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Article ; Online: Reducing bacterial contamination in an Orthopedic Theatre ventilated by natural ventilation, in a Developing Country.

Thomas, Stephanie / Palmer, Rish / Phillipo, Edward / Chipungu, Geoffrey

Journal of infection in developing countries

2016 Volume 10, Issue 5, Page(s) 518–522

Abstract: Introduction: All surgical procedures have the potential for infection and some of the main sources are contamination from airborne particles, theatre personnel and the theatre environment. There is strong evidence that the use of ultra-clean air flow ... ...

Abstract	Introduction: All surgical procedures have the potential for infection and some of the main sources are contamination from airborne particles, theatre personnel and the theatre environment. There is strong evidence that the use of ultra-clean air flow systems in orthopedic operating theatres reduces the incidence of deep sepsis after surgery. In the developing world however, this is often an unrealistic solution. The aim of this study was to establish baseline levels of contamination in a working orthopedic theatre, at the Queen Elizabeth Central Hospital, Blantyre, Malawi. To feedback results to the theatre team, promote infection prevention discussion and work with the team to implement workable and realistic goals to improve the intra-operative environment. Methodology: Samples were collected from theatre equipment available at the time of surgery, from theatre water and theatre air using passive air sampling techniques. Samples were immediately transferred to the Central Microbiology Laboratory for culture on basic culture media. Results: Bacterial contamination of theatre equipment, intra-operative theatre air and water was detected. Results were discussed with the theatre and infection prevention team who were receptive to feedback with regards to infection prevention strategies and keen to develop simple measures which could be put in place to change practice. Conclusions: In this setting, we suggest that implementing workable and realistic goals such as, establishing baseline rates of bacterial contamination and introduction of strict protocols for asepsis and theatre etiquette, may reduce bacterial contamination rates and subsequent intra-operative infection in the absence of expensive engineering solutions.
MeSH term(s)	Air Microbiology ; Bacteriological Techniques ; Developing Countries ; Hospitals ; Humans ; Infection Control/methods ; Malawi ; Operating Rooms ; Ventilation/methods ; Water Microbiology
Language	English
Publishing date	2016-05-31
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2394024-4
ISSN	1972-2680 ; 2036-6590
ISSN (online)	1972-2680
ISSN	2036-6590
DOI	10.3855/jidc.7436
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi.

Kaswaswa, Kruger / MacPherson, Peter / Kumwenda, Moses / Mpunga, James / Thindwa, Deus / Nliwasa, Marriott / Mwapasa, Mphatso / Odland, Jon / Tomoka, Tamiwe / Chipungu, Geoffrey / Mukaka, Mavuto / Corbett, Elizabeth L

PloS one

2022 Volume 17, Issue 9, Page(s) e0269219

Abstract: Background: Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to ... ...

Abstract	Background: Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake. Methods: Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines. Main outcome and measures: The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering. Results: Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60-7.95). Eligible PACTS contacts (37/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27/101, 26.7%; aOR 2.27, 95% CI: 1.04-4.98). U5Y children in the PACTS arm (47/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36/89, 41.4%; aOR: 2.31, 95% CI: 1.05-5.06). Conclusions and relevance: A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings. Clinical trial registration: TRIAL REGISTRATION NUMBER: ISRCTN81659509 https://www.isrctn.com/ISRCTN81659509?q=&filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. 19 July 2012.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Contact Tracing ; Family Characteristics ; Humans ; Isoniazid/therapeutic use ; Malawi/epidemiology ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; Tuberculosis/prevention & control
Chemical Substances	Isoniazid (V83O1VOZ8L)
Language	English
Publishing date	2022-09-08
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0269219
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Article ; Online: The occurrence and frequency of genomic mutations that mediate Isoniazid and Rifampicin resistance in

Kumwenda, Geoffrey P / Chipungu, Geoffrey / Sloan, Derek J / Kaimila, Yankho / Chiumya, Kondwani / Pangani, Harry

Malawi medical journal : the journal of Medical Association of Malawi

2018 Volume 30, Issue 1, Page(s) 1–5

Abstract: Background: The emergence and spread of drug-resistant Tuberculosis (TB) is a major public health threat. TB resistance originates in the course of treatment due to genomic mutations in : Methods: A cross-sectional retrospective study was conducted ... ...

Abstract	Background: The emergence and spread of drug-resistant Tuberculosis (TB) is a major public health threat. TB resistance originates in the course of treatment due to genomic mutations in Methods: A cross-sectional retrospective study was conducted on a panel of 141(n=141) MTB clinical isolates recovered between June 2010 and January 2012 from >2+ Ziehl-Neelsen smear positive new pulmonary-TB patients with no history of treatment. Frozen isolates were revived using the BACTEC MGIT detection system. DNA was extracted using GenoLyse DNA extraction kit and detection of genomic mutations was carried out using the GenoType MTBDRplus Ver 2.0 assay. Results: Out of the 141 isolates studied, 3 (2.1%) were found carrying mutations in the Conclusion: The
MeSH term(s)	Antibiotics, Antitubercular/pharmacology ; Bacterial Proteins/drug effects ; Bacterial Proteins/genetics ; Catalase/drug effects ; Cross-Sectional Studies ; DNA-Directed RNA Polymerases/drug effects ; Humans ; Isoniazid/pharmacology ; Malawi ; Molecular Diagnostic Techniques ; Mutation ; Mycobacterium tuberculosis/drug effects ; Mycobacterium tuberculosis/genetics ; Mycobacterium tuberculosis/isolation & purification ; Oxidoreductases/drug effects ; Polymerase Chain Reaction ; Promoter Regions, Genetic/genetics ; Retrospective Studies ; Rifampin/pharmacology ; Tuberculosis, Multidrug-Resistant/genetics
Chemical Substances	Antibiotics, Antitubercular ; Bacterial Proteins ; rpoB protein, Mycobacterium tuberculosis ; Oxidoreductases (EC 1.-) ; Catalase (EC 1.11.1.6) ; katG protein, Mycobacterium tuberculosis (EC 1.11.1.6) ; InhA protein, Mycobacterium (EC 1.3.1.9) ; DNA-Directed RNA Polymerases (EC 2.7.7.6) ; Isoniazid (V83O1VOZ8L) ; Rifampin (VJT6J7R4TR)
Language	English
Publishing date	2018-06-05
Publishing country	Malawi
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2491952-4
ISSN	1995-7270 ; 1995-7262
ISSN (online)	1995-7270
ISSN	1995-7262
DOI	10.4314/mmj.v30i1.1
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Article: Infant HIV diagnosis and turn-around time for testing in Malawi, 2015.

Ali, Hammad / Minchella, Peter / Chipungu, Geoffrey / Kim, Evelyn / Kandulu, James / Midiani, Dalitso / Kim, Andrea / Swaminathan, Mahesh / Gutreuter, Steve / Nkengasong, John / Singer, Daniel

African journal of laboratory medicine

2020 Volume 9, Issue 1, Page(s) 904

Abstract: Background: For HIV-exposed infants in Malawi, there are missed opportunities at each step of the testing and treatment cascade.: Objective: This study assessed factors associated with HIV positivity among infants in Malawi and turn-around times for ... ...

Abstract	Background: For HIV-exposed infants in Malawi, there are missed opportunities at each step of the testing and treatment cascade. Objective: This study assessed factors associated with HIV positivity among infants in Malawi and turn-around times for infant HIV testing. Methods: HIV testing data for infants aged 0-18 months from 2012 to 2015 were extracted from the Malawi HIV laboratory information management system and analysed using logistic regression. Turn-around time was defined as time between collection of samples to results dispatch from the laboratory. Results: A total of 106 997 tests were included in the analyses. A subset of 76 006 observations with complete dates were included in the turn-around time analysis. Overall positivity was 4.2%. Factors associated with positivity were increasing age (infants aged 3-6 months: adjusted odds ratio [aOR] = 2.24; infants aged 6-9 months: aOR = 3.42; infants aged > 9 months: aOR = 4.24), female sex (aOR = 1.08) and whether the mother was alive and not on antiretroviral therapy at time of the infant's test (aOR = 1.57). Provision of HIV prophylaxis to the infant after birth (aOR = 0.38) was found to be protective against HIV positivity. The median turn-around time was 24 days (increased from 19 to 34 days between 2012 and 2015). Conclusion: Infant HIV positivity has decreased in Malawi, whereas turn-around time has increased. Factors associated with positivity include increasing age, female sex, and whether the mother was alive and not on antiretroviral therapy at the time of the infant's test.
Language	English
Publishing date	2020-11-26
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2708535-1
ISSN	2225-2010 ; 2225-2002
ISSN (online)	2225-2010
ISSN	2225-2002
DOI	10.4102/ajlm.v9i1.904
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Article ; Online: 'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi.

Chikovore, Jeremiah / Hart, Graham / Kumwenda, Moses / Chipungu, Geoffrey A / Corbett, Liz

Global health action

2015 Volume 8, Page(s) 26292

Abstract: Background: Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment.: Objective: To understand ... ...

Abstract	Background: Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective: To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Design: Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Results: Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Conclusions: Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing precarity, in efforts to improve men's engagement with their health.
MeSH term(s)	Adult ; Aged ; Cough/etiology ; Cough/prevention & control ; Early Diagnosis ; Female ; Focus Groups ; Grounded Theory ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Humans ; Malawi ; Male ; Masculinity ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Poverty ; Qualitative Research ; Sex Factors ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Tuberculosis/therapy ; Urban Population
Language	English
Publishing date	2015
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9716
ISSN (online)	1654-9880
ISSN	1654-9716
DOI	10.3402/gha.v8.26292
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Article ; Online: 'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi.

Chikovore, Jeremiah / Hart, Graham / Kumwenda, Moses / Chipungu, Geoffrey A / Corbett, Liz

Global health action

2015 Volume 8, Issue 1, Page(s) 26292

Abstract: Background Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective To understand masculinity's ... ...

Abstract	Background Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Design Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Results Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Conclusions Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing precarity, in efforts to improve men's engagement with their health.
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9716
ISSN (online)	1654-9880
ISSN	1654-9716
DOI	10.3402/gha.v8.26292
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Article ; Online: Specimen origin, type and testing laboratory are linked to longer turnaround times for HIV viral load testing in Malawi.

Minchella, Peter A / Chipungu, Geoffrey / Kim, Andrea A / Sarr, Abdoulaye / Ali, Hammad / Mwenda, Reuben / Nkengasong, John N / Singer, Daniel

PloS one

2017 Volume 12, Issue 2, Page(s) e0173009

Abstract: Background: Efforts to reach UNAIDS' treatment and viral suppression targets have increased demand for viral load (VL) testing and strained existing laboratory networks, affecting turnaround time. Longer VL turnaround times delay both initiation of ... ...

Abstract	Background: Efforts to reach UNAIDS' treatment and viral suppression targets have increased demand for viral load (VL) testing and strained existing laboratory networks, affecting turnaround time. Longer VL turnaround times delay both initiation of formal adherence counseling and switches to second-line therapy for persons failing treatment and contribute to poorer health outcomes. Methods: We utilized descriptive statistics and logistic regression to analyze VL testing data collected in Malawi between January 2013 and March 2016. The primary outcomes assessed were greater-than-median pretest phase turnaround time (days elapsed from specimen collection to receipt at the laboratory) and greater-than-median test phase turnaround time (days from receipt to testing). Results: The median number of days between specimen collection and testing increased 3-fold between 2013 (8 days, interquartile range (IQR) = 6-16) and 2015 (24, IQR = 13-39) (p<0.001). Multivariable analysis indicated that the odds of longer pretest phase turnaround time were significantly higher for specimen collection districts without laboratories capable of conducting viral load tests (adjusted odds ratio (aOR) = 5.16; 95% confidence interval (CI) = 5.04-5.27) as well as for Malawi's Northern and Southern regions. Longer test phase turnaround time was significantly associated with use of dried blood spots instead of plasma (aOR = 2.30; 95% CI = 2.23-2.37) and for certain testing months and testing laboratories. Conclusion: Increased turnaround time for VL testing appeared to be driven in part by categorical factors specific to the phase of turnaround time assessed. Given the implications of longer turnaround time and the global effort to scale up VL testing, addressing these factors via increasing efficiencies, improving quality management systems and generally strengthening the VL spectrum should be considered essential components of controlling the HIV epidemic.
MeSH term(s)	HIV Infections/blood ; HIV Infections/diagnosis ; HIV Infections/virology ; HIV-1/genetics ; HIV-1/isolation & purification ; Humans ; Infant ; Malawi ; Molecular Diagnostic Techniques ; Time Factors ; Viral Load
Language	English
Publishing date	2017-02-24
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0173009
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Article ; Online: Assessing stakeholder perceptions of the acceptability and feasibility of national scale-up for a dual HIV/syphilis rapid diagnostic test in Malawi.

Maddox, Brandy L Peterson / Wright, Shauntā S / Namadingo, Hazel / Bowen, Virginia B / Chipungu, Geoffrey A / Kamb, Mary L

Sexually transmitted infections

2017 Volume 93, Issue S4, Page(s) S59–S64

Abstract: Objectives: The WHO recommends pregnant women receive both HIV and syphilis testing at their first antenatal care visit, as untreated maternal infections can lead to severe, adverse pregnancy outcomes. One strategy for increasing testing for both HIV ... ...

Abstract	Objectives: The WHO recommends pregnant women receive both HIV and syphilis testing at their first antenatal care visit, as untreated maternal infections can lead to severe, adverse pregnancy outcomes. One strategy for increasing testing for both HIV and syphilis is the use of point-of-care (rapid) diagnostic tests that are simple, proven effective and inexpensive. In Malawi, pregnant women routinely receive HIV testing, but only 10% are tested for syphilis at their first antenatal care visit. This evaluation explores stakeholder perceptions of a novel, dual HIV/syphilis rapid diagnostic test and potential barriers to national scale-up of the dual test in Malawi. Methods: During June and July 2015, we conducted 15 semistructured interviews with 25 healthcare workers, laboratorians, Ministry of Health leaders and partner agency representatives working in prevention of mother-to-child transmission in Malawi. We asked stakeholders about the importance of a dual rapid diagnostic test, concerns using and procuring the dual test and recommendations for national expansion. Results: Stakeholders viewed the test favourably, citing the importance of a dual rapid test in preventing missed opportunities for syphilis diagnosis and treatment, improving infant outcomes and increasing syphilis testing coverage. Primary technical concerns were about the additional procedural steps needed to perform the test, the possibility that testers may not adhere to required waiting times before interpreting results and difficulty reading and interpreting test results. Stakeholders thought national scale-up would require demonstration of cost-savings, uniform coordination, revisions to testing guidelines and algorithms, training of testers and a reliable supply chain. Conclusions: Stakeholders largely support implementation of a dual HIV/syphilis rapid diagnostic test as a feasible alternative to current antenatal testing. Scale-up will require addressing perceived barriers; negotiating changes to existing algorithms and guidelines; and Ministry of Health approval and funding to support training of staff and procurement of supplies.
MeSH term(s)	Adolescent ; Adult ; Cost-Benefit Analysis ; Diagnostic Tests, Routine ; Feasibility Studies ; Female ; HIV Infections/diagnosis ; HIV Infections/transmission ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical/prevention & control ; Malawi/epidemiology ; Mass Screening ; Outcome Assessment (Health Care) ; Patient Acceptance of Health Care/statistics & numerical data ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/prevention & control ; Pregnancy Outcome ; Pregnant Women ; Prenatal Care ; Reagent Kits, Diagnostic ; Syphilis/diagnosis ; Syphilis/transmission
Chemical Substances	Reagent Kits, Diagnostic
Language	English
Publishing date	2017-11-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1420303-0
ISSN	1472-3263 ; 1368-4973
ISSN (online)	1472-3263
ISSN	1368-4973
DOI	10.1136/sextrans-2016-053062
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Article ; Online: Control, struggle, and emergent masculinities: a qualitative study of men's care-seeking determinants for chronic cough and tuberculosis symptoms in Blantyre, Malawi.

Chikovore, Jeremiah / Hart, Graham / Kumwenda, Moses / Chipungu, Geoffrey A / Desmond, Nicola / Corbett, Liz

BMC public health

2014 Volume 14, Page(s) 1053

Abstract: Background: Men's healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity's role in ... ...

Abstract	Background: Men's healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity's role in healthcare-seeking delay for men with TB-suggestive symptoms, with a view to developing potential interventions for men. Methods: Data were collected during March 2011- March 2012 in three high-density suburbs in urban Blantyre. Ten focus group discussions were carried out of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers. Individual interviews were done with 20 TB patients (female =14) and 20 un-investigated chronic coughers (female = eight), and a three-day workshop was held with 27 health stakeholder representatives. Results: An expectation to provide for and lead their families, and to control various aspects of their lives while facing limited employment opportunities and small incomes leaves men feeling inadequate, devoid of control, and anxious about being marginalised as men. Men were fearful about being looked at as less than men, and about their wives engaging in extramarital sex without ability to detect or monitor them. Control was a key defining feature of adequate manhood, and efforts to achieve it also led men into side-lining their health. Articulate and consistent concepts of men's bodily strength or appropriate illness responses were absent from the accounts. Conclusions: Facilitating men to seek care early is an urgent public health imperative, given the contexts of high HIV/AIDS prevalence but increasingly available treatment, and the role of care-seeking delay in TB transmission. Men's struggles trying to achieve ideal images seem to influence their engagement with their health. Ambiguous views regarding some key masculinity representations and the embrace of less harmful masculinities raise questions about some common assumptions that guide work with men. Apparent 'emergent masculinities' might be a useful platform from which to support the transformation of harmful masculinity. Finally, the complex manifestations of masculinity indicate the need for interventions targeting men in health and TB control to assume supportive, multidimensional and long-term outlooks.
MeSH term(s)	Adult ; Chronic Disease ; Cough/diagnosis ; Cough/etiology ; Female ; Focus Groups ; Gender Identity ; HIV Infections/complications ; HIV Infections/diagnosis ; Health Behavior ; Humans ; Malawi ; Male ; Masculinity ; Men/psychology ; Patient Acceptance of Health Care/psychology ; Qualitative Research ; Residence Characteristics ; Spouses ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Tuberculosis/psychology
Language	English
Publishing date	2014-10-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/1471-2458-14-1053
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Article ; Online: Treatment-Seeking for Tuberculosis-Suggestive Symptoms: A Reflection on the Role of Human Agency in the Context of Universal Health Coverage in Malawi

Kumwenda, Moses / Desmond, Nicola / Hart, Graham / Choko, Augustine / Chipungu, Geoffrey A / Nyirenda, Deborah / Shand, Tim / Corbett, Elizabeth L / Chikovore, Jeremiah

PloS one

2016 Volume 11, Issue 4, Page(s) e0154103

Abstract: Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these ... ...

Abstract	Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-density locales of urban Blantyre, Malawi. Data were collected in March 2011 -March 2012 using focus group discussions, of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers; and in-depth interviews with 20 TB patients (female = 14) and 20 un-investigated chronic coughers (female = eight). The research process employed a modified version of grounded theory. Data were coded using a coding scheme that was initially generated from the study aims and subsequently progressively amended to incorporate concepts emerging during the analysis. Coded data were retrieved, re-read, and broken down and reconnected iteratively to generate themes. A myriad of problems were described for health systems at the primary health care level, centring largely on shortages of resources (human, equipment, and drugs) and unprofessional conduct by health care providers. Participants consistently pointed out how the problems could drive patients from promptly reporting symptoms at primary healthcare centres. The accounts suggest that in responding to illness symptoms including those suggestive of TB, patients navigate their options taking into cognisance past and current experiences with formal health systems. Understanding and factoring in the mediating role of such 'agency' is critical when implementing efforts to promote timely response to TB-suggestive symptoms.
MeSH term(s)	Antimalarials/therapeutic use ; Artemether, Lumefantrine Drug Combination ; Artemisinins/therapeutic use ; Chronic Disease ; Community Health Services/standards ; Community Health Services/statistics & numerical data ; Cough/diagnosis ; Cough/drug therapy ; Drug Combinations ; Ethanolamines/therapeutic use ; Female ; Fever/drug therapy ; Fluorenes/therapeutic use ; Focus Groups/methods ; Health Behavior ; Health Personnel/standards ; Health Personnel/statistics & numerical data ; Humans ; Malawi ; Male ; Masculinity ; Patient Acceptance of Health Care/statistics & numerical data ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy
Chemical Substances	Antimalarials ; Artemether, Lumefantrine Drug Combination ; Artemisinins ; Drug Combinations ; Ethanolamines ; Fluorenes
Language	English
Publishing date	2016-04-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0154103
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Inter-library loan at ZB MED