rural (18.5%) schools. Plastic toothbrush users (95%) overshadowed chewing stick users (24.9%). The use of chewing stick was significantly higher in rural (49%) than in urban (1.9%) schools. Likewise, tooth brushing before bed was significantly higher in rural (33%) than in urban (17.2%) pupils. The use of toothpaste during tooth brushing was significantly higher among urban (91.9%) than among rural (64%) pupils.
Conclusion: Most pupils reported cleaning their teeth regularly, mostly using plastic toothbrush rather than chewing stick, using toothpaste, and having adequate knowledge about dental caries and gingival disease, and a quarter of them had suffered from these diseases with evidence of rural-urban disparities. Integration of oral health in school health promotion program and further research on its impact on oral health status are recommended.

P157_002037. OBSTRUCTIVE LUNG DISEASES ASSOCIATED WITH WORKPLACE EXPOSURES AMONG SMALL-SCALE TOBACCO FARMERS IN MALAWI
Author(s): Yotam M Moyo1,4, Mohamed F Jeebhay1, Roslynn Baatjies1,2, Sufia Dadabhai3 and Shahieda Adams1
Affiliations:
1.Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, South Africa
2.Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
3.Johns Hopkins-College of Medicine Project, Blantyre, Malawi
4.Worksafe Africa Limited, Malawi.
Email: director@worksafeafrica.org

Introduction: Nicotine and pesticide exposure in agricultural settings have been linked to the development of chronic respiratory disease in workers although not extensively studied in Africa.
Objectives: The aim of this study was therefore to determine the prevalence of obstructive lung disease and its relationship to concurrent nicotine and pesticide exposure among small-scale tobacco farmers in Zomba, Malawi.
Methods: A cross-sectional study was conducted enrolling 279 workers in flue-cured tobacco farms. The study outcomes were assessed using a standardised European Community Respiratory Health Survey II (ECRHS) questionnaire and Spirometry testing. The questionnaire was aimed at collecting data on sociodemographic factors, respiratory health outcomes as well as potential pesticide and nicotine exposures.
Results: The mean age of participants was 38 years with 68% being male. The prevalence of work-related oculonasal symptoms, chronic bronchitis, and work-related chest symptoms was 20%, 17%, and 29%, respectively. Airflow limitation (FEV1/FVC <70%) was found in 8% of workers. Self-reported exposure to pesticides varied from 72%- to 83%, whilst the prevalence of recent green tobacco sickness was 26%. Tasks linked to nicotine exposure, such as sowing (OR: 2.5; CI 1.1–5.7) and harvesting (OR: 2.6; CI 1.4–5.1), were significantly associated with work-related chest symptoms. Pesticide application (OR:1.96; CI 1.0–3.7) was associated with an increased risk of work-related oculonasal symptoms. Duration of pesticide exposure was also associated with obstructive impairment FEV1/FVC<LLN (OR: 5.11; CI 1.6–16.7) and FEV1/FVC <70% (OR: 4.68; CI 1.2–18.0).
Conclusions: These findings show that tobacco farmers in Malawi had a high prevalence of respiratory symptoms and airflow limitation due to obstructive lung disease. This could be attributed to nicotine or pesticide exposure in tobacco farming. The implementation of occupational health and safety measures may play an important role in modifying the risk of obstructive lung disease in this population.

P158_002058. PHYTOCHEMICAL AND IN-SILICO CHARACTERIZATION OF COMPOUNDS FROM MULTIDENTIA CRASSA (HIERN) BRIDSON & VERDC EXTRACT FOR ANALGESIC AND ANTI-INFLAMMATORY ACTIVITIES IN ORAL HEALTH DISEASES
Author(s): Ibrahim Chikowe1*, King David Bwaila2, Samuel Ugbaja3, and Amr S. Abouzied4,5
Affiliation(s):
1.Pharmacy department, Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi.
2.Pharmacy Department, Malawi College of Health Sciences, Zomba, Malawi.
3.The Department of Population Science, African Health Research Institute (AHRI), Durban South Africa.
5.Department of Pharmaceutical Chemistry, College of Pharmacy, University of Hail, Hail 81442, Saudi Arabia
6.Department of Pharmaceutical Chemistry, National Organization for Drug Control and Research (NODCAR), Giza 12553, Egypt.”
Email: ichikowe@medcol.mw

Introduction: Various plants are still in use for many diseases in oral health, but very few have been studied to generate evidence and justification for their use in these conditions and Multidentia crassa (Hiern) Bridson & Verdc is one of the understudied plants in Malawi.
Objectives: This study investigated the chemical composition and the therapeutic potential of M. crassa of Rubiaceae for pain and inflammation associated with oral health diseases.
Methods: GC-MS and FT-IR analyses were employed to identify compounds and functional groups in the extracts of this plant species. In silico pharmacokinetics tools namely pkCSM and SwissADME and pharmacodymics tool namely molecular docking were employed in evaluating the therapeutic potential of the GC-MS identified compounds by testing their binding affinities on druggable receptor proteins in dental pain and inflammation pathways that involve activation of classical cyclooxygenases and Interleukin-1 receptors, activation of odontoblast cold sensor proteins and the purinergic receptor P2X3.
Results: Fourier transform infrared spectroscopy (FT-IR) analysis of water extracts showed characteristic peaks of phenols, carboxylic acids, alkenes, alkyl halides, amines, esters, ethers, aromatics, and lipids. Gas chromatography-mass spectrometry (GC–MS) showed the presence of 58 bioactive phytocompounds that have various pharmacological activities relevant to oral health and toothache such as antimicrobial, anticancer, analgesic, and anti-inflammatory properties, among others. Molecular docking studies identified compounds with the potential for analgesic and anti-inflammatory properties such as Stigmastan-3,5-diene. To the best of our knowledge, this is the first report on the bioactive compounds of M. crassa extracts showing analgesic and anti-inflammatory effects. These study results can lead to the production of new herbal medicines for oral health and the development of new medications.
Conclusion: Subsequent investigations including in vivo and in vitro studies are needed to further elucidate the pharmacological effects of the plant extracts.

P159_002064. UNMET SUPPORTIVE CARE NEEDS OF PEOPLE LIVING WITH TYPE 2 DIABETES: A CROSS SECTIONAL STUDY OF ADULTS ATTENDING DIABETES CLINICS IN MALAWI
Affiliation(s): Madalo Gloria Kalero Kuchawo1, Lisa Whitehead2, Deborah Kirk3 and Gemma Doleman4
Affiliation(s):
1.Kamuzu University of Health Sciences, School of Nursing; Edith Cowan University, School of Nursing and Midwifery.
2.Edith Cowan University, School of Nursing and Midwifery.
3.Edith Cowan university, School of Nursing and Midwifery.
4.Edith Cowan University, School of Nursing and Midwifery; Sir Charles Gaidener Hospital, Centre for Nursing Research.
Email: mmalemba@kuhes.ac.mw

Background: Type 2 diabetes (T2D) is a chronic condition that requires a comprehensive and multidisciplinary approach including ongoing support to effectively manage it and prevent complications. We need to understand the supportive care needs of individuals with T2D to optimise their health outcomes. There is a paucity of research exploring the unmet supportive care needs of people with diabetes in low-income countries like Malawi.
Objectives: This study aimed to identify unmet supportive care needs and determine associated factors among people living with T2D in Malawi.
Methods: A cross-sectional study was conducted among a sample of 286 adults with T2D attending diabetes clinic at Kamuzu Central and Queen Elizabeth Central Hospitals in Malawi. Supportive care needs were assessed using a modified Supportive Care Needs Survey (SCNS-SF34). Descriptive statistics and binary logistic regression were used to determine the prevalence of unmet needs and associated factors.
Results: The results revealed a high prevalence of unmet supportive care needs among people living with T2D in Malawi. The most frequently reported unmet needs were related to the domains health system and information (93%), followed by patient care and support (85%), physical and daily living (80.4%), psychological (80.4%), and sexuality (70.6%). Participants age, marital status, employment status and ethnic tribe were statistically significantly associated with reporting unmet physical and daily living and sexuality needs. The odds of reporting unmet psychological needs and patient care and support needs were higher for participants at QECH.
Conclusion: The findings highlight the significant burden and the multifaceted nature of challenges faced by people with T2D in Malawi. The findings emphasize the need for targeted interventions, such as providing comprehensive patient-centred and collaborative care to improve quality of life for people with T2D in Malawi. Future research and policy initiatives should prioritize addressing the supportive care needs of individuals with.

P160_002072. A Quasi-experimental study on determinants of non-communicable disease risk factors amongst pre-hypertensive persons from Ndirande and Chilomoni Catchment area, Blantyre Malawi 2020-2021.
Author(s): Katete P.G1, Mbeba, M2, Kabuluzi K3, and Ng’ambi W3,
Affiliation(s):
1.School of Nursing-Department of Adult Nursing – Kamuzu University of Health Sciences.
2.Department of Adult Nursing – Kamuzu University of Health Sciences.
3.School of Allied Sciences: Kamuzu University of health Sciences.
Email: pkatete@kuhes.ac.mw

Introduction: One of the non-communicable diseases (NCDs), hypertension, is the main global cause of mortality and disability. One in every eight persons globally dies from hypertension each year, making it the third leading cause of death in the world. In Sub-Saharan Africa, hypertension has become a widespread public health issue, with urban rather than rural areas being more affected. Ages 30 to 50 have a 45% prevalence rate in Malawi. The two main causes of hypertension—inactivity (39%), and unhealthy eating (33%) are well-known, but no intervention study has been done to address them.
Objective: The study compared the participants in the intervention and control groups on the development of hypertension in order to ascertain the efficacy of an intervention of physical activity and a healthy diet for the prevention of hypertension in pre-hypertensive clients.
Methods: A quasi-experimental study at the households of Ndirande and Chilomoni. 20 participants—10 Ndirande intervention group members and 10 Chilomoni families. A WHO tool with 47 items was used to collect data about food, physical activity, and demography. SPSS was used to analyze the data.
Results: In the intervention group, six participants had overweight and obese pre-test BMI while post-test BMI showed that 5 participants were overweight. In the control group, four participants had overweight and obese pre-test BMI and the. post-test results showed that five were overweight and obese. Pre-test results showed that all participants, from Chilomoni and Ndirande, had stage 1 (pre-hypertensive) hypertension, while post-test results showed that two participants from Chilomoni developed hypertension. Participants in intervention group 1 had their blood pressure drop from prehypertensive to normal, while six participants were still prehypertensive after the intervention.
Conclusion: The results indicated that increasing physical activity levels and maintaining a healthy diet are necessary for preventing hypertension.

P161_002078. PREFERENCES FOR HYPERTENSION CARE AMONG PEOPLE LIVING WITH HIV IN MALAWI: A DISCRETE CHOICE EXPERIMENT (DCE)
Author(s): Risa Hoffman2, Khumbo Phiri1, Hannah Whitehead2, Pericles Kalande3, Joep J van Oosterhout1,2, Agnes Moses1, Chi-Hong Tseng2, Corrina Moucheraud2 and Sam Phiri1,3
Affiliation(s):
1.Partners in Hope, Lilongwe, Malawi
2.University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, United States,
3.School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
Email: chagstrom@mednet.ucla.edu

Introduction: Hypertension is the most common non-communicable disease diagnosed among people living with HIV (PLHIV) in sub-Saharan Africa. However, little is known about client preferences for hypertension care, including priorities and trade-offs involved in care-seeking.
Objectives: We performed a discrete choice experiment in Malawi with PLHIV and hypertension.
Methods: Participants were asked to select between two care scenarios, each with 6 attributes: distance, waiting time, provider friendliness, individual or group care, antihypertensive medication supply, and antihypertensive medication dispensing frequency (three vs one month). Eight choice sets (each with two scenarios) were presented to each individual with the assumption that care for HIV and hypertension was integrated. Mixed effects logit models quantified preferences for each attribute. Estimated model coefficients were used to predict uptake of five pairs of scenarios representing hypothetical models of HTN care.
Results: Between July 2021 and April 2022 we enrolled 501 adults from 14 facilities, median age 54 years (IQR 49-60), 58% female, with median of 4.5 years (IQR 3-7) on antihypertensives. Participants were on ART for a median of 11 years (IQR 6-15), with 99% virologically suppressed (<1000 copies/mL). Participants strongly preferred seeing a provider alone vs in a group (OR 15.4, 95%CI 13.6-17.4) (Figure, Panel A), but 66% and 51% of respondents would choose group hypertension care over individual care if the facility had other favorable attributes (Panel B, choice scenarios 1 and 2). Three-month vs monthly dispensing (OR 4.7; 95% CI 4.1-5.3), and high vs low stock of antihypertensives (OR 3.8; 95%CI 3.3-4.2) were also strongly preferred.
Conclusions: Preferences for individual care were strong in this population, but participants would theoretically accept group care if other facility/care attributes were favorable. Multi-month dispensing of antihypertensives as well as reliable drug supply were also prioritized. These findings have implications for the scale-up of integrated HIV-hypertension care in Malawi and similar settings.
P162_002089. PHYSICAL ACTIVITY LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS; BLANTYRE, MALAWI
Author(s): Chikumbutso Phiri1, Peter Ndalakwaya1, Esther Jelenje1 Fridah Gamuka1 and Nesto Tarimo1
Affiliation(s):
1.Kamuzu University of Health Sciences, Department of Rehabilitation Sciences
Email: pgndalakwaya@stud.medcol.mw

Introduction: Regular physical activity plays an important role as one of non-pharmacological management of Diabetes mellitus (DM). In Malawi there is paucity of data on physical activity levels (PAL) of patients with DM.
Objective: This study therefore aimed at assessing PAL among type 2 diabetes mellitus (T2DM) patients attending diabetes clinic at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.
Methods: A cross – sectional study collected the data of T2DM patients attending diabetes clinic at QECH. Eighty-two participants completed the study, from which 31.71% (n=26) and 68. 29% (n=56) were males and females respectively. T2DM patients aged 19 to 69 years old who consented were eligible for the study. Using the long version of International Physical Activity Questionnaire physical activities that were done within the past 7 days were recorded and categorized as low, moderate and vigorous. Anthropometrics including height (cm) and weight (Kg) were measured from which the body mass index (BMI) was calculated. Associations between PAL with BMI, gender and age were analysed using the Pearson correlation test (ρ < 0.05).
Results: Eighty-two participants were assessed: 51.22% (n=42) were in low PAL category, 28.05% (n=23) were in moderate PAL category and 20.73% (n=17) were in vigorous PAL category. Males were found to be more active than females in vigorous PAL category (ρ = 0.03). Within the low PAL category majority of participants (40.48%) were obese and majority of those with normal weight (58.82%) were within vigorous PAL category (ρ = 0.008). However, there was no association between PAL and age (ρ = 0.17).
Conclusion: Most T2DM patients attending diabetes clinic at QECH have low PAL and more females are physically inactive than males.

P163_002107. FACTORS AFFECTING OPTIMAL ASTHMA MANAGEMENT IN ADULT PATIENTS ACCESSING CARE AT THE QUEEN ELIZABETH CENTRAL HOSPITAL.
Author(s): Eltas Nyirenda Dziwani1, NPK Banda1 and J Kumwenda1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: enyirenda@kuhes.ac.mw

Introduction: Asthma is the most common chronic respiratory disease in the world. The burden of asthma is severe in developing countries due to the lack of appropriate management and control of asthma symptoms. Successful management and control of asthma symptoms would reduce the burden on the health care system.
Objective: This study aimed to explore and describe factors affecting optimal asthma management in patients accessing care at the Queen Elizabeth Central hospital (QECH) adult chest clinic.
Methods: This was a descriptive cross-sectional study targeting patients aged ≥18 years. A questionnaire and the global initiative for asthma (GINA) tool was used to determine level of asthma symptom control, and spirometry was conducted to assess lung function.
Results: One hundred and seventeen participants were recruited. The mean age was 43 years, and 92 (78.6%) were women. Thirty-six (30.8%) of participants had well controlled asthma, 37 (31.6%) had partly controlled asthma, and 44 (37.6%) had uncontrolled asthma. Factors associated with uncontrolled asthma were age range 40-64 years (P=0.03), family history of asthma (p=0.01), history of acute exacerbations (P=0.00), and symptoms of gastro esophageal reflux disease (GERD) (P=0.01). Fifty-six (47.9%) had reduced FEV1 (˂80%), and 63(57.8%) had an obstructive pattern (FEV1/FVC ratio of ˂ 70%), of which 19 (30.6%) showed no reversibility. Having an obstructive pattern was associated with uncontrolled asthma (P=0.04). At QECH, most key asthma medications were out of stock in 2019.
Conclusions: Over half of asthma patients had partly controlled and uncontrolled asthma, and over half had FEV1/FVC ratio of ˂ 70%. These findings emphasize the need for early diagnosis of asthma, the prevention of acute exacerbations, and improving asthma education including education on the correct use of inhalers. The health care system in Malawi needs to be strengthened to adequately provide asthma care and appropriate medications.

P164_002177. PREVALENCE OF PREDIABETES AND ASSOCIATED RISK FACTORS AMONG PERI-URBAN DWELLING ADULTS IN BLANTYRE, MALAWI
Authors: Grace Mukoka Bwezani1, Ndaziona Kwanjo-Banda2, Thom Kaledzera3, Adamson Muula4, Enock Chisati1,4
Affiliation(s):
1.Department of Rehabilitation Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Department of Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences and Queen Elizabeth Central Hospital, Blantyre, Malawi
3.Department of Public health, School of Public and Global Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
4.Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
Email: gmukoka@kuhes.ac.mw

Introduction: Prediabetes is a state of high risk for developing diabetes. In Malawi, there is little evidence on the prevalence of prediabetes.
Objective: The aim of the study was to determine the prevalence of prediabetes and its associated factors in Blantyre, Malawi.
Methods: This was a quantitative cross-sectional study in which data was collected from Blantyre, Malawi. The following data was collected: demographic characteristics (Age, sex, education, employment), behaviour (smoking, drinking, physical activity and eating status), Body Mass Index (BMI), blood pressure and Fasting Plasma Glucose (FPG) level. FPG of 110 – 125 mg/dl (6.1-6.9mmol/L) was used to determine the pre-diabetic state. A Chi-square test was used to find the association between risk factors and FPG. T-test was done to compare the mean difference between continuous variables and FPG. P-value of 0.05 was considered significant.
Results: A total of 215 adults with a mean age of 40±13 participated in this study. The prevalence of prediabetes was 9.3%, and 82% of all participants were not physically active. High FPG (≥110mg/dl) were significantly associated with BMI (p=0.01), High intensity – Physical activity (p = 0.02), wait-hip ratio (WHR) (p=0.01), waist circumference (p=0.01), age (p=0.01) and eating food made outside home (p=0.01).
Conclusion: There is a 9.3% prevalence of prediabetes in Blantyre, Malawi. BMI, waist circumference, WHR, physical activity and eating food made outside home were the major modifiable risk factors for prediabetes.

P165_002196. A META-SYNTHESIS OF SELF-MANAGEMENT OF MULTIMORBIDITY IN SUB- SAHARAN AFRICA: A FOCUS ON DIABETES, HYPERTENSION, HIV INFECTION AND CHRONIC KIDNEY DISEASE
Author(s): Sangwani Salimu1, Stephen Spenser1, Mellisa Taylor1, Deborah Nyirenda1, Nicola Desmond1 and Ben Morton1
Affiliation(s):
1.Malawi Wellcome Trust, Clinical Research Programme, Malawi
Email: sangwasalimu@gmail.com

Introduction: The rising rates of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is an urgent concern. Self-management, an individuals’ active management of a chronic illness in collaboration with their family members and clinicians, is central to individuals living with chronic disease to reduce secondary complications and particularly so for multimorbidity.
Objective: This review aims to identify, critically appraise, and synthesize qualitative evidence on self-management of HIV, diabetes, hypertension and chronic kidney diseases as the most prevalent chronic conditions in SSA.
Methods: We applied Sandelowsi and Barroso approach to qualitative meta-synthesis and searched PubMed, Medline, CINAHL Global Health, Google Scholar and grey literature. We synthesized 15 studies published between 2000-2023 on self-management of diabetes, hypertension, HIV and chronic kidney disease in SSA. We used a 10-point CASP-Qualitative-Checklist to assess the quality of the studies. Diabetes was the most prevalent singular disease and HIV+ hypertension was the most common combination.
Results: Self-management approaches were described in four categories: medical, diet, physical and lifestyle management. Self-management is a complex negotiation of systemic and individual factors with medication stock-outs and, limited knowledge and poverty respectively. Personal skills like decision making and problem solving demonstrate willingness improve self-efficacy for self-management. Patients’ indifference to some medical recommendations raises concerns about mental issues while physical self-management remains below optimal levels. Generally, self-efficacy to self-manage is higher among individuals with HIV or single disease than diabetes, hypertension or chronic kidney disease or multimorbid patients. Lessons from successful HIV self-management indicate that task shifting, community management could help address some systemic and cultural challenges.
Conclusion: Self-management of multimorbidity should address systemic factors and self-empower patients and their carer’s. Self-management support should consider multi-level platforms like family, communities and facilities.

P166_002208. PHYSICAL ACTIVITY LEVELS OF SELECTED BANK WORKERS IN BLANTYRE URBAN, MALAWI: A QUANTITATIVE CROSS-SECTIONAL STUDY
Author(s): Yankho Mhango1, Drolly Kachipeya1, Wandiya Chikanda1, Christina Sakhura1, Feston Sakama1, Nesto Tarimo1, and Enock Chisati2
Affiliation(s):
1.Kamuzu University of Health Sciences (KUHeS), Department of Rehabilitation Sciences, Malawi Private Bag 360 Blantyre
2.Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
Email: m201850024685@stud.medcol.mw

Introduction: Physical inactivity increases the risk of hypertension (HTN), obesity, and certain cancers. Due to the nature of their work which include prolonged sitting hours most cooperate workers such as bankers are reported to be physically inactive. However, in Malawi there is paucity of information about physical activity levels among the bank workers. Therefore this study aimed at determining the physical activity levels of bank employees in Blantyre, Malawi.
Methods: A quantitative cross-sectional study was conducted. Eighty-two bank workers (n=33 males and n=49 females) with at least two years of work experience were recruited from selected banks in Blantyre. International Physical Activity Questionnaire (IPAQ) short form version, was used to measure physical activity. Blood pressure, weight and height were measured using aneroid sphygmomanometer, weighing scale and tape measure. Data were analyzed descriptively and associations were tested using Chi-square test at 0.05 alpha level. Ethics requirements were sought and followed.
Results: Thirty-two participants (39%) had low levels of physical activity, 38 (46%) had moderate levels of physical activity, and 12 (15%) had vigorous levels of physical activity. Sixty-four (78%) of the participants had normal blood pressure, while 18 (22%) were hypertensive. Thirty-four (42%) of the participants were overweight, while 23 (28%) were obese. Low physical activity was linked to HTN, but it was not statistically significant (p=0.877).
Conclusion: The findings indicate that bank employees in Blantyre have low and moderate levels of physical activity, implying that they lead a physically inactive lifestyle. Furthermore, the majority of bank employees with low physical activity levels are hypertensive. Cooperating institutions, such as banks, must encourage and promote bank employees to live actively in order to prevent diseases such as HTN.

P168_002286. ASSESSING KNOWLEDGE, ATTITUDES AND PRACTICES ON LIFESTYLE MODIFICATION AMONG ADULT HYPERTENSIVE PATIENTS AT CHILOMONI HEALTH CENTER, BLANTYRE
Author(s): Doreen Makwinja1, Wadson Gunde1, Englate Wellings1, Asiatu Mores1, Paul Craig Katete1, Ndawona Kamanga Chitaniate1, and Mary Mbeba1
Affiliate(s):
1.Kamuzu University of Health Sciences, School of Nursing, Adult Health Nursing Department
Email: marymbeba@kuhes.ac.mw

Introduction: Hypertension is a global health concern affecting about 1.28 billion people (34% of men, 32% of women) aged 30 to 79 years worldwide (WHO, 2021). Recommended lifestyle modification which include: Dietary Approaches to Stop Hypertension (DASH) eating plan, exercise, low sodium intake, reduced alcohol consumption and cessation of smoking are essential for the prevention and control of hypertension globally, regionally and nationally (WHO, 2021). Despite widely published literature on lifestyle modification, the knowledge, attitudes and practices of hypertensive patients regarding lifestyle modification continues to be a problem at Chilomoni Health Center, Blantyre, Malawi.
Objective: The study aimed to assess knowledge, attitude and practices on lifestyle modification among hypertensive patients at Chilomoni Health Centre, in Blantyre.
Methods: A quantitative study was conducted among 185 hypertensive patients attending adult hypertension clinic at Chilomoni Health Centre from 9th to 30th August 2023. Study subjects were selected using systematic sampling technique where every 2nd person was selected. Data were collected using structured questionnaire and subjects code numbers were used in data collection. Data were analyzed using Statistical Packages for the Social Sciences (SPSS) version 22. Descriptive statistics were computed to determine the knowledge, attitude and practices of hypertensive patients on lifestyle modification. The results were presented in tables, bar graphs.and pie charts.
Results: A total of 185 subjects took part in this study with a response rate of 100%. The study showed that 99.5% (n=184) of the subjects were knowledgeable, 98.9% (n=183) had positive attitude and 57.3% (n=106) of the subjects had good practice on recommended lifestyle modification.
Conclusion: Patients demonstrated high knowledge, fairly positive attitude yet poor practice on lifestyle modification on recommended life style. This calls for creation of support groups, individualized counselling intervention programs that can help them get engaged in practicing recommended lifestyle.

P169_002305. GLYCEMIC RESPONSES TO STIFF AND THIN WHOLE PEARL MILLET FLOUR PORRIDGES AMONG PEOPLE WITH TYPE 2 DIABETES MELLITUS
Author(s): Noel Chikumbu1, Alexander Kalimbira1, and Gertrude Mphwanthe1
Affiliation(s):
1.Lilongwe University of Agriculture and Natural Resources
Email: noelchikumbu1@gmail.com

Introduction: Glycemic Index (GI) assesses the carbohydrate content of foods through its effect on postprandial blood glucose concentration. Low GI foods have been associated with reduced glycated hemoglobin and post meal blood glucose in people with type 2 Diabetes Mellitus (T2DM). Data on low GI foods such as Pearl millet is lacking despite evidence on its potential on reducing Postprandial Prandial Glycemia (PPG), fasting blood sugar (FBS) and glycated hemoglobin.
Objectives: To investigate the PPG, GI and consumer acceptability of stiff and thin whole Pearl millet porridge.
Methods: Using a repeated measures factorial design, we conducted a study among 21 patients with Type 2 Diabetes Mellitus at African Bible College Clinic in Lilongwe. Data were analyzed using IBM SPSS for MacOS version 25 to derive descriptive statistics while Graphs, Incremental Area under Blood glucose response curve and Glycemic Index were generated in Excel.
Results: Consumption of whole stiff and thin Pearl millet was associated with PPG of 9.9±0.41mmol/L and 11.05± 0.56mmol/L, respectively. Whole stiff Pearl millet porridge had a low Glycemic Index (67±11.9) compared to thin millet porridge (69±8.73). However, the difference in GI between the two porridges was not statistically significant (P=0.89). Using the GI classification of Low (50), Medium (56-69) and High (>70), the flour porridges in our study fall within medium GI foods. Both porridges were ‘liked extremely’, receiving a score of 1 on a 1-7 hedonic scale by 50 percent of the population. However, there sensory attributes did not differ between stiff and thin millet porridges.
Conclusion: The stiff and thin Pearl millet porridge had medium GI with stiff millet porridge showing a low postprandial glucose response than thin millet porridges in comparison to the reference. Incorporating Pearl millet flour into diets of people with diabetes can help prevent rapid spikes in blood glucose and ensure optimum glycemic control.

NEGRATED TROPICAL DISEASES
P170_001949. DIFFERENTIAL DIAGNOSIS FOR MALARIA AND TRYPANOSOMES IN AREAS WHERE THE DISEASES CO-EXIST, IN MALAWI
Authors: Marina Makuluni1, Janelisa Musaya1, and Peter Nambala1
Affiliation(s):
1.Kamuzu University of Health Sciences
Email: marinamakuluni@gmail.com

Introduction: Treatment of Human African Trypanosomiasis (HAT) tends to be delayed as the first diagnostic measure. Any patient presenting with the HAT symptoms gets malaria treatment first. Malaria is ubiquitous, and Malawi, it is mainly caused by Plasmodium falciparum and diagnosis requires a Malaria Rapid Diagnostic Test (mRDT) at the point of care. HAT in Malawi is caused by T.brucei rhodesiense and standard of care diagnosis requires microscopy of stained blood smears although not sensitive when parasitemia is low. HAT stage one, has better treatment adherence as compared to stage two which is also known as late stage. Unfortunately, in Malawi most cases are diagnosed with late stage disease.
Objectives: This study was to assess the magnitude of HAT patients that are missed out when using microscopy for diagnosis in comparison with a diagnostic HAT PCR and to identify individuals co-infected with Malaria and HAT.
Methods: A total of 248 participants who were being investigated for Malaria were recruited from the two study sites, Nkhotakota and Rumphi districts after consent and tested simultaneously for malaria and trypanosomiasis. Venous blood samples were collected, Malaria was screened using both rapid diagnostic test and microscopy while trypanosomiasis was screened by whole blood giemsa staining, microscopy and molecular diagnosis, ITS PCR test.
Results: The results showed that HAT parasites were seen in 0.004% of the samples when microscopy was used and 2.4% when PCR was used. 1.21% of the samples had co-infection.
Conclusion: The low sensitivity of the current HAT microscopy methodology and co-infection of HAT and Malaria might contribute to HAT cases being missed in first stage.

P171_001957. HUMAN-BABOONS CO-EXISTENCE AND PARASITES CO-TRANSMISSION
Authors: Abel chipembo1, Amandalee Salb1, and Melaku Tefera1
Affiliation(s):
1.Lilongwe Wildlife Trust
Email: abelchipembotmsic@gmail.com

Introduction: Human baboon conflict arises from the interaction between humans and baboons that result in negative impacts on human social, economic or cultural life, on the conservation of baboon’s wildlife populations, or on the environment. Human baboon’s conflict is caused by human factors and have negative impact both to human and animals. Human baboons conflict also create avenues for zoonotic and anthropozoonotic transmission of gastrointestinal parasites. The similarities in physiology, behaviour, and genetics between humans and baboons increase the susceptibility to cross-species of infections by the same parasites.
Objectives: The purpose of study aimed at evaluation and respond to conflict associated with
human baboon’s co-existence, and parasite co transmission at Kuti wildlife reserve.
Methods: The study used cross-sectional design. Baboon’s census was used to collect population of baboons, collection of fecal samples was used to find prevalence of baboons parasites at the reserve, questionnaire and PRA were used to asses human baboons coexistence. The findings were there after analyzed in SPSS, stata and MATLAB software’s.
Results: People around the reserve face a lot of challenges and one of those challenges is human baboon conflict; however, it was found out that that only 24% of villages were affected by human baboon’s conflict. The preverance of baboon’s parasites was found to be 80%. There was no significance difference between troop type and parasites attack it (p< 0.0045) with little work done by men and most of work being done by women to guard fields
Conclusion: The human baboons conflict seem to be increasing and, the parasite co -transmission seem to be possible. There is need control measures to be in place both by the reserve managers and people around the reserve in to prevent baboons conflict and zoonotic parasites transmission to human beings.

P172_002057. EVALUATION OF ENVIRONMENTAL MANAGEMENT FOR MALARIA VECTOR AND SCHISTOSOMIASIS INTERMEDIATE HOST CONTROL IN IRRIGATED SUGARCANE LANDS AT ILLOVO NCHALO ESTATE
Author(s): Kambewa, E. A.2,3, Mbewe, R.2, Jones, C.M.2,3, Chiepa, B.2,3, Kapumba, B.2, Boelee, E.4, Mzilahowa, T.1 and Wilson, A.3.
Affiliation(s):
1.Malaria Alert Centre of the College of Medicine, Blantyre, Malawi.
2.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
3.Liverpool School of Tropical Medicine, Liverpool, UK.
4.Deltares, Netherlands.
Email: ekambewa@mlw.mw

Introduction: Irrigation schemes are beneficial in places of unreliable weather patterns as they provide water for farmers all year round. Irrigation schemes increase crop yields, improve hygiene in places of water scarcity and improve the social-economic status of farmers. However, irrigation schemes have long been associated with an increase in water-related vector-borne diseases such as malaria and schistosomiasis. Irrigation schemes may create favorable microhabitats for vectors to thrive thereby increasing disease risk in areas adjacent to them. Environmental management has previously been proven to work efficiently in controlling vectors and reducing vector-borne disease prevalence but it has fallen out of favor with the transition to insecticide-based interventions.
Objectives: Determine environmental factors that affect vector abundance, composition, and risk of malaria and schistosomiasis transmission. Determine the social-cultural factors that influence risk of malaria and schistosomiasis transmission. Identify the environmental management methods suitable for use to control malaria and schistosomiasis vectors in sugarcane irrigation schemes. Determine the effectiveness of environmental management on malaria and schistosomiasis vector density, cost and acceptability.
Methods: In this study, environmental control will be assessed as a tool for the control of malaria and schistosomiasis vectors and intermediate hosts respectively. The study will assess the feasibility of using environmental management as a control strategy on the Illovo irrigated sugar cane estates, Chikwawa District, Malawi. This will be achieved by conducting entomological and malacological surveillance of malaria and schistosomiasis vectors in the Illovo sugarcane estates before and after intervention.
Expected results: Appropriate environmental control tools will be identified and implemented in the intervention arm of the study. The feasibility and acceptability of the use of environmental control will be assessed by the appropriate stakeholders, including staff from the sugar cane estate and local communities.

P173_002148. IDENTIFYING THE PRIMARY ETIOLOGIC AGENT OF TINEA CAPITIS IN PATIENTS AT QUEEN ELIZABETH CENTRAL HOSPITAL
Author(s): Mary Chikwakwa1, Kettie Hauli1 and Pauline Katundu1
Affiliation(s):
1.Medical Laboratory Sciences Department, Kamuzu University of Health Sciences
Email: m201850014310@stud.medcol.mw

Introduction: Tinea Capitis is a common fungal infection that affects the worldwide population, especially children, with Africa having the highest number if cases. It affects the scalp and hair, and understanding its etiology is important for developing effective prevention and treatment strategies.
Objectives: Main – To identify the primary etiologic agent of Tinea Capitis in patients at Queen Elizabeth Central Hospital (1) To calculate the prevalence of each etiologic agent of Tinea Capitis in patients at Queen Elizabeth Central Hospital (2) To survey the age group of children most affected by Tinea Capitis (3) To calculate the proportion of Tinea Capitis in patients at Queen Elizabeth Central Hospital by gender.
Methods: A convenient cross sectional study was conducted at the dermatology department of Queen Elizabeth Central Hospital, in which 30 particioants with Tinea Capitis, of all age groups, underwent scalp scrapings for analysis by potassium hydroxide(KOH)microscopy, culture and Lactophenol Cotton Blue microscopy. Data was collected and analysed using Kobotoolbox and Microsoft Excel respectively.
Results: It was found out that 83% of Tinea Capitis cases caused by trichophyton species, 17% by microsporum species. Males were found to be more susceptible than females, with 70% prevalence and children aged 5 to 9 were shown to be the most vulnerable group.
Conclusion: The findings indicate that trichophyton species are the most common etiologic agents of Tinea Capitis among patients at Queen Elizabeth Central Hospital, therefore, proper diagnosis aids in choice of treatment. Proper measures should be put in place to prevent spread of the infection in children. Further studies on individual specie identification is recommended.

NUTRITION
P174_001804. THE DIET QUALITY, MALNUTRITION AND QUALITY OF LIFE AMONG ADULT PATIENTS WITH STROKE UNDERGOING PHYSIOTHERAPY AT KAMUZU CENTRAL HOSPITAL
Author(s): Thokozire Mlotha¹, Stephano Saul1, Elson Chileta 1, Monica Nayeja1 and Getrude Mphwanthe1
Affiliation(s):
1.Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
Email: thokomlo@outlook.com

Introduction: Malnutrition is prevalent not solely in children and the elderly, but also in hospitalised patients, including stroke survivors. Despite adequate nutrition being one of the most important aspects in enhancing the quality of life of stroke survivors, it is marginalised in post-stroke care management. Furthermore, the ministry of health has no major initiatives emphasising on nutritional screening and assessment.
Objective: To assess at the diet quality, malnutrition prevalence, and quality of life of adult patients with stroke receiving physiotherapy at Kamuzu Central Hospital (KCH).
Methods: The study was conducted at KCH’s physiotherapy clinic, using a descriptive cross-sectional design with non-probability sampling. The target population included adult patients with stroke undergoing physiotherapy. Data collection involved gathering demographic information, level of malnutrition, diet quality, dysphagia, and quality of life. Data analysis was performed using IBM SPSS.
Results: The Prime Diet Quality Score (PDQS) was used to measure diet quality, and the results revealed that 92.2% had poor diet quality. Subjective Global Assessment tool (SGA) revealed that 74.5% of the individuals were malnourished. Patients with stroke faced functional difficulties with mobility, self-care, activity, pain, and anxiety. There were associations between malnutrition and reduced quality of life, an association was also found between dysphagia, with malnutrition level and diet quality. Higher educational attainment was also linked to poor nutritional status, indicating a possible relationship between education, nutrition knowledge, and improved nutritional status.
Conclusion: Adult patients with stroke undergoing physiotherapy had poor diet quality, high prevalence of malnutrition, and reduced quality of life, emphasizing the need for nutritional interventions and improved post-stroke care management. Hence, there is a need of screening, rescreening, assessment and treating malnutrition among patients with stroke through targeted nutrition interventions.

P175_001918. COMPLEMENTARY FOOD AND NUTRIENT GAPS IN CHILDREN AGED 6-23 MONTHS BELONGING TO ADOLESCENT MOTHERS LIVING IN RURAL AND URBAN AREAS OF KASUNGU DISTRICT, MALAWI
Author(s): Bridget Mkama1,G. Mphwanthe1, and A. Kalimbira1
Affiliation(s):
1.Lilongwe University of Agriculture and Natural Resources
Email: briemkama@gmail.com

Introduction: At the age of six months, it is recommended to introduce complementary foods as breast milk alone is inadequate to meet growth and developmental requirements of infant and young children despite most of these complementary foods being poor in nutrients putting children at risk of malnutrition. There is however, inadequate data on complementary feeding practices of adolescent mothers.
Objective: This study aims to identify food and nutrient gaps in complementary foods of children aged 6-23 months belonging to adolescent mothers in Kasungu urban and rural communities, Malawi.
Methods: A cross-sectional study was conducted in Kasungu urban and rural with a total of 198 households with children aged 6-23 months selected using purposive sampling. Data collected included, socio demographic and economic characteristics of the mother/caregiver and dietary intake information of the children. The dietary data were collected using quantitative 24-hour dietary recall and semi-quantitative food frequency questionnaire. Using IBM SPSS Statistics version “25” software data were entered and analyzed to derive descriptive statistics and identify nutrients gaps, and mean nutrients were compared with recommended nutrient Intakes.
Results: Children were meeting World Health Organization standards of minimum dietary diversity (78.3%), minimum meal frequency (77.8%), minimum acceptable diet (63.1%) and egg and/or fresh food consumption (63.1%) although there were high consumption of sweet beverages and unhealthy foods (31.3% and 33.3%, respectively). There was a gap in the daily consumption of foods such as red meat (0%), white meat (0.5%), eggs (1%), fruits (4.5%) and dairy products (10.6%).
Conclusion: The children’s diets were lacking in vitamin A, vitamin C, iron and calcium but the most limiting nutrients were zinc and vitamin B12. The study recommends strategies that promote the consumption of animal source foods and dietary diversification.

P176_001981. COMPARATIVE ANALYSIS OF ANTHROPOMETRY INDICES AS INDICATORS OF BODY COMPOSITION IN KARONGA AND LILONGWE, MALAWI
Author(s): Shekinah Munthali-Mkandawire1, Owen Nkoka1, Kondwani Mwandira1, Albert Dube1, Wiseman Scott1, Thandile Gondwe1, Estelle Mclean1, Marko Kerac1, Alison Price1 and Amelia Crampin1
Affiliation(s):
1.Malawi Epidemiology and Intervention Research Unit
Email: shekiemunthali@gmail.com

Introduction: The rising prevalence of obesity and related health concerns necessitates the identification of reliable and accessible body composition assessment tools, particularly in resource-constrained settings such as Malawi. We assessed the effectiveness of anthropometry indices, including body mass index (BMI) and waist-to-hip ratio (WHR), in determining body composition.
Methods: We analysed data from 14,691 individuals aged ≥15 years in Karonga and Lilongwe recruited in an ongoing study on long-term conditions. We measured body fat percentage (BF%) and weight with Omron HBF-51 monitors, height using Seca-209 height boards and waist/hip measurements using Seca-201 measuring tapes. BMI and WHR were calculated using the standard formulae. Receiver operating characteristics (ROC) curves and area under the curve (AUC) analysis were used to assess anthropometry indices’ ability to identify high BF%.
Results: Of 14, 691 participants, 8,408 (57.2%) were females, and 11, 065 (75.3%) were rural dwellers. There was a strong association between BMI and BF% (AUC: 0.89, 95% confidence interval (CI): 0.88 – 0.99). BMI performed better in women (AUC: 0.96, 95% CI: 0.95 – 0.96) than in men (0.70, 95% CI: 0.68 – 0.72). Age-stratified analysis showed a stronger association in adults aged 20 to 49 years (AUC: 0.91, 95% CI: 0.91 – 0.92) than in adolescents (AUC: 0.72, 95% CI: 0.68 – 0.75). WHR (AUC: 0.63, 95% CI: 0.63 – 0.64) had poor discriminatory power in identifying people with high BF% in all age groups.
Conclusion: Our study revealed that BMI serves as a reasonable proxy for the prediction of BF% in the rural and urban Malawian population. However, the association was weaker in males, especially adolescents. BMI remains a viable adiposity measure in resource-constrained countries like Malawi, where body composition equipment is limited and expensive.

P177_002202. ASSOCIATIONS BETWEEN WOMEN’S EMPOWERMENT IN NUTRITION AND SELECTED MATERNAL NUTRITION OUTCOMES: FINDINGS FROM A CROSS-SECTIONAL STUDY IN A RURAL MALAWIAN COMMUNITY
Author(s): Zione Kalumikiza-Chikumbu1, Innocent Pangapanga2, John Phuka1, Alexander Kalimbira2, Elaine Ferguson3 and Adamson Muula1
Affiliation(s):
1.School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
2.Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
3.Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
Email: zkalumikiza@luanar.ac.mw

Introduction: Maternal malnutrition increases the risk of maternal morbidity, foetal growth restriction, neonatal deaths, childhood stunting, and infant mortality. Women’s empowerment has gained popularity as one of selected nutrition-sensitive approaches to address malnutrition alongside specific interventions. However, its associations with nutrition have not been widely studied, results are mixed, and different measures of empowerment, have been used, some without direct influence on nutrition, limiting policy and programmatic actions.
Objective: Using a nutrition-centred metric, the Women’s Empowerment in Nutrition Index (WENI), we investigated associations between women’s empowerment and nutrition outcomes (dietary diversity, BMI and MUAC status) among women aged between 20 to 49 years in a rural Malawian community.
Methods: We used a cross-sectional survey design to collect data from 154 WRA using 41 indicators across 10 domain-dimensions namely, food-knowledge, resources, and agency; health-knowledge, resources, and agency; fertility-knowledge, resources, and agency; and institutions. We tested associations using chi-square and t-tests and conducted regression analysis to assess the predictive potential of empowerment.
Results: Using a threshold of 0.5, 49% of the women in our study were nutritionally empowered and faced obstacles in health-resources, food-knowledge and agency, and all fertility DDs. A positive association was found between empowerment and MDD, with empowerment predicting MDD scores by about 36%. Empowered women achieved better scores for minimum dietary diversity (3.3 versus 2.9) with higher scores among those empowered in fertility resources (3.9 vs 3.1) and institutions (3.3 vs 2.8). Women empowered in health resources (24.3 vs 22.9) and fertility agency (24.2 vs 22.9) had better BMI values than their disempowered counterparts.
Conclusions: Nutritional empowerment was associated with better dietary quality. Associations with BMI were positive but insignificant while those for MUAC were varied. Increasing access to, and control over fertility and health resources while maintaining an enabling environment might benefit maternal dietary adequacy and BMI.

P178_002209. ANTHROPOMETRIC ASSESSMENT IN THE KHULA LEAP 1000 DAYS STUDY
Author(s): Godwin Zimba1, Asante Kadama1, Friday Nantongwe1, Ernest Namaheya1. Taryn Smith2. Prof. Kirsten A3, Donald4, Karen Chetcuti5. Giulia Ghillia6, Vukiwe Ng’oma6, Ethwako Mlia Phiri4, Emmie Mbale4, and Melisa Gladstone5
Affiliation(s):
1.Blantyre Malaria Project
2.University of Liverpool
3.University of Capetown.
4.Kamuzu University of Health Sciences,
5.University of Liverpool,
6.Queen Elizabeth Central Hospital,
Email: gzimba8@gmail.com

Introduction: The “”Kula Leap 1000 Days Study”” is a comprehensive longitudinal study aimed at understanding brain development in diverse contexts during the first 1000 days of life including assessment of EEG, Hyperfine MRI and child behavioural assessments. Children’s nutritional status is integrally related to children’s development but often there is lack of clarity as to how these are related in terms of longitudinal trajectories.
Objectives: Our primary objective is to evaluate physical growth trends and relate this to developmental and brain development trajectories in children up to 3 years of age.
Methodology: We are recruiting 330 mothers in late pregnancy (28-36 weeks), and infants between 0-3months in Blantyre who are assessed seven times at 3, 6, 12, 18, 24 and 36months. We assessed head circumference, height and weight at each time point using quality-controlled assessment and compared these trajectories to the EEG, MRI hyperfine and child development assessments to better understand the relationship between these trajectories.
Conclusion: Anthropometric assessments within the Khula Leap study contribute significantly to understanding child nutrition in its relationship to child development during the first 1000 days of life. By recognizing differences in child growth trajectories alongside child brain development we may be able to better understand factors that cause difficulties in developmental trajectories in the first 1000 days.

P179_002265. EEG INSIGHTS IN THE KHULA LEAP 1000 DAYS STUDY
Author(s): Grace Baloyi Gondwe1, Ruth Muhowa1, Meffa Saukila1, Colleta Mphasa1, Pius Makaka1, Emmie Gausi Chirwa1, Vukiwe Ng’oma2, Ethwako Mlia Phiri3, Taryn Smith4, Giullia Ghillia4, Lameck Khonde1. Innocent Mpakiza1, Chikondi Mchazime1, Kirsten A. Donald1, Mellisa Gladstone1, and Emmie Mbale2
Affiliate(s):
1.Blantyre Malaria Project
2.Kamuzu University of Health Sciences
3.Queen Elizabeth Central Hospital, Paediatrics Department
4.University of Liverpool
5.University of Capetown
Email: gracee.baloyi92@gmail.com

Introduction: The Khula Leap 1000 Days Study is a multi-faceted initiative aimed at comprehending early child development in diverse environments during the first 1000 days of life. One crucial facet of this study involves the utilization of EEG to uncover neural underpinnings and cognitive trajectories. EEG provides a unique window into early brain development. This non-invasive technique records electrical activity from the scalp, enabling researchers to explore the neurophysiological basis of cognitive and sensory processes. It offers valuable insights into how the infant brain evolves.
Objectives: The primary objective is to examine neural markers of cognitive development within the early childhood period. By analysing EEG data, the study aims to recognize patterns of brain maturation, sensory processing, and their association with cognitive abilities.
Methods: EEG data collection involves specialized infant-friendly equipment and protocols, integrated into the larger Khula Leap study. This method permits non-intrusive monitoring of brain activity while infants engage with stimuli and age-appropriate activities. EEG is conducted at 3,6,12 and 24 months.
Conclusion: Incorporating EEG in the Khula Leap study enhances our understanding of the intricate neural processes during the first 1000 days of life. By unravelling brain development trajectories and associations with cognitive abilities, this research contributes not only to neurodevelopmental science but also provides a basis for interventions that support early cognitive development in children. Successful implementation will help to inform policy on incorporation of EEG test to be used in Malawian Children.

P180_002283. ASSOCIATIONS BETWEEN PREDICTED METABOLIC PATHWAYS FROM FECAL 16S RRNA SEQUENCE DATA AND STUNTING IN RURAL MALAWIAN INFANTS
Author(s): Peter Mangani1, Benjamin Kumwenda1, Arox Kamng’ona1, Emma Kortekangas2, Chikondi Malamba1, Per Ashon2,3, Ken Maleta1, and David Chaima1
Affiliate(s):
1.Kamuzu University of Healthy Sciences (KuHeS), Malawi.
2.Center of Child Health Research, Faculty of Medicine and Health Technology, University of Tampere, Finland.
3.Department of Paediatrics, Tampere University Hospital, Tampere, Finland.”
Email: petermangani@live.com

Objective: Stunting is a pervasive issue in low-income countries, with a global prevalence of 22% in children under five years of age. In Malawi, a staggering 37% of children under five are stunted, with profound and enduring consequences for health, cognition, education, and socioeconomic prospects. While previous research has linked stunting to gut microbiota, the precise mechanisms are unclear.
Methods: This was a retrospective cross-sectional study aimed to identify metabolic pathways associated with stunting in rural Malawian infants at 30 months of age using 16S rRNA sequence data deposited in the European Nucleotide Archive (accession number PRJEB29433), which were generated from 536 fecal samples. The 16S rRNA sequence data were pre-processed using the QIIME2 pipeline to generate amplicon sequence variants (ASVs). We used PICRUSt2 analysis to predict metagenomes from the generated ASVs of all the 536 16S-rRNA gene amplicon sequences. Random Forest model was used to determine which metabolic pathways were important for stunting. We compared relative abundance of the predicted superpathway between stunted and non-stunted using Wilcoxon Ranked-Sum test. All statistical analyses were performed in R.
Results: PICRUSt2 analysis predicted that the 16S sequence data of the 536 samples accounted for 377 metabolic pathways, which were collapsed to 10 (ten) super pathways for downstream analysis. Of the 10 super pathways, the Superpathway of polyamine biosynthesis was differentially abundant between stunted and non-stunted groups after adjusting for false discovery rate. The Superpathway of polyamine biosynthesis I was notably reduced (adjusted p value < 0.0036) in stunted infants while the Superpathway of demethylmenaquinol-6 biosynthesis II (p value = 0.2894), Peptidoglycan biosynthesis V (beta-lactam resistance) (p value =0.0810), and Protein N-glycosylation (bacterial) (P value =0.4024) displayed higher relative abundance, but not significantly enriched, in stunted groups.
Conclusion: The superpathway of polyamine biosynthesis I is involved in the synthesis of polyamines, which are organic compounds with multiple amino groups. The superpathway Polyamines have diverse functions in cells, including promoting cell growth, and participating in various cellular processes. The reduction of the Superpathway of polyamine biosynthesis I in stunted groups suggests a potential inhibition of cellular growth and other cellular processes. Further research is necessary to unravel the relationship between this pathway and stunting.

PUBLIC HEALTH
P181_001969. MEASURING SOCIOECONOMIC DIFFERENTIALS IN ADULT MORTALITY FROM SIBLING SURVIVAL DATA IN MALAWI
Authors: Albert Dube1, Jethro Banda1, Amelia Crampin1,2,3 , and Stephane Helleringer2
Affiliation(s):
1.Malawi Epidemiology and Interventions Research Unit
2.London School of Hygiene of Tropical Medicine
3.University of Glasgow
Emails: albert.dube@meiru.mw

Introduction: In developing countries, siblings’ survival histories (SSH) are often used to estimate maternal and adult mortality. However, they do not allow measuring socioeconomic differences in mortality rates, because SSH do not elicit the characteristics of siblings beyond gender, age and vital status.
Objectives and Methods: We assess the feasibility of collecting information on socioeconomic correlates of adult mortality during SSH and whether it is correct to assume that education of the reporting sibling is similar to that of their siblings. We use collected data to compare education differentials in mortality between self-reported and sibling reported education status, respondent education status and deceased sibling education status.
Results: We found that it is feasible to collect data on education status of deceased siblings by extending sibling survival histories. We also found high level of concordance between respondents’ reports of their sibling education with self-reports of education. There was also high correlation between reports of number of years siblings have been in school to self-report of number of years the respondents had been in school. Respondents and siblings belonging to the same family acquired different levels of education. When we use proxy education, the education effect on mortality is not clear while using siblings own education, hazards for no education were 2.2 times those of primary, and mortality hazards fell with education beyond primary school.
Conclusion: Quality data on education status of deceased siblings can be collected. Respondents can correctly report education status of their deceased siblings regardless of whether deceased were males or females. This study show that using respondents’ level of education gives incorrect estimates of the effects of education on mortality. We recommend that Demographic and Health Surveys do include questions that can be asked to siblings to solicit education status of their deceased siblings.

P182_001983. RISK FACTORS ASSOCIATED WITH CORONA VIRUS DISEASE-19 IN MALAWI: A COMPARISON OF URBAN AND RURAL COMMUNITIES
Author(s): Martin Makayiko Mizwa1, Alinafe Tonnex Phiri 1 and Chantel Shamiso Bwanali 1
Affiliation(s):
1.Medical Laboratory Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
Email: m201850014357@stud.medcol.mw

Introduction: Coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, has had a devastating impact on global health, the economy, and society. The severity of COVID-19 varies across geographical regions and countries.
Objectives: This study aimed to identify the risk factors associated with COVID-19 susceptibility in urban and rural communities in Malawi.
Methods: We recruited 1,949 individuals from urban and rural communities in Lilongwe and Karonga. Socio-demographics, comorbidities, and COVID-19 status were collected from our study participants. Categorical and continuous data were summarized using the chi-squared test and t-test, respectively. Associations between risk factors and COVID-19 were assessed using univariate and multivariable logistic regression analyses implemented in R version 4.2. Stratified analyses were performed for the Lilongwe and Karonga sites.
Results: Our multivariable logistic regression analyses revealed that age and education level were significantly associated with COVID-19 infection at both study sites. Individuals of ages 18-35 (odds ratio [OR] = 2.37; 95% confidence interval [95%CI] = 1.80-3.12, p-value =7.08 x 10-10) and >35 years (OR=2.45, 95%CI =1.8.-3.24, p-value =3.69 x 10-10) were significantly associated with COVID-19 infection compared to those aged <18 years. Moreover, those with secondary (OR=1.45, 95%CI =1.15-1.84, p-value =1.91 x 10-3) and tertiary education (OR=1.82, 95% CI=1.16-2.89, p-value = 1.10 x 10-2), were significantly associated with COVID-19 infection compared to those with primary education.
Conclusion: Our study found that age and education were significant risk factors for COVID-19 infection in urban and rural communities in Malawi.

P183_002010. FROM SIBLINGS’ SURVIVAL HISTORIES TO LINKED FAMILY SAMPLES: RESULTS FROM A TRIAL OF MOBILE PHONE REFERRALS IN MALAWI
Author(s): Albert Dube1, Sarah Brumfield2, Amelia Crampin1, 3, 4 and Stephane Helleringer2
Affiliation(s):
1.Malawi Epidemiology and Interventions Research Unit,
2.Boston University,
3.London School of Hygiene & Tropical Medicine,
4.University of Glasgow
Email: ankhata@gmail.com

Introduction: Household surveys in low-income and lower-middle-income countries often ask respondents to list their siblings, in order to collect data on adult mortality. These siblings’ survival histories provide limited information on the determinants of adult health.
Objective: To enhance siblings’ survival histories by recruiting listed siblings into a linked family sample.
Methods: We selected 159 families with at least two known siblings from a health and demographic surveillance system in Karonga district, in northern Malawi. In each family, we randomly sampled one index individual among maternal siblings. Following an in-person interview during which they completed a siblings’ survival history, index respondents were asked to refer their adult siblings residing in Malawi to the study. Interviewers then contacted by mobile phone the siblings who indicated interest in participating.
Results: One hundred and twenty-two index respondents listed a total of 740 siblings. Among those, 416 were adults who lived in Malawi, but did not reside in the same household as the index respondent. Two hundred and eighty of these siblings (67.3%) were enrolled by mobile phone, with lower enrolment rates observed among siblings who did not own a phone. The health data collected during mobile interviews allowed identifying pairs of siblings with discrepant health behaviours (e.g., smoking).
Conclusion: In Malawi, a large proportion of the adult siblings of survey respondents might be recruited by mobile phone. Adding mobile phone referrals to siblings’ survival histories might help establish platforms to study the determinants of adult health in low-income and lower-middle-income countries.

P184_002017. CHOLERA SURVEILLANCE STRENGTHENING INITIATIVE: BLANTYRE DISTRICT HEALTH OFFICE
Author(s): Upendo Mseka1, Matthew Mvula 2, Austin Zgambo 3, Natasha Kainga 4, Chifuniro Baluwa 1, Latif Ndeketa 1,5,6, Patrick Musicha 1,7, Khuzwayo Jere 1,5,6 and Kondwani Jambo 1,7
Affilication(s):
1.Malawi Liverpool Wellcome Programme
2.Digital Health Division, Ministry of Health
3.Public Health Institute of Malawi, Ministry of Health
4.Blantyre District Health Office
5.Kamuzu University of Health Sciences
6.University of Liverpool
7.Liverpool School of Tropical Medicine
Email: umseka@mlw.mw

Introduction: From March 2022, Malawi experienced the deadliest cholera outbreak in history, with over 58,000 cholera cases and over 1,500 deaths (CFR 3.0%) reported. This highlighted the urgent need to strengthen epidemiological surveillance for early detection of outbreaks. We reintroduced an electronic surveillance system to health facilities in Blantyre for the generation and reporting of real-time cholera surveillance data and report the findings from March 2023 to September 2023.
Objective: To strengthen the capacity of disease surveillance at the Blantyre DHO by improving the current surveillance system to ensure the generation, availability, and use of quality data for public health action.
Methods: We implemented the initiative in 11 out of 39 facilities in Blantyre. The IDSR focal person at each facility was provided with a tablet with the OHSP mobile application to enter individual case-based cholera cases and submit weekly and monthly IDSR reports. A customised dashboard on the OHSP web portal was created to monitor the timeliness and completeness of the reports.
Results: The reporting rates increased significantly following the OHSP training in March 2023, rising from 2.3% for weekly reports and 9.1% for monthly reports to 97.7% and 100% in May 2023, respectively. 10 out of the 11 health facilities have achieved and maintained 100% completeness and timeliness for weekly reports and all have achieved and maintained 100% completeness and timeliness for monthly reports against a national target of 80% for both indicators.
Conclusion: Reinforcement of OHSP improved the reporting rate, timeliness, and completeness of aggregated data reporting. We recommend the adoption of the OHSP for facility-level individual case-based data entry and IDSR weekly and monthly reports countrywide. Ensuring the sustainability of the electronic surveillance system will require additional support and resources.

P185_002144. TEST COMPARER: A NEW PACKAGE TO COMPARE TWO BINARY DIAGNOSTIC TESTS BASED UPON PAIRED DATA
Author(s): Kyle J Wilson1,4, Jose A Roldan-Nofuentes2 and Marc YR Henrion1,3
Affiliation(s):
1.Malawi-Liverpool-Wellcome Trust, Malawi
2.Universidad de Grenada , Spain
3.Liverpool School of Tropical Medicine, UK
4.University of Liverpool, UK
Email: kyle.wilson@liverpool.ac.uk

Introduction: In medical research binary diagnostic tests are those which yield either a positive or negative result. Their application, ranging from disease detection to risk stratification, is pivotal to patient care and clinical decision-making. As the technological and methodological advancements continue, there arises a need for a systematic comparison of new diagnostic tests against existing ones to ensure their precision, reliability, and validity.
Objective: To develop an R package which facilitates comprehensive statistical analyses when comparing two binary diagnostic tests against a recognized gold standard.
Methods: By performing descriptive and inferential statistics, the testCompareR package provides a complete picture of the test metrics, allowing researchers to draw valid conclusions.
Results: We employed a real-world motivating example focused on cerebral malaria. In this scenario, two different definitions of malarial retinopathy were used as a diagnostic test for true cerebral malaria and were compared against the gold-standard for post-mortem diagnosis – histopathological evidence of malarial parasites in the cerebral microvasculature.
testCompareR shows superiority of one defintion of malarial retinopathy as a marker of true cerebral malaria. Comparison against other R packages and programs show that testCompareR achieves comparable results with faster computation times.
Conclusion: testCompareR rapidly performs the statistics necessary to compare two binary diagnostic tests against a recognized gold standard. It is both precise and computationally efficient. By offering a streamlined and user-friendly approach to comparing binary diagnostic tests, testCompareR provides a valuable tool for medical researchers when evaluating, comparing, and choosing the best diagnostic tests for their needs.

P186_002146. A HEALTHCARE SERVICE DELIVERY AND EPIDEMIOLOGICAL MODEL FOR INVESTIGATING RESOURCE ALLOCATION FOR HEALTH: THE THANZI LA ONSE MODEL
Author(s): Timothy B. Hallett1, Tara D. Mangal1, Asif Tamuri2, Nimalan Arinaminpathy1
Valentina Cambiano3, Martin Chalkley4, Joseph H. Collins3, Jonathan Cooper2, Mathew Graham2, Eva Janoušková3, Britta L. Jewell1, Ines Li Lin3, Robert Manning-Smith5, Gerald Manthalu6, Emmanuel Mnjowe7, Sakshi Mohan4, Margherita Molaro1, Wingston Ng’ambi7, Dominic Nkhoma7, Paul Revill4, Alison Rodger3, Bingling She1, Mikaela Smit1, Pakwanja D. Twea6, Tim Colbourn3, Joseph Mfutso-Bengo7, and Andrew N. Phillips3
Affiliation(s):
1.MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London.
2.UCL Centre for Advanced Research Computing, University College London, London, UK
3.Institute for Global Health, University College London, London, UK
4.Centre for Health Economics, University of York, York, UK
5.Centre for Advanced Spatial Analysis (CASA), University College London, London, UK
6.Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
7.Kamuzu University of Health Sciences, Malawi
Email: emnjowe@kuhes.ac.mw

Introduction: There are fundamental questions about the impact of healthcare services and how it can be improved. Evidence on these issues could have enormous consequences for the health of populations, especially in the lower-income settings.
Objective: To investigate the Healthcare Service for resource allocation using Thanzi La Onse Model
Methods: We have developed an individual-based simulation model of healthcare needs in a population and the healthcare service delivery system that meets these needs. We have applied the model in Malawi, drawing on demographic, epidemiological and routine healthcare system data (on facilities, staff, and consumables.
Results: In Malawi, the impact of the healthcare system totals 30 million DALYs averted in the five-year period to end-2019, is strongly focussed on young children, is mediated largely by programmes addressing HIV, TB malaria and respiratory infections in children, and is distributed iniquitously so that more of the benefits are among wealthier persons. More appointments seem to be delivered than would be expected based on number of staff and expected durations of appointments, and this flexibility doubles the impact of the healthcare system (i.e., an extra 15 million DALYS averted in the same period). If system strengthening allowed ill persons immediate access to healthcare, led to optimal referral and diagnosis accuracy, and eliminated consumable stock-outs, the overall impact of the healthcare system could increase by up to ~30% (8.7 million more DALYS averted.
Conclusion: The healthcare system generates health gains in the population vastly beyond what would reasonably be expected based on the resources it has available. The impact of further strengthening interventions is potentially enormous and must be a priority for investment. A detailed individual-based simulation model of the healthcare service delivery system can provide novel insights for healthcare system planning and evaluating proposals for healthcare system strengthening.

P187_002183. HOW GOOD AND USEFUL IS ROUTINE BLOOD TRANSFUSION DATA IN INFORMING BEST PRACTICES IN TRANSFUSION MEDICINE: A CASE OF DISTRICT AND CENTRAL HOSPITALS IN MALAWI
Authors: Lucky Mangwiro1, Sylvester S Malunga 1, Princess Kayira 2, Titus Chiwindo 3, Tiyamike Nthani 3, Effie Chipeta 2, Victor Mwapasa 1, Andrew Likaka 4, Bridon M’baya 4, Mina Hosseinipour, 3, 5, Emmanuel Singogo, 3
Affiliation(s):
1.Kamuzu University of Health Sciences, Malawi, School of Global and Public Health
2.Kamuzu University of Health Sciences, Malawi, Centre for Reproductive Health
3.University of North Carolina Project-Lilongwe, Malawi
4.Malawi Blood Transfusion Services
5.University of North Carolina at Chapel Hill School of Medicine, Division of Infectious Diseases, Chapel Hill, NC, USA
Email: lmangwiro@medcol.mw

Introduction: Nationally standardized data collection systems are necessary for better utilization of routine blood transfusion data that has the potential to provide better insights into patterns of care in patients that receive blood products. Good-quality data is important to inform national blood transfusion needs and identify gaps to improve documentation and local use of data for planning.
Objective: Therefore, there is a need to continually conduct data quality assessments and explore how these data inform the implementation of best practices in transfusion medicine.
Methods: We conducted a cross-sectional qualitative study to assess data quality and its usage at two tertiary hospitals (Kamuzu and Mzuzu central hospitals) and also at two district hospitals (Nsanje and Balaka) from December 18, 2021, to January 11, 2022. The Purposive sampling technique was used to enroll participants in key informant interviews and focus group discussions. All interviews and discussions with participants were audio-recorded and transcribed verbatim. The data were coded and analyzed using the qualitative thematic analysis method.
Results: The majority of the facilities had poor quality data. Some of the challenges in data collection, collation, and reporting included lack of documentation, heavy workloads, lack of proper internal monitoring and supervision, health care worker’s attitudes, lack of motivation, and lack of awareness. Hospital departments with available data indicated that they use the routinely collected blood transfusion data in different ways, such as the development of support projects, community awareness campaigns, ordering of blood products and other supplies, and flagging out any problems and coming up with remedial steps.
Conclusion: Poor quality blood transfusion data remains a challenge in the majority of hospitals. Deliberate efforts are needed to leverage existing data quality initiatives being implemented for other diseases at hospital-level to help improve the quality of blood transfusion and subsequent data utilization.

P188_002200. ASSESSING MULTIPLE SEXUAL PARTNERSHIPS AND OTHER HIGH-RISK SEXUAL PRACTICES AMONG YOUNG PEOPLE IN MALAWI: 2015-2016 MALAWI DEMOGRAPHIC HEALTH SURVEY
Author(s): Samuel K. Ngwala1, Maganizo Chagomerana2 and Emmanuel Singogo2
Affiliation(s):
1.Kamuzu University of Health Sciences, Malawi
2.University of North Carolina Project -Lilongwe Malawi
Email: sngwala@kuhes.ac.mw

Introduction: The HIV epidemic has had a devastating impact on people around the world. Its magnitude is largely attributed to socio-cultural, socio-economic, and health-related factors. To curb the spread of HIV and other STIs, there is a need to identify and reach out to high-risk groups, such as young people, who are engaging or are more likely to engage in Multiple Sexual Partnerships (MSPs) with tailor-made interventions.
Objective: To assess multiple sexual partnerships and other high-risk sexual practices among young people in Malawi
Methods: This was a cross-sectional study using 2016 Malawi DHS secondary data. Young sexually active women and men aged 15-24 were recruited for the study. MSP was defining as having more than one partner during the same time frame. Examples of high-risk sexual practices included sexual intercourse without condom use, age at onset sexual debut, and alcohol abuse
Results: A total of 8025 (75.8% men and 24.2% women) were included in the analysis. Mean age at sex debut was 18 [SD=3.97, 95%CI=17.59-18.4] for men, and 18.63(SD=4.06, 95%CI=17.91-19.36) for women. Those with one partner were 989 (mean age = 21.97, SD=1.67), and 8% had STI. 189 (mean age=22.38, SD=1.4) had more than one partner and 11% had STI. Out of 473 men and women, 431(91.12%) reported not using a condom for the last recent sexual encounter.
Conclusion: Engaging in high risk activities among 15-24 years age group increases the risks of contracting STIs and spreading HIV.

P189_002211. PREVALENCE, TRENDS AND PREDICTORS OF ANAEMIA AMONG PROSPECTIVE FIRST-TIME VOLUNTARY NON- REMUNERATED BLOOD DONORS IN MALAWI
Author(s): Ednas Billiat Mayani1, Emmanuel Singogo2, Mina Hosseinipour2, Titus Chiwindo2, Robert Mbwana3, Linda Namalomba3, and Bridon M’baya3
Affiliation(s):
1.Maryland Global Initiatives Corporation
2.University of North Carolina Project
3.Malawi Blood Transfusion Services
Email: ednasbilliat92@gmail.com

Introduction: Anaemia is a known reason for exclusion from blood donation, affecting the availability of adequate blood supplies. Malawi has a paucity of information on the prevalence and predictors of anaemia among first-time blood donors.
Objective: To estimate the prevalence, and trend and assess predictors of anaemia among first-time voluntary non-remunerated blood donors (VNRBDs) in Malawi.
Methods: We conducted a retrospective cross-sectional study using secondary data of first-time VNRBDs who presented for blood donation at MBTS blood donation sites across the country from January 2018 to December 2020. Multinomial logistic regression was used to determine the association between socio-demographic factors and anaemia, defined as haemoglobin <12.5g/dL. Results: A total of 101,822 individuals attempted to donate blood during the study period, 71.6% were male, 75.3% were aged ≤25 years, 67.0% were students and 79.4% were single. A total of 18,107 (17.8%) were deferred from donating blood out of which 5,163 (28.5%) were deferred due to anaemia. Overall anaemia prevalence was 5.1% (5,163/101,822). Anaemia prevalence increased from 4.1% in 2018 to 6.0% in 2020. The following factors were associated with anaemia: females (AOR: 6.48 (95%CI: 6.05,6.93), donating blood in the central region (AOR: 3.47, 95%CI:2.93,4.11) and southern region (AOR: 5.84, 95%CI: 4.96,6.88) and among those with occupation classified as others (AOR: 2.05, 95%CI:1.84–2.28). Being married was associated with a lower risk of anemia (AOR: 0.64, 95%CI: 0.56,0.72). Age of >25 years was not significantly associated with anaemia (AOR: 0.96, 95%CI: 0. 86,1.06).
Conclusion: Approximately 5% of prospective blood donors had anemia as the reason for deferral. While female sex as a risk factor for anemia was expected, regional differences in anemia prevalence require further investigation. Improved screening and iron supplementation could help lower deferrals due to anaemia.

P190_002282. LANDSCAPE ANALYSIS OF GENDER AND GLOBAL HEALTH IN MALAWI
Author(s): Hannah Nyirenda1
Affiliation(s):
1.Women in Global Health Malawi
Email: wghmalawi@womeningh.org

Introduction: Women in Global Health (WGH) Malawi was founded as a chapter in June 2020 by a group of emerging female leaders seeking a network aimed at enhancing skills for influential and transformative women leadership. The development of a strategic plan to drive the chapter’s direction and target activities was required.
Objective: WGH-Malawi conducted a landscape analysis in Malawi to identify gaps, key issues, and policies concerning gender and global health.
Method: The context analysis (guided by the Longwe women’s empowerment analytical framework) used a qualitative approach and a review of the literature to better understand the factors, issues, and gaps affecting gender equality in Malawi’s health structure.
Results: 1) Dimensions of equality – a) welfare – lack of paternity leave, work-life conflict; b) access – lack of access to education, glass ceilings in career advancement, tokenism; c) conscientization – lack of gender sensitization training; d) participation – under-representation of women in leadership positions; e) mobilization – silenced voices due to lack of mobilization; f) control. 2) Lack of access to education, tokenism, glass ceilings, and insufficient mobilization were barriers to gender equality in leadership positions.
Conclusion: 1) Advocate for the development and implementation of gender equality policies in the health sector. These policies include a policy against violence and sexual harassment, a work-life balance policy, and a family leave policy (and or paternity leave). 2) Create role-modeling campaigns aimed at the education and workplace sectors. 3) Provide gender awareness training specific to the health sector. 4) Encourage male participation in gender equality initiatives. 5) Establish meaningful relationships with stakeholders in the fields of gender equality and health. 6) Use the organization performance agreement to track the government’s and its agencies’ adherence to gender equality commitments.
VACCINES
P191_001796. CONSTRUCTION OF MULTIPLE EPITOPE VACCINE AGAINST H3N8 STRAIN OF AVIAN INFLUENZA: A BIOINFORMATICS APPROACH
Author(s): Chimenya H. Ntweya1,2, Mahadev Jadhav2, Ojochenemi A. Enejoh3, Deborah O. Ayando4, Margaret A. Oyekunle5, Adham Hallal5, Oudou Diabate6, Anjellina Rukundo7,8 Eniola Onabowale9 and Olaitan I. Awe10
Affiliation(s):
1.Department of Medical Laboratory, Queen Elizabeth Central Hospital, Blantyre, Malawi
2.Department of Biotechnology and Bioinformatics, Deogiri College, Aurangabad, India
3.Genomics and Bioinformatics Department, National Biotechnology Development Agency, Abuja, Nigeria
4.Department of Public Health, Kwara State University, Malete, Nigeria
5.Research and Innovations Department, EHA Clinics Abuja, Nigeria
6.African Centre of Excellence in Bioinformatics (ACE-B), University of Sciences, Techniques and Technologies of Bamako (USTTB), Mali
7.Department of Pathogen Genomics and Phenotype Immunology (PGPI), Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe
8.Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Uganda
9.Department of Medical Laboratory, Reddington Hospital Lagos, Nigeria
10.African Society for Bioinformatics and Computational Biology, Cape Town, South Africa
Email: chimenyantweya54@gmail.com

Introduction: Influenza is an important disease for both humans and animals. Of the four types of influenza viruses; A, B, C and D, influenza type A viruses are most significant to public health. Types A evolve rapidly, leading to greater variability. It is classified into two subtypes; Hemagglutinin ( HA) and Neuraminidase (NA). These two are major antigenic determinant of AIV. The World Health Organization categorized Avian Influenza as a variant of concern, having numerous mutations in spike protein, which have been found to evade the effect of antibodies stimulated by the influenza vaccine. To avoid the risk of arising viral illness, the construction of a specific vaccine that triggers the production of targeted antibodies to combat infection remains highly imperative.
Objective: To develop a particular vaccine exploiting bioinformatics approaches which can target B- and T-cells epitopes.
Methods: Through this approach, novel epitopes of the S protein H3N8 were predicted for the development of a multiple epitope vaccine. Multiple epitopes were selected on the basis of toxicity, immunogenicity and antigenicity, and vaccine subunit was constructed having potential immunogenic properties.
Results: The epitopes were linked with linkers, along with an adjuvant to enhance its immunogenicity. The vaccine construct was described stable having low instability index (II). Using ClusPro, the vaccine was docked for compatibility and effectiveness assessment against human receptor TLR-4. Immune simulations demonstrated a significant increase in antibody levels in response to vaccine.
Conclusion: The current study identified a Multi-Epitope Vaccine (MEV) as a significant vaccine candidate that could potentially help the global world to combat Avian Influenza infections.

P192_001905. SEX-BASED VARIATIONS IN PNEUMOCOCCAL CARRIAGE, IgG CONCENTRATION AND VACCINE PROTECTION: IMPLICATIONS FOR VACCINATION IN EXPERIMENTAL HUMAN PNEUMOCOCCAL INFECTION MODEL FROM MARVELS AND EHPC STUDIES
Author(s): Evaristar Kudowa1, Godwin Tembo1, Anthony Chirwa1, Tarsizio Chikaonda1, Lumbani Makhaza1, Edna Nsomba1, Neema Toto1, Dingase Dula1, Kondwani Jambo1, Daniela Ferreira2, Marc Henrion1,2 and Stephen Gordon1,2
Affiliation(s):
1.Malawi Liverpool Wellcome Programme, Blantyre, Malawi
2.Liverpool School of Tropical Medicine, Liverpool, UK
Email: ekudowa@mlw.mw

Introduction: Controlled Human Infection Model study programmes from EHPC and MARVELS have demonstrated the efficacy of PCV-13 against experimental pneumococcal carriage serotype 6B. We interrogated the association between sex and vaccine efficacy, and explored differences in IgG concentration by sex.
Methods: The MARVELS and EHPC studies were double-blinded, parallel-arm, randomized controlled trials conducted in Blantyre, Malawi and Liverpool, UK, respectively. The intervention arm received PCV-13 vaccine, and were later inoculated with pneumococcal serotype 6B. Nasal washes at days 2, 7, 14 and 21 post inoculation were cultured for pneumococcal carriage. Log-binomial models assessed vaccine efficacy, and the effect of sex on experimental carriage. We compared IgG level differences by sexes at all visits.
Results: The MARVELS study analysed 204 participants with 147 (72%) males. Carriage was 18% (27/147) in males and 23% (13/57) among females. Vaccine efficacy was 73% (RR 0.27; 95% CI 0.12-0.63) in males and 31% (RR 0.69; 95% CI 0.25-1.91) in females. The EHCP study, analysed 96 participants with 37 (39%) males. Males had 22% (8/37) carriage and 34% (20/59) among females. The vaccine efficacy was 86% (RR 0.14; 95% CI 0.02-0.99) in males and 74% (RR 0.26; 95% CI 0.10-0.68) in females. Combining EHPC and MARVELS data, males had 20% reduction in carriage risk compared to females (p=0.304) and 45% among vaccinated males compared to vaccinated females (p=0.290). There were no significant differences in IgG concentration by sex in either the EHPC or MARVELS study.
Conclusion: We observed a higher carriage rate in females and a higher vaccine efficacy in males from both studies. Our results did not indicate sex-specific immune response. If these findings are confirmed in larger, more powered studies, it would have implications on vaccine strategy. Our studies were not powered to confirm these differences hence highlighting the need for future vaccine trials to comprehensively investigate sex differences.

P193_001982. KNOWLEDGE AND PERCEPTIONS OF COVID-19 DISEASE AND COVID-19 VACCINE AMONG PREGNANT WOMEN RECEIVING ANTENATAL CARE AT KCH, LILONGWE. MALAWI
Author(s): Eugenia Norah Chigamane 1,2, Fan Lee 3,5, Lameck Chinula 1,2,3,4, Agatha Bula 3 ,Wezi Dunda 3 , Annie Thom 3 , Priscilla Phiri-Mwanza 2 ,Jennifer Tang 1,3,4 and Friday Saidi 1,2,3,4
Affiliation(s):
1.Kamuzu University of Health Sciences, Malawi
2.Kamuzu Central Hospital
3.University of North Carolina Project-Malawi, Lilongwe, Malawi
4.University of North Carolina Department of Ob-Gyn’s, Division of Global Women Health, NC, USA
5.Duke University, NC, USA
Email: eugechigamane@gmail.com

Introduction: Pregnant women with a COVID-19 diagnosis are at increased risk of preterm delivery, intensive care unit [ICU] admission, and maternal death, when compared to pregnant women without a COVID-19. COVID-19 vaccination of pregnant women is essential in preventing COVID-19-associated maternal and neonatal morbidity and mortality. However, COVID-19 vaccination uptake has been low in Malawi. Knowledge of COVID-19 disease and the COVID-19 vaccine and its protection in pregnancy has been correlated with vaccine uptake. However, similar data is limited in resource-limited countries, including Malawi.
Objective: To assess the knowledge and perceptions of COVID-19 disease and COVID-19 vaccination among pregnant women at Kamuzu Central Hospital (KCH), Lilongwe, Malawi.
Methods: In this qualitative study, we sampled and interviewed 20 pregnant women receiving antenatal care at KCH. We used a semi-structured interview guide for the in-depth interviews [IDIs]. The IDIs were translated, transcribed and double-coded in NVivo version 12 using a codebook that was developed using deductive and inductive approaches. The codebook was reviewed throughout the coding process. Thematic analysis was used to analyze the data. All participants provided a written informed consent.
Results: 9 participants had been vaccinated with COVID-19 vaccine pre-pregnancy. Participants had correct knowledge of COVID-19 disease, its mode of transmission, preventive measures and high-risk groups. There was poor knowledge of COVID-19 vaccine effects on pregnancy. Self-efficacy, partner involvement, and community opinion positively influenced the decision to receive the COVID-19 vaccine. Community beliefs, religious convictions and misinformation about COVID-19 effects in pregnancy negatively affected the decision to receive the COVID-19 vaccine.
Conclusion: In light of the research, addressing knowledge gaps and dispelling misconceptions regarding COVID-19 vaccination among pregnant women in resource-limited settings, like Malawi, is crucial. Enhancing education, community engagement, and dispelling myths through targeted campaigns could significantly improve vaccination uptake and contribute to better maternal and neonatal health outcomes.

P195_002000. ANTIGENIC CARTOGRAPHY OF ENTERIC VIRUSES USING ANTIGENIC SEQUENCE-BASED APPROACH
Author(s): Ernest Matambo1, Benjamin Kumwenda1 and Khuzwayo Jere1,2
Affiliation(s):
1.Kamuzu University of Health Sciences
2.University of Liverpool
Email: ematambo@kuhes.ac.mw

Introduction: Rotavirus vaccines have reduced all-cause-diarrhoea mortalities in children below 5 years of age to 129,000 per year from 525,000 per year globally. However, the vaccines have low effectiveness (39-66%) in low and middle-income countries and in high-mortality settings. Currently, only rotavirus has four WHO prequalified vaccines and increase in prevalence of other pathogenic enteric viruses such as adenovirus and norovirus has been reported post rotavirus vaccine introduction. Epitope- and structure-based approaches including antigenic cartography (mapping) have been used to study antigenic relationships among SARS-CoV-2 and influenza H1N1 and H3N2 virus variants and strains, predict effectiveness of a vaccine against specific virus variants/strains and develop broadly protective, immunogenic and thermostable Multiepitope-Fusion Antigen vaccines against some bacteria pathogens and not yet for viruses.
Objective: We will adopt a sequence-based antigenic cartography method to study antigenic relationships, predict vaccine effectiveness and accelerate development of more efficacious vaccines against enteric viruses.
Methodology: Rotavirus sequences will be utilised to develop a sequenced-based antigenic cartography method thereafter, the method will be applied to other enteric viruses such as adenovirus and norovirus. VP4, VP6, VP7 and NSP4 antigenic rotavirus nucleotide sequences will be downloaded from the Genbank followed by construction of phylogenetic trees to select representative strains per each clade (a maximum of 100 sequences per each antigenic sequence type) and then nucleotide sequences will be translated into amino acids (AA). Antigenic distances will be calculated based on AA mismatches of the antigenic regions. Multidimensional scaling will be used to cluster closely related antigenic strains for visualisation on a 2D graph. The method will be validated through antigen-antibody neutralising assays to determine the ability of the current vaccines to illicit antibody response against circulating rotavirus strains.
Conclusion: Development of an easy-to-interpret method for studying antigenic relationships among strains in enteric virus types.

P196_002067. EVALUATION OF SAFETY, REACTOGENICITY, AND IMMUNE RESPONSE OF A TRIVALENT VACCINE AGAINST INTS AND TYPHOID FEVER IN EUROPEAN AND AFRICAN ADULTS: A PHASE 1/2A OBSERVER BLINDED MULTICOUNTRY STUDY
Author(s). Usman Nasir Nakakana1, Priyanka D Patel2, Valentino Conti1, Theresa Misiri2, Felistas Mwakisighile2, Chiara Crispino2, Georgina Makuta2, Richard Wachepa2, Antonio Lorenzo Dipasquale1, Giulia Luna Cilio, Alimamy Serry-Bangura, Beatrice Grossi1, Yasir Shitu isa1, Rita La Gaetana1, Elisa Marchetti1, Omar Rossi1, Rocio canals1, Ashwani Kumar Arora1 and Melita A Gordon2,4,5
Affiliation(s):
1.GSK Vaccines Institute for Global Health, Siena, Italy
2.Malawi Liverpool Wellcome Programme, Blantryre, Malawi
3.GSK Biologicals, Siena, Italy
4.University of Liverpool Liverpool, United Kingdom
5.Kamuzu Univesity of Health Sciences
Email: patelpriya24d@gmail.com

Introduction: Invasive nontyphoidal Salmonella (iNTS) and typhoid fever are significant public health concerns, particularly in sub-Saharan Africa (sSA), where the burden of these diseases is substantial. Currently, there is no vaccine available for iNTS.
Objective: This study aims to evaluate the safety, reactogenicity, and immune response of the trivalent vaccine against iNTS and typhoid fever in healthy European and African adults.
Methods: This is a Phase 1/2a, observer-blind, randomized, dose-escalation, controlled, multi-country, two-staged, staggered study involving nine groups. The study will recruit 155 healthy adults aged 18 to 50 years from Europe and Africa. The GVGH invasive nontyphoidal Salmonella-typhoid conjugate vaccine (iNTS-TCV) candidate vaccine is currently undergoing its initial evaluation in European adults as part of Stage 1 of the clinical trial. Subsequently, Stage 2 of the trial will involve assessing the same vaccine in African adults. Participants will receive one intramuscular (IM) study intervention per arm on Day 1, Day 57, and Day 169. Randomization will occur in a 2:2:1 and 3:3:1 ratio in Europe and Africa respectively. The study will span approximately 13 months, including a 6-month follow-up period after the third intervention. Adverse events and serious adverse events will be recorded and reported promptly.
Anticipated Results: Ethical approval has been sought from the local ethics committee and the study start date is anticipated to be Aug 2023 in Malawi. We will report the safety and reactogenicity profile of the GVGH iNTS-TCV in healthy European and study progress from the African site at the conference. The study will provide valuable data on the safety, immunogenicity, and seroresponse of the GVGH iNTS-TCV vaccine in both European and African populations.
Conclusion: This study represents a crucial step in evaluating the GVGH iNTS-TCV candidate vaccine in humans. The findings will contribute to the development of an effective vaccine against iNTS, addressing the urgent need for preventive measures in Africa. The results will provide insights into the safety, reactogenicity, and immunogenicity of the vaccine, paving the way for further clinical trials and potential implementation in high-risk populations.

P198_002077. BROADLY SIMILAR LYMPHOID CELLULAR PROFILES BETWEEN THE NASAL INFERIOR TURBINATE AND NASOPHARYNX IN ADULTS
Author(s): Precious Chigamba1, Joseph Phiri1,2, Gloria Luhanga1,2, Robert Nyirenda1, and Kondwani Jambo1,2
Affiliation(s):
1.Liverpool Wellcome Program, Department of Clinical Sciences,
2.Liverpool School of Tropical Medicine, Liverpool, UK.
Email: pchigamba@mlw.mw

Introduction: The nasal mucosa remains an important site for pathogen entry and colonisation. The advent of non-invasive technologies for sampling nasal immune cells gives us an unprecedented opportunity to revolutionise our understanding of nasal mucosa immunity.
Objective: To compare two nasal sampling methods, nasal curettes and nasopharyngeal swabs, in their ability to profile lymphocytes in the upper respiratory tract.
Methods: In a prospective cohort study, we recruited 45 otherwise asymptomatic adults, in Blantyre, Malawi. We collected paired peripheral blood and nasal cell samples from the inferior turbinate and nasopharynx using nasal curettes (NC) and nasopharyngeal swabs (NPS), respectively. We then used multiparametric flow cytometry to characterise and compare lymphocyte profiles in the two nasal sampling sites, and the systemic circulation.
Results: CD4+ T cell proportions were lower in the nasal mucosa compared to blood (NC, 20% vs 75%, p<0.0001; NPS, 48.20% vs 75%, p=0.033). The proportion of CD8+ T cells in the inferior turbinate was higher than in blood (65% vs 25%, p<0.0001) and nasopharynx (65% vs 33.10%, p=0.0032). Moreover, the proportion of MAIT cells was higher in the inferior turbinate (4.96% vs 2.80% p<0.0001) and nasopharynx (4.20% vs 2.80%, p=0.01), than in blood. In contrast, the proportion of NK cells was lower in the inferior turbinate (12.10% vs 48%, p<0.0001) and nasopharynx (9.70% vs 48%, p=0.0003), compared to blood. While the proportion of gamma-delta T cells was similar in the nasal compartments and systemic circulation (p>0.05).
Conclusion: Overall, these findings reveal that the nasal lymphoid cellular compartment is immunologically distinct from blood but is broadly similar between the inferior turbinate and the nasopharynx.
P199_002096.

WHOLE GENOME SEQUENCE ANALYSIS OF G9-ROTAVIRUSES REVEALS A SWITCH OF G9P[6] STRAINS FROM WA-LIKE TO A DS-1-LIKE GENOTYPE-CONSTELLATION AFTER ROTAVIRUS VACCINE INTRODUCTION IN BLANTYRE, MALAWI
Author(s): Landilani Gauti1, Chimwemwe Mhango1,2, Jones Chipinga1,2, End Chinyama1, Jonathan J. Mandolo1,2, Benjamin Kumwenda2, Celeste M. Donato4,5,, A. Duncan Steele6, Nigel A. Cunliffe3,8, Arox W. Kamng’ona1,2, Francis E. Dennis10, Martin M. Nyaga7, Chrispin Chaguza3,9,10 and Khuzwayo C. Jere1,3,8
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.Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK;
4.Enteric Diseases Group, Murdoch Children’s Research Institute, Australia;
5.Department of Paediatrics, the University of Melbourne, Australia;
6.Diarrheal Pathogens Research Unit, Sefako Makgatho Health Sciences University, South Africa;
7.Next Generation Sequencing Unit and Division of Virology, Faculty of Health Sciences, University of Free State, South Africa;;
8.NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom;
9.Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA;
10.NIHR Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom.
Email: lgauti@mlw.mw

Introduction: Rotavirus surveillance in Malawi dates back to 1997. Data from 1997 to 2019 shows intermittent circulation of genotype G9 strains of which G9P[8] strains were frequently detected before Rotarix® vaccine introduction in 2012 and G9P[6] were common from 2013 during the post-vaccine period. We leveraged on the available whole genome sequence (WGS) data from Malawi to describe the patterns and genetic diversity of genotype G9 rotavirus strains that circulated before and after introduction of Rotarix® vaccine in Malawi.
Methods: We generated and analysed WGS for G9P8 and G9P6 strains that circulated from 2001 to 2019 in Blantyre, Malawi. We assigned and compared complete genotype constellations of pre- and post-vaccine G9 strains. We implemented maximum-likelihood method to explore the relationship of Malawian to globally detected G9’s.
Results: WGS revealed that pre-vaccine G9P8 strains had the Wa-like G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 while one had the DS-1-like G9-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2 genotype constellations. G9P[6] strains (n=6) had the reassortant Wa-like G9-P[6]-I1-R1-C1-M1-A1-N1-T2-E1-H1, two had the Wa-like G9-P[6]-I1-R1-C1-M1-A1-N1-T1-E1-H1 and the other two had a DS-1-like G9-P[6]-I2-R2-C2-M2-A2-N2-T2-E2-H2 genotype constellations. Conversely, the post vaccine G9P[6] strains (n=11) had the DS-1-like G9-P[6]-I2-R2-C2-M2-A2-N2-T2-E2-H2 while G9P[8] strains (n=2) had a Wa-like G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 genotype constellations. Phylogeographic analysis of the VP7 genome segment revealed monophyletic clusters of our pre- and post-vaccine G9P[6] strains within clades having other African G9 strains. G9P[8] detected post-vaccine introduction clustered closely to G9P[8] strains reported in Asian countries.
Conclusion: Our findings highlight the switch of G9P[6] strains from a predominantly Wa-like genotype constellation associated with pre-vaccine strains (G9P[6] and G9P[8]) to a DS-1-like genotype constellation associated with post-vaccine strains. This data highlights the predominance of DS-1-like rotaviruses post-vaccine introduction. While our work cannot definitively attribute this predominance to vaccine use, further work is warranted to understand the increased frequency of detection of DS-1-like rotaviruses post-vaccine introduction in our setting.

P200_002115. INVESTIGATING THE HETEROGENEITY OF TRAINED IMMUNITY IN INNATE IMMUNE CELLS USING HIGH-RESOLUTION SINGLE-CELL RNA-SEQ AND EPIGENETIC ANALYSIS POST BCG-VACCINATION
Author(s): Vita Nyasulu1,2, Anmol Kiran2, Benjamin Kumwenda1 and Louise Afran1,2
Affiliation(s):
1.Kamuzu University of Health Sciences, School of Life Sciences & Allied Health Professions, Blantyre, Malawi
2.Malawi Liverpool Wellcome Trust, Blantyre.
Email: vnyasulu@mlw.mw

Introduction: Bacillus Calmette-Guérin (BCG) vaccination induces trained immunity, modifying innate immune cell responses. Understanding the heterogeneity of trained immunity in innate immune cells post-BCG vaccination is crucial, particularly in Sub-Saharan populations with limited data. This knowledge can enhance vaccination strategies and therapeutic interventions, benefiting global healthcare and immunization programs.
Objective: This study aims to comprehensively characterize transcriptional and epigenetic profiles of innate immune cells following BCG vaccination. It evaluates trained immunity’s presence and heterogeneity, focusing on heightened antimicrobial activity and altered responsiveness to stimuli.
Method: We will integrate scRNA-Seq and scATAC-Seq data, conduct functional assessments, and compare vaccinated individuals to an unvaccinated reference group. Rigorous data processing, normalization, clustering, differential expression analysis, and visualization are ensured through an extensive analysis pipeline. Ethical clearance is granted within established guidelines. The study consists of two phases: Data collection and preprocessing, using existing data from the TIA study involving Malawian newborns post-BCG vaccination, and Analysis & Functional Assessment, involving single-cell RNA-Seq analysis to identify cell populations, assess gene expression, and explore functional implications. Comparisons with a control group and statistical analysis reveal key regulators of innate immune cell functions. Characterization of Transcriptional Landscapes defines transcriptional profiles of innate immune cells using scRNA-Seq, providing a comprehensive understanding of trained immunity.
Results: We expect to reveal inherent transcriptional profile heterogeneity in innate immune cells post-BCG vaccination, offering insights into trained immunity. Identifying epigenetic modifications driving heightened immune responses may correspond with functional changes, including enhanced antimicrobial activity and altered immune responsiveness post-vaccination.
Conclusion: These findings may profoundly impact vaccine strategies and targeted interventions against infectious diseases.

P201_002123. FACTORS ASSOCIATED WITH COVID-19 VACCINE UPTAKE HESITANCY AMONG UNDERGRADUATE STUDENTS AT KAMUZU UNIVERSITY OF HEALTH SCIENCES
Author(s): Karim Arif Karim1, Amanda Khupe1, Petro Liundi1 and Waliko dF Lipemba1
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi
Email: m201850044548@stud.medcol.mw

Introduction: COVID-19 was first reported on 02 April 2020 in Malawi and has so far claimed over 2,500 lives in Malawi. As of 21st November 2022, through global and national efforts, about 4 million doses, of the COVID-19 vaccine were distributed and used in Malawi from 11th March 2021. Although healthcare students are likely to come into contact with COVID-19, there is not a universal level of vaccination coverage among them, and the causes of this are unknown.
Objectives: The broad objective was, to approximate the level of hesitancy towards COVID-19 vaccine uptake amongst undergraduate healthcare students at Kamuzu University of Health Sciences (KUHeS) and its associated factors. The specific objectives were as follows: (1) to estimate the proportion of undergraduate students at KUHeS that are hesitant in taking the COVID-19 vaccine, (2) to assess factors associated with hesitancy of COVID-19 vaccine uptake among undergraduate healthcare students at KUHeS, and (3) to assess perceptions and attitudes towards COVID-19 vaccines.
Methods: A cross-sectional study was conducted between 3rd October and 30th October 2022 involving a sample size of 323 randomly selected KUHeS undergraduate students based at three campuses in Blantyre districts, Malawi. An online questionnaire was used to collect data on socio-demographic characteristics and factors associated with COVID-19 hesitancy. Data were analyzed using Statistical Package for Social Sciences software and Epi-info. Chi-square and Fisher’s exact test were used to assess the association between vaccine hesitancy and non-demographic factors.
Results: The median (range) age of the enrolled 323 students was 22 (17-30) and 51% of them were females. Overall, 149 of the students (46.1%) expressed views of vaccine hesitancy, the proportion was higher among females (51%) than males (49%). The main barriers to vaccine hesitancy were being concerned about the side effects of the COVID-19 vaccine (OR = 0.0065, 95% CI, 0.00 – 0.10, p < 0.01), not yet being ready for the vaccine (OR = 0.0064, 95% CI, 0.00 – 0.01, p<0.01), and being concerned about the safety and ineffectiveness of the vaccine (OR = 0.0058, 95% CI, 0.00 – 0.10, p<0.01). Twenty-nine point seven percent (29.7%) had a poor perception of the COVID-19 vaccine. Their negative perceptions were influenced by the ineffectiveness of the vaccines, haste manufacturing, adverse effects following immunization, and reduced perceived susceptibility. Nonetheless, 70.3% had a positive perception towards the COVID-19 vaccine, citing issues such as reduced number of cases, morbidity, and mortality.
Conclusion:
COVID-19 vaccine hesitancy is high among KUHeS students and is significantly influenced by their knowledge about the side effects following immunization.

P205_002156. ROBUST NEUTROPHIL RESPONSE IS ASSOCIATED WITH PROTECTION AGAINST PNEUMOCOCCAL CARRIAGE IN MALAWIAN ADULTS
Author(s): Kamng’ona R1,2, Chimgoneko L1,2, Kudowa E1,2, Mayuni M1,2, Tembo G1,2, Chiwala G1,2, Morton B1,2,3,4, Chikaonda T1,2, Nsomba E1,2, Manda-Taylor L1,5, Henrion MYR1,2,3, Banda NP4,5 ,Rylance J1,2, 4 ,Ferreira DM2, Jambo K1,2, Gordon SB1,2 on behalf of the MARVELS collaborators
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.Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi, e. College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi
3.Liverpool School of Tropical Medicine, Liverpool, United Kingdom
4.Liverpool University Hospitals NHS Foundation Trust Liverpool, United Kingdom
Email: lchimgoneko@mlw.mw

Introduction: The burden of pneumonia-related illnesses and death remains high among children and immune-compromised adults in sub-Saharan countries like Malawi, despite the introduction of the pneumococcal conjugate vaccine (PCV-13). This has been attributed to persistent nasal carriage of vaccine-type Streptococcus pneumoniae (S. pneumoniae) and hence transmission after vaccination. In the UK, it has been shown that nasal neutrophils are associated with protection against experimental S. pneumoniae nasal colonisation.
Methods: We studied the nasal neutrophil response to experimental inoculation of S. pneumoniae in Malawi. We used an experimental human pneumococcal challenge (EHPC) model to determine neutrophil response following S. pneumoniae serotype 6B inoculation. We measured neutrophil counts before inoculation and at 2-, 7-, and 14-days post-inoculation. We compared the counts between participants that established experimental pneumococcal carriage (n=24), natural carriage (n=50) and those that did not (n=97).
Results: We found that inoculation with S. pneumoniae increased nasal mucosal neutrophil counts at days 2 and 7 post-challenge. Importantly, we showed that upregulation of neutrophil response after S. pneumoniae challenge on day 2 was protective against EHPC.
Conclusion: These results suggest that a robust neutrophil response might play a crucial role in preventing carriage and could be a target for new interventions against nasal pneumococcal carriage.

P206_002157. SAFE AND EFFECTIVE INOCULUM DELIVERY IN HUMAN INFECTION STUDIES
Author(s): Faith Thole1, Bridgette Galafa1, Morrison Kamanga1, Tarsizio Chikaonda1, Edna Nsomba1, Anthony Chirwa1, John Ndaferankhande1, Lumbani Makhaza1, Everister Kudowa1, Lorensio Chimgoneko1, Godwin Tembo1, Marc Y.R. Henrion1, Kondwani Jambo1, Stephen Gordon1, on behalf of MARVELS consortium
Affiliation(s):
1.Malawi Liverpool Wellcome Programme
Email: faiththole27@gmail.com

Introduction: Experiment human pneumococcal carriage success is highly dependent on safe inoculum of challenge bacteria in participants. Delivery of safe protocol is crucial in ensuring safety of the study participants in which case microbiology is one key. In the Human challenge model on effectiveness of PCV13, strain/serotype 6B of Streptococcus Pneumoniae (S. Pneumoniae) has been used to challenge participants. We audited our inoculum preparation during a recent study that recruited and challenged 204 participants.
Objectives:
1.Determine delivery of dose for carriage within the required range as per protocol
2.Audit preparation of pure uncontaminated bacteria for carriage.
Methods: Of the 204 participants recruited between November 2021 and September 2022, 60 inocula were used, with a single inoculum used to challenge multiple participants up to a maximum of 4. Batches of the challenge inoculum stock delivered from LSTM, went through quality checks of gram staining, serotyping, purity and drug sensitivity testing. Prepared inoculum concentration (CFU) was calculated from the CFU before and after inoculation. The average presenting the actual CFU of the inoculum.
Results: Quality controls done on newly received batches confirmed the stock to be pure alpha hemolytic colonies upon culture, resistant to oxacillin with a zone of inhibition of 28mm and serotyped as serotype 6B. We produced inoculum of within the required range of 40,000CFU-160,000CFU for a target of 80,000CFU.
Conclusion: We are able to deliver safe Human challenge inoculum as per protocol. In country production of challenge bacteria. A batched produced, yet to undergo quality checks and sequenced by external laboratory for confirmation.

P207_002179. PREVALENCE, CLINICAL PRESENTATIONS AND OUTCOMES OF SEVERE MALARIA AMONG HOSPITALIZED ADULT PATIENTS IN MALAWI: ANALYSIS OF COVID-19 VACCINES ADVERSE EVENTS HOSPITAL-BASED SENTINEL SURVEILLANCE DATA
Authors: Apatsa Villiera1, Chinsinsi Mbekeani1, Bvukani Chirwa1, Rhoda Chado2, Mike Chisema2, 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
Email: avilliera@kuhes.ac.mw

Introduction: In Malawi, malaria is a significant public health problem that accounted for 36% of outpatient visits and 16% of hospitalizations in 2020. Malaria control efforts have focused on children and pregnant women with the adult population receiving limited attention. Assessing and monitoring malaria in adults is crucial for elimination efforts.
Objective: To assess prevalence, clinical presentations and outcomes of severe malaria among adults enrolled in the hospital-based Covid-19 vaccines adverse events of special interest (AESIs) sentinel surveillance in four central and two district hospitals in Malawi.
Methods: Data from the Malawi hospital-based COVID-19 vaccine adverse event surveillance from were analyzed. Surveillance involved screening of all patients presenting to the hospitals and those with 12 pre-selected AESIs enrolled. Among enrolled from the adult wards, all patients diagnosed with malaria were identified. Retrospective review of medical records was performed to obtain data on: malaria signs and symptoms, tests and results, treatments and outcomes.
Results: Out of 1,835 patients enrolled, 294 (16%) were diagnosed with malaria. Medical records were available and reviewed for 240 (82%) patients. The mean age of malaria patients was 34 years with most aged 18-27 years (28%) and being females (55%). Among reviewed patients, 31% met severe malaria definition, 9% uncomplicated, 35% clinically diagnosed and 25% not meeting any malaria case definition. Prevalence of severe malaria was 4%. Common presentations among severe malaria patients were convulsions (55%), impaired consciousness (28%) and anemia (19%). Mortality rate among severe malaria patients was 7%, uncomplicated malaria 1%, clinically diagnosed malaria 14% and malaria negative cases 12%.
Conclusion: The prevalence of adult severe malaria is low and mortality is lower among those with test confirmed diagnosis. Most adult malaria patients are either clinically diagnosed or misdiagnosed contributing to mistreatment and poor outcomes. Interventions are needed to reduce malaria misdiagnoses in adults to improve patient outcomes.

P208_002187. UNMASKING THE EVOLUTIONARY DYNAMICS OF G1P[8] ROTAVIRUSES TO ELUCIDATE REASONS FOR THE DISAPPEARANCE OF G1P[8] STRAINS IN BLANTYRE, MALAWI
Author(s): Chimwemwe Mhango1,2, End Chinyama1, Benjamin Kumwenda2, Celeste M. Donato3,4, A. Duncan Steele5, Nigel A. Cunliffe6,7, Valantine N. Ndze8, and Arox Kamng’ona1,2,
Affiliation(s):
1.Malawi-Liverpool-Wellcome Program; 2 Department of Biomedical Sciences, School of Life Sciences and
2.Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi; 3 Enteric
3.Diseases Group, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia;
4.Department of Paediatrics, the University of Melbourne, Parkville 3010, Australia;
5.Diarrheal Pathogens Research Unit, Sefako Makgatho Health Sciences University, Medunsa 0204, Pretoria, South Africa;
6.Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK;
7.NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom;
8.Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon;
9.Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana;
10.Next Generation Sequencing Unit and Division of Virology, Faculty of Health Sciences, University of Free State, Bloemfontein 9300, South Africa;
11.Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA;
12.NIHR Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom;”
Email: cmhango@mlw.mw

Background: G1P[8] rotaviruses consistently circulated in Malawi from 1997 to 2019. They represent genogroup I and normally possess Wa-like genetic backbone. However, G1P[8] strains that circulated after introduction of Rotarix® rotavirus vaccine in Blantyre (2013-2014) exhibited DS-1-like genetic backbone, synonymous with genogroup II rotaviruses. Here we conducted whole genome sequencing (WGS) study to determine the phylodynamics of G1P[8] post 2014 as well as elucidate why G1P[8] rotavirus strains stopped circulating in Malawi from 2019.
Methods: We recruited under-five children presenting with acute gastroenteritis at Queen Elizabeth Central Hospital. We systematically generated WGS for G1P[8] strains that circulated from 2015 to 2019 in Blantyre. Time-resolved phylogenetic analysis was used to establish rotavirus lineage clusters post 2014. Haplotype inference was used to estimate genetic diversity while phylogeographic analysis was used to establish genetic relatedness of Malawian to globally classified G1P[8] strains.
Results: WGS revealed that G1P8 strains had G1-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 while two strains had G1-P[8]-I1-R1-C1-M1-A1-N2-T1-E1-H1 genotype constellations. Genome segment time-resolved phylogenies revealed new clusters L4 and L5, genetically distinct from L1, L2 and L3 previously described in Malawi from 1997 – 2014. Phylogeographic analysis revealed monophyletic cluster between L4 and contemporary G1P[8] strains characterised in Mozambique and India. Haplotype inference of VP7 and VP4 segments of G1P[8] strains revealed wider genetic diversity before vaccine introduction compared to post-vaccine strains. Phylogenetic analysis revealed an antigenic shift of outer capsid proteins between L4 and G12P[8] strains that emerged in 2018.
Conclusion: These findings highlight the role of cross-border introductions in shaping population dynamics of rotavirus strains in Blantyre Malawi post-vaccine introduction. Our work suggests that the narrower genetic diversity of L4 strains possibly rendered these strains susceptible to immunity induced by both vaccine and natural infection. Our findings further suggests that G12P[8] strains that emerged in 2018 outcompeted G1P[8], eventually leading to their disappearance.

P209_002201. BUILDING CAPACITY FOR PATHOGEN GENOME SEQUENCING IN MALAWI
Author(s): David Chaima1, Samuel Gwayi1, Chisomo Msefula1, Benjamin Kumwenda1, Khuzwayo C. Jere1,2,3, Tonney Nyirenda1 and Arox Kamng’ona1
Affiliation(s):
1.Kamuzu University of Health Sciences, Blantyre, Malawi,
2.Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
3.University of Liverpool, Liverpool, UK
Email: dchaima@kuhes.ac.mw

Introduction and Objective: Genome sequencing technologies have enabled greater utilization of genomic data in public healthcare delivery. During the COVID-19 pandemic, for example, genome sequencing was key to determining the SARS-CoV-2 variants in circulation, development of diagnostic assays, immunological interventions and monitoring pathogen transmission patterns. Efforts to keep up with the evolving virus across the globe were hampered by the lack of capacity to generate genomic data in low and middle income countries (LMICs) particularly in Africa, as evidenced by the limited data repositories on GISAID from this region. In Malawi, lack of sequencing facilities affected the healthcare delivery, resulting in the need to ship samples abroad for such services. This affected timely decision making and responses in the fight against infections. The COVID-19 pandemic highlighted the need to build local sequencing capacity in Malawi.
Methods: In 2021, we secured funding from the Public Health Alliance for Genomic Epidemiology (PHA4GE), which enabled us to purchase the MinION Mk1C sequencing platform and implement standardized bioinformatics practices, pipelines, and data structures in SARS-CoV-2 sequencing at the Kamuzu University of Health Sciences (KUHeS). Building on the successes from the PHA4GE project, we were funded by the the Global Fund COVID-19 through the Malawi Ministry of Health (MoH) to scale up our pathogen genome sequencing infrastructure by purchasing a high throughput illumina sequencing platform (Nextseq 1000) and expanding laboratory space.
Results and Conclusion: The establishment of a sequencing facility at KUHeS will support efforts by MoH to utilise pathogen genomics data in public healthcare. However, Malawi lacks the relevant experience to handle advanced sequencing platforms, despite having molecular and bioinformatics expertise. To maximize the benefit from this significant investment and ensure sustainability, Malawi needs to build local capacity and establish partnerships with other laboratories from which it can draw synergy and expertise to strengthen its Next Generation DNA Sequencing Facility.