Abstract
Background
Dyslipidaemia among individuals with diabetes is a significant modifiable risk factor for atherosclerotic cardiovascular diseases (ASCVDs). ASCVDs are a major cause of mortality ...and morbidity globally, especially in people with diabetes. In Malawi, limited data exist on the prevalence and biochemical characteristics of diabetic dyslipidaemia. This study investigated the prevalence and biochemical characteristics of dyslipidaemia in individuals attending the diabetes clinic at Kamuzu Central Hospital, the largest tertiary referral hospital in Central Malawi.
Methods
Using a cross-sectional design, sociodemographic, medical and anthropometric data were collected from 391 adult participants who were enrolled in the study. Blood samples were analysed for glycosylated haemoglobin (HBA1c) and fasting lipid profiles. The prevalence of dyslipidaemia was calculated, and the biochemical characteristics of the dyslipidaemia were defined. The associations between dyslipidaemia and risk factors such as sociodemographic characteristics, obesity, and HBA1c levels were evaluated using logistic regression analysis.
Results
Prevalence of dyslipidaemia was observed in 71% of the participants, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality among the study participants. None of the participants were receiving any lipid-lowering therapy. On bivariate analysis, dyslipidemia was positively associated with female sex OR 1.65 (95% CI 1.05- 2.58);
p
= 0.09, age ≥ 30 years OR 3.60 (95% CI 1.17-7.68);
p
= 0.001 and overweight and obesity OR 2.11 (95% CI 1.33-3.34);
p
= 0.002. On multivariate analysis, being overweight or obese was an independent predictor of dyslipidaemia AOR 1.8;(95% CI 1.15- 3.37);
p
= 0.04.
Conclusion
Dyslipidaemia was highly prevalent among individuals with diabetes in this study, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality. Overweight and obesity were also highly prevalent and positively predicted dyslipidaemia. This study highlights the importance of appropriately addressing dyslipidaemia, overweight and obesity among individuals with diabetes in Malawi and other similar settings in Africa as one of the significant ways of reducing the risk of ASCVDs among this population.
To assess medical and nursing students' intentions to migrate abroad or practice in rural areas.
We surveyed 3199 first- and final-year medical and nursing students at 16 premier government ...institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models.
Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96).
A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.
Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of ...dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical characteristics, screening and management practices for dyslipidaemia among persons with diabetes mellitus, hypertension, and diabetes mellitus and hypertension comorbidity at Queen Elizabeth Central hospital in Blantyre, Malawi.
This was a cross-sectional study conducted in 2021. A total of 256 adult participants (diabetes mellitus = 100); hypertension = 100; both conditions = 56) were included. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were also assessed.
Dyslipidaemia was prevalent in 58%, 55%, and 70% of participants with diabetes mellitus, hypertension, and both conditions. Low-density lipoprotein cholesterol (LDL-C) dyslipidaemia was the most common in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2-4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p < 0.02). Being overweight or obese and age over 30 years were risk factors for dyslipidaemia in participants with diabetes mellitus alone (OR 1.3 (95% CI 1.1-1.6), p < 0.04, and OR 2.2 (95% CI 1.2-4.7) (p < 0.01), respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (OR 3.5 (95% CI 1.2-9.9) p < 0.001). Poorly controlled hypertension and the use of beta-blockers and thiazide diuretics predicted dyslipidaemia among patients with both diabetes mellitus and hypertension (OR 6.50 CI 1.45-29.19; and OR 5.20 CI 1.16-23.36 respectively). None of the participants had a lipogram performed before the study or were on lipid-lowering therapy.
Dyslipidaemia with LDL-C derangement was highly prevalent, especially in individuals with both diabetes mellitus and hypertension, and there was absent use of lipid-lowering therapy. Screening and managing dyslipidaemia should be reinforced to reduce the risk of cardiovascular complications in this population at increased risk.
Malawi experienced prolonged use of sulfadoxine/pyrimethamine (SP) as the front-line anti-malarial drug, with early replacement of chloroquine and delayed introduction of artemisinin-based ...combination therapy. Extended use of SP, and its continued application in pregnancy is impacting the genomic variation of the Plasmodium falciparum population.
Whole genome sequence data of P. falciparum isolates covering 2 years of transmission within Malawi, alongside global datasets, were used. More than 745,000 SNPs were identified, and differences in allele frequencies between countries assessed, as well as genetic regions under positive selection determined.
Positive selection signals were identified within dhps, dhfr and gch1, all components of the parasite folate pathway associated with SP resistance. Sitting predominantly on a dhfr triple mutation background, a novel copy number increase of ~twofold was identified in the gch1 promoter. This copy number was almost fixed (96.8% frequency) in Malawi samples, but found at less than 45% frequency in other African populations, and distinct from a whole gene duplication previously reported in Southeast Asian parasites.
SP resistance selection pressures have been retained in the Malawian population, with known resistance dhfr mutations at fixation, complemented by a novel gch1 promoter duplication. The effects of the duplication on the fitness costs of SP variants and resistance need to be elucidated.
In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a ...tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation.
Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach.
Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector.
Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors.
Malawi has one of the lowest physician densities in the world, at 1.1 doctors per 100,000 population. Undergraduate training of doctors at the national medical school has increased considerably in ...recent years with donor support. However, qualified doctors continue to leave the public sector in order to work or train abroad. We explored the postgraduate plans of current medical students, and the extent to which this is influenced by their background.
A self-administered questionnaire was developed after discussion with students and senior staff. This included questions on background characteristics, education before medical school, and future career plans. This was distributed to all medical and premedical students on campus over 1 week and collected by an independent researcher. One reminder visit was made to each class. Chi-squared tests were performed to investigate the relationship of student characteristics with future career plans.
One hundred and forty-nine students completed the questionnaire out of a student body of 312, a response rate of 48%. When questioned on their plans for after graduation, 49.0% of students plan to stay in Malawi. However, 38.9% plan to leave Malawi immediately. Medical students who completed a 'premedical' foundation year at the medical school were significantly more likely to have immediate plans to stay in Malawi compared to those who completed A-levels, an advanced school-leaving qualification (P = 0.037). Current premedical students were slightly more likely to have immediate plans to work or train in Malawi compared to medical students (P = 0.049). However, a trend test across all the years was not significant. When asked about future plans, nearly half of students intend to work or train outside Malawi.
The majority of respondents plan to leave Malawi in the future. The effectiveness of the substantial upscaling of medical education in Malawi may be diminished unless more medical students plan to work in Malawi after graduation.
Dyslipidaemia, obesity and vitamin D insufficiency are important risk factors for cardiovascular disease and may increase the risk for severe COVID-19 among individuals with Diabetes mellitus.
To ...investigate the prevalence of dyslipidaemia, obesity and vitamin D insufficiency among patients attending the diabetes clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi.
A total of 102 participants were included in the cross-sectional study. Medical data were collected, and anthropometric measurements were performed. Blood samples were collected for HbA1C, serum lipogram and vitamin D analyses. Associated risk factors for dyslipidaemia and vitamin D insufficiency were assessed.
A proportion of 74% of the participants had dyslipidaemia. Low-density lipoprotein-cholesterol dyslipidaemia was the most common form of dyslipidaemia (52%). Overweight and obesity was prevalent in 58% of the participants. The median (IQR) HBA1C level was 11% (9-14 %). Overweight or obesity and age over 30 years were risks for dyslipidaemia (RR 1.3 (95% CI 1.1 – 1.6), p=0.04, and RR 2.2 (95% CI 1.2 – 4.7) p=0.003, respectively. The prevalence of vitamin D insufficiency in the study group was 76%. HBA1C of > 7% was positively associated with vitamin D insufficiency (RR 1.6 (CI 1.0 – 2.8), p=0.02).
Dyslipidaemia, obesity, and vitamin D insufficiency were highly prevalent in the study group. Poorly controlled blood glucose was associated with vitamin D insufficiency. The high prevalence of dyslipidaemia, obesity and vitamin D deficiency are the possible precipitating factors for the increasing rates of cardiovascular events and COVID-19 severity among patients with diabetes in Malawi.
Dyslipidaemia is a significant risk factor for cardiovascular events but is often neglected in most resource-poor settings.
We aimed to investigate the prevalence, biochemical characteristics, ...screening and management practice for dyslipidaemia among patients with DM, hypertension, and both DM and hypertension at a tertiary teaching hospital in Southern Malawi, Africa.
A total of 256 adult participants (DM=100; hypertension =100; both condition = 56) were included in the cross-sectional study in 2021. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were assessed.
Dyslipidaemia was prevalent in 73.5%, 71.8%, and 76.7% of participants with DM, hypertension, and both conditions. High low-density lipoprotein cholesterol (LDL-C) was the most common dyslipidaemia type in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2 - 4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p=0.02). Overweight or obesity, and age over 30 years were risks for dyslipidaemia in patients with DM alone (RR 1.3 (95% CI 1.1 – 1.6), p=0.04, and RR 2.2 (95% CI 1.2 – 4.7) (p<0.01) respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (RR 3.492 (95% CI 1.234 - 9.884) p <0.001). Poorly controlled hypertension was associated with a 1.8 times risk (95% CI 1.06 – 2.7) of dyslipidaemia in patients with both DM and hypertension (p<0.01). Only 1% of the participants ever had a lipogram performed before the study and were on lipid-lowering therapy.
Dyslipidaemia was highly prevalent, especially in individuals with both DM and hypertension. Screening and managing dyslipidaemia should be reinforced to reduce the risk of major cardiovascular events in this population at high risk.
Medical schools in sub-Saharan Africa Mullan, Fitzhugh, Prof; Frehywot, Seble, MD; Omaswa, Francis, FRCS ...
The Lancet (British edition),
2011, Letnik:
377, Številka:
9771
Journal Article
Recenzirano
Odprti dostop
Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School ...Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.
Abstract The “first digit law” or “Benford’s law” is a mathematical distribution discovered by Simon Newcomb and Frank Benford. It states, that the probability of the leading number d (d ∈ {1,…,9}) ...in many natural datasets follows: P (d) = log10 (d + 1) − log10 (d) = log10 (1 + 1/d). It was successfully used through tax authorities and “forensic accounting” in order to detect fraud and other irregularities. Benfords law was almost neglected for its use outside financial accounting. The planning for health care systems in developing countries is extremely dependant on good, valid data. Whether you plan the catchment area for the future district hospitals, the number of health posts, the staff establishment for the central hospital or the drug budget in the Ministry. The “first digit law” can be used in medicine, public health, physiology and development aid to unmask questionable data, to discover unexpected challenges, difficulties in the data collection process, loss through corruption and criminal fraud. Our hypothesis suggests, that the “first digit law” is a cost effective tool, which is easy to use for most people in the medical profession, which does not really needs complicated statistical software and can be used on the spot, even in the resource restricted conditions of developing countries. Several preconditions (like the size of the data set and its reach over more than two dimensions) have to be fulfilled, but then Benfords law can be used by any clinician, physiologist, public health specialist or aid consultant without difficulties and without deeper statistical knowledge in the four steps, we suggest in this article. The consequences will be different depending on the level (local regional, national, continental, international) on which you will use the law. All levels will be enabled to get insight into the validity of the data-challenges for the other levels without the help of trained statisticians or accountants. We believe that the “first digit law” is a vastly underestimated and neglected, but extremely useful tool for the identification of unexpected challenges, supervision and control in various parts of medicine and public health for almost all aspects of development aid.
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