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Article ; Online: Serum Concentrations of Selected Poly- and Perfluoroalkyl Substances (PFASs) in Pregnant Women and Associations with Birth Outcomes. A Cross-Sectional Study from Southern Malawi.

Mwapasa, Mphatso / Huber, Sandra / Chakhame, Bertha Magreta / Maluwa, Alfred / Odland, Maria Lisa / Röllin, Halina / Choko, Augustine / Xu, Shanshan / Odland, Jon Øyvind

International journal of environmental research and public health

2023 Volume 20, Issue 3

Abstract: Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with adverse pregnancy outcomes. The aim of the present study was to examine the determinants of different serum PFAS concentrations in late pregnancy and their ... ...

Abstract	Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with adverse pregnancy outcomes. The aim of the present study was to examine the determinants of different serum PFAS concentrations in late pregnancy and their relationship with birth outcomes in southern Malawi. The sample included 605 pregnant women with a mean age of 24.8 years and their offspring from three districts in the southern region of Malawi. Six PFAS were measured in serum from third-trimester women. The serum PFAS concentrations were assessed with head circumference, birth length, birth weight, gestational age and ponderal index. Participants living in urban areas had significantly higher serum levels of PFOA, PFNA and SumPFOS, while SumPFHxS concentrations were higher in women from rural settings. High PFOA, PFNA and SumPFHxS concentrations were generally inversely associated with head circumference. Birth length was negatively associated with PFOA and PFNA while SumPFHxS was negatively associated with birth weight. SumPFOS was inversely associated with gestational age. Urban area of residence was the strongest predictor for high PFAS concentrations in the maternal serum and was generally associated with adverse birth outcomes. The results highlight the need to investigate SumPFHxS further as it follows a pattern that is different to similar compounds and cohorts.
MeSH term(s)	Humans ; Pregnancy ; Female ; Young Adult ; Adult ; Pregnant Women ; Cross-Sectional Studies ; Birth Weight ; Malawi ; Environmental Pollutants ; Fluorocarbons ; Pregnancy Outcome/epidemiology ; Alkanesulfonic Acids
Chemical Substances	Environmental Pollutants ; Fluorocarbons ; Alkanesulfonic Acids
Language	English
Publishing date	2023-01-17
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20031689
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Article ; Online: Predictors of Maternal Serum Concentrations for Selected Persistent Organic Pollutants (POPs) in Pregnant Women and Associations with Birth Outcomes: A Cross-Sectional Study from Southern Malawi.

Mwapasa, Mphatso / Huber, Sandra / Chakhame, Bertha Magreta / Maluwa, Alfred / Odland, Maria Lisa / Ndhlovu, Victor / Röllin, Halina / Xu, Shanshan / Odland, Jon Øyvind

International journal of environmental research and public health

2023 Volume 20, Issue 7

Abstract: Population exposure to persistent organic pollutants (POPs) may result in detrimental health effects, especially to pregnant women, developing foetuses and young children. We are reporting the findings of a cross-sectional study of 605 mothers in their ... ...

Abstract	Population exposure to persistent organic pollutants (POPs) may result in detrimental health effects, especially to pregnant women, developing foetuses and young children. We are reporting the findings of a cross-sectional study of 605 mothers in their late pregnancy, recruited between August 2020 and July 2021 in southern Malawi, and their offspring. The aim was to measure the concentrations of selected POPs in their maternal serum and indicate associations with social demographic characteristics and birth outcomes. A high level of education was the main predictor of
MeSH term(s)	Child ; Humans ; Female ; Pregnancy ; Child, Preschool ; DDT ; Pregnant Women ; Dichlorodiphenyl Dichloroethylene ; Persistent Organic Pollutants ; Cross-Sectional Studies ; Malawi ; Parturition ; Environmental Pollutants ; Mothers
Chemical Substances	o,p'-DDT (D4K93Z1TBH) ; DDT (CIW5S16655) ; Dichlorodiphenyl Dichloroethylene (4M7FS82U08) ; Persistent Organic Pollutants ; 2,2-(2-chlorophenyl-4'-chlorophenyl)-1,1-dichloroethene (DM084YLQ1L) ; Environmental Pollutants
Language	English
Publishing date	2023-03-28
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20075289
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Article ; Online: Women's perceptions of and experiences with the use of misoprostol for treatment of incomplete abortion in central Malawi: a mixed methods study.

Chakhame, Bertha Magreta / Darj, Elisabeth / Mwapasa, Mphatso / Kafulafula, Ursula Kalimembe / Maluwa, Alfred / Odland, Jon Øyvind / Odland, Maria Lisa

Reproductive health

2023 Volume 20, Issue 1, Page(s) 26

Abstract: Background: Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi.: Methods!# ...

Abstract	Background: Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi. Methods: A descriptive cross-sectional study that used mixed methods was conducted in three hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part. Results: From the qualitative data, three themes emerged around the following areas: experienced effects, support offered, and women's perceptions. Most women liked misoprostol and reported that the treatment was helpful and effective in expelling retained products of conception. Quantitative data revealed that the majority of participants, 376 (94%) were satisfied with the support received, and 361 (90.3%) believed that misoprostol was better than surgical treatment. The majority of the women 364 (91%) reported they would recommend misoprostol to friends. Conclusions: The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women.
MeSH term(s)	Pregnancy ; Female ; Humans ; Misoprostol/therapeutic use ; Abortion, Incomplete/drug therapy ; Abortion, Incomplete/surgery ; Abortifacient Agents, Nonsteroidal/therapeutic use ; Cross-Sectional Studies ; Malawi ; Abortion, Induced/methods ; Abortion, Spontaneous
Chemical Substances	Misoprostol (0E43V0BB57) ; Abortifacient Agents, Nonsteroidal
Language	English
Publishing date	2023-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2149029-6
ISSN	1742-4755 ; 1742-4755
ISSN (online)	1742-4755
ISSN	1742-4755
DOI	10.1186/s12978-022-01549-w
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Article ; Online: Experiences of Using Misoprostol in the Management of Incomplete Abortions: A Voice of Healthcare Workers in Central Malawi.

Chakhame, Bertha Magreta / Darj, Elisabeth / Mwapasa, Mphatso / Kafulafula, Ursula Kalimembe / Maluwa, Alfred / Chiudzu, Grace / Malata, Address / Odland, Jon Øyvind / Odland, Maria Lisa

International journal of environmental research and public health

2022 Volume 19, Issue 19

Abstract: Complications after abortion are a major cause of maternal death. Incomplete abortions are common and require treatment with surgical or medical uterine evacuation. Even though misoprostol is a cheaper and safer option, it is rarely used in Malawi. To ... ...

Abstract	Complications after abortion are a major cause of maternal death. Incomplete abortions are common and require treatment with surgical or medical uterine evacuation. Even though misoprostol is a cheaper and safer option, it is rarely used in Malawi. To improve services, an intervention was performed to increase the use of misoprostol in post-abortion care. This study explored healthcare providers' perceptions and experiences with misoprostol in the Malawian setting and their role in achieving effective implementation of the drug. A descriptive phenomenological study was conducted in three hospitals in central Malawi. Focus group discussions were conducted with healthcare workers in centres where the training intervention was offered. Participants were purposefully sampled, and thematic analysis was done. Most of the healthcare workers were positive about the use of misoprostol, knew how to use it and were confident in doing so. The staff preferred misoprostol to surgical treatment because it was perceived safe, effective, easy to use, cost-effective, had few complications, decreased hospital congestion, reduced workload, and saved time. Additionally, misoprostol was administered by nurses/midwives, and not just physicians, thus enhancing task-shifting. The results showed acceptability of misoprostol in post-abortion care among healthcare workers in central Malawi, and further implementation of the drug is recommended.
MeSH term(s)	Abortion, Incomplete ; Abortion, Induced/methods ; Female ; Health Personnel ; Humans ; Malawi ; Misoprostol/therapeutic use ; Pregnancy
Chemical Substances	Misoprostol (0E43V0BB57)
Language	English
Publishing date	2022-09-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph191912045
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Article ; Online: Effectiveness of a training intervention in increasing the use of misoprostol in postabortion care in Malawi: a quasi-experimental study.

Magreta Chakhame, Bertha / Darj, Elisabeth / Mwapasa, Mphatso / Kafulafula, Ursula / Chiudzu, Grace / Maluwa, Alfred / Malata, Address / Odland, Jon Øyvind / Odland, Maria Lisa

BMJ open

2022 Volume 12, Issue 12, Page(s) e061886

Abstract: Objectives: The study was conducted to determine effectiveness of a training intervention in increasing use of misoprostol in management of incomplete abortions.: Design: A quasi-experimental study with training intervention on use of misoprostol in ... ...

Abstract	Objectives: The study was conducted to determine effectiveness of a training intervention in increasing use of misoprostol in management of incomplete abortions. Design: A quasi-experimental study with training intervention on use of misoprostol in treatment of incomplete abortion. Setting: Five secondary-level public hospitals in Malawi, one in urban and four in semiurban settings. Three intervention and two control sites. Participants: Records of women treated for first-trimester incomplete abortion from March to May 2020 (baseline) and April to June 2021 (endline). Clinical data were collected from 865 records, 421 before and 444 after the intervention in all study sites. Intervention: Three-hour theoretical training sessions for 81 healthcare workers were conducted in July 2020 at the three intervention sites. Primary and secondary outcome measures: Proportion of women with incomplete abortion treated with misoprostol before and after the intervention. The proportion of women treated with sharp curettage at the study sites. Results: At the intervention sites, there was a significant increase in use of misoprostol from 22.8% (95% CI 17.9% to 28.0%) to 35.9% (95% CI 30.5% to 41.6%) and significant reduction in use of sharp curettage from 48.1% (95% CI 41.9% to 54.3%) to 39.4% (95% CI 35.3% to 42.6%) p<0.01 at baseline and endline, respectively. The use of misoprostol was significantly higher at the intervention sites with OR of 5.02 (95% CI 1.7 to 14.7) p<0.05 compared with control sites at the endline in multivariable models, and there was a difference in the difference of 14.4% ((95% CI 10.4% to 18.2%) p<0.001) between the intervention and control sites after the intervention. Conclusions: A training intervention effectively increased the use of misoprostol in the treatment of incomplete abortions. Increasing misoprostol use will make treatment of incomplete abortion cheaper, easier and more easily accessible. Making quality postabortion care accessible to more women may reduce maternal morbidity and mortality. Further training interventions are recommended.
MeSH term(s)	Pregnancy ; Female ; Humans ; Misoprostol/therapeutic use ; Abortion, Incomplete/therapy ; Abortifacient Agents, Nonsteroidal/therapeutic use ; Aftercare ; Malawi ; Abortion, Induced ; Abortion, Spontaneous
Chemical Substances	Misoprostol (0E43V0BB57) ; Abortifacient Agents, Nonsteroidal
Language	English
Publishing date	2022-12-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-061886
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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: "Are we getting the biometric bioethics right?" - the use of biometrics within the healthcare system in Malawi.

Mwapasa, Mphatso / Gooding, Kate / Kumwenda, Moses / Nliwasa, Marriott / Kaswaswa, Kruger / Sambakunsi, Rodrick / Parker, Michael / Bull, Susan / Desmond, Nicola

Global bioethics = Problemi di bioetica

2020 Volume 31, Issue 1, Page(s) 67–80

Abstract: Biometrics is the science of establishing the identity of an individual based on their physical attributes. Ethical concerns surrounding the appropriate use of biometrics have been raised, especially in resource-poor settings. A qualitative investigation ...

Abstract	Biometrics is the science of establishing the identity of an individual based on their physical attributes. Ethical concerns surrounding the appropriate use of biometrics have been raised, especially in resource-poor settings. A qualitative investigation was conducted to explore biometrics clients (
Language	English
Publishing date	2020-06-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2040347-1
ISSN	1591-7398 ; 1591-7398
ISSN (online)	1591-7398
ISSN	1591-7398
DOI	10.1080/11287462.2020.1773063
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Article ; Online: High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses.

Nliwasa, Marriott / MacPherson, Peter / Gupta-Wright, Ankur / Mwapasa, Mphatso / Horton, Katherine / Odland, Jon Ø / Flach, Clare / Corbett, Elizabeth L

Journal of the International AIDS Society

2018 Volume 21, Issue 7, Page(s) e25162

Abstract: Introduction: HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been ... ...

Abstract	Introduction: HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta-analyses to estimate HIV and TB prevalence, and short-term (two to six months) mortality, among adults with TB symptoms at community- and facility level. Methods: We searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta-analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels. Results: Sixty-two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short-term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level. Conclusions: Adults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom-based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short-term mortality are urgently needed.
MeSH term(s)	Adult ; Global Health ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV Infections/mortality ; Humans ; Prevalence ; Risk Assessment ; Tuberculosis, Pulmonary/epidemiology
Language	English
Publishing date	2018-08-01
Publishing country	Switzerland
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	2467110-1
ISSN	1758-2652 ; 1758-2652
ISSN (online)	1758-2652
ISSN	1758-2652
DOI	10.1002/jia2.25162
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Article: Characterization of DNA methylation in Malawian

Ndhlovu, Victor / Kiran, Anmol / Sloan, Derek J / Mandala, Wilson / Nliwasa, Marriott / Everett, Dean B / Kumwenda, Benjamin / Mwapasa, Mphatso / Kontogianni, Konstantina / Kamdolozi, Mercy / Corbett, Elizabeth / Caws, Maxine / Davies, Gerry

PeerJ

2020 Volume 8, Page(s) e10432

Abstract: Background: Although : Methods: We completed methylomes of 18 : Results: We replicate and confirm four methylation disrupting mutations in 4 lineages ... ...

Abstract	Background: Although Methods: We completed methylomes of 18 Results: We replicate and confirm four methylation disrupting mutations in 4 lineages of
Language	English
Publishing date	2020-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2703241-3
ISSN	2167-8359
ISSN	2167-8359
DOI	10.7717/peerj.10432
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Article ; Online: Post-test adverse psychological effects and coping mechanisms amongst HIV self-tested individuals living in couples in urban Blantyre, Malawi.

Kumwenda, Moses Kelly / Corbett, Elizabeth Lucy / Choko, Augustine Talumba / Chikovore, Jeremiah / Kaswaswa, Kruger / Mwapasa, Mphatso / Sambakunsi, Rodrick / Gutteberg, Tore Jarl / Gordon, Stephen / Munthali, Alister / Desmond, Nicola

PloS one

2019 Volume 14, Issue 6, Page(s) e0217534

Abstract: Introduction: Mandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing. We investigated adverse psychological effects and coping mechanisms following HIV-positive and HIV- ... ...

Abstract	Introduction: Mandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing. We investigated adverse psychological effects and coping mechanisms following HIV-positive and HIV-discordant test results amongst self-tested individuals living in couples in urban Blantyre, Malawi. Methods: Qualitative data from 35 in-depth interviews with self-tested individuals living in couples for more than 3 months were collected and analysed using thematic content analysis. Results: Adverse psychological effects seemed to mostly occur among individuals learning for the first-time that they were HIV-positive or living in HIV-discordant relationship. Irrespective of test outcomes, women living in couples expressed difficulty making important decisions about the future of their relationships while men seemed to shoulder the emotional burden associated with feeling or being seen as responsible for introducing HIV into the relationship. Post-test psychosocial support and ascertained positive behaviour change of the perceived index partner allowed some couples to overcome adverse psychological effects linked to test results. Conclusion: Self-tested individuals living in couples may lack collective coping capability to collaboratively manage post-test adverse events after new HIV-positive or HIV-discordant results. Psychosocial support seemed to enable couples to foster both an individual and a collective ability to manage adverse psychological effects within the context of a couple. More research is needed to ascertain the magnitude of the deficiency of collective coping competency in couples following an HIV test.
MeSH term(s)	Adaptation, Psychological/physiology ; Adult ; Aged ; Counseling/methods ; Family Characteristics ; Female ; HIV Infections/psychology ; Humans ; Malawi ; Male ; Mass Screening/psychology ; Middle Aged ; Sexual Partners/psychology ; Young Adult
Language	English
Publishing date	2019-06-12
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.0217534
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