Papers by Charles Maibvise
Antimicrobial Resistance & Infection Control, 2017
There was a significant reduction of 57% in SSI rate from 14% to 6% (p < 0.001) but no significan... more There was a significant reduction of 57% in SSI rate from 14% to 6% (p < 0.001) but no significant change in mortality 3.3% to 1.4% (p = 0.098). Important challenges to the implementation of the intervention phase included the death of the lead investigator, inertia for behavior change among staff and frequent rotation of staff. Major facilitating factors included support from hospital leadership and communication with other participating study sites. Conclusion Our intervention bundle led to a 57% reduction in SSI. This otherwise inexpensive intervention package can be effective in reducing SSI occurrence and should be adopted in other low resource hospital settings.
Curēus, Jan 26, 2024
Background and aims: Following antiretroviral therapy (ART) initiation, HIV-associated immune rec... more Background and aims: Following antiretroviral therapy (ART) initiation, HIV-associated immune reconstitution inflammatory syndrome (IRIS), indicated by an array of opportunistic infections, may occur, presenting as either paradoxical, a worsening of a previously treated infection, or unmasking, a flare-up of an underlying, previously undiagnosed infection. The impact of ART as the backbone of HIV treatment and prevention has prolonged the survival of people living with HIV. In pregnancy, benefits have been shown by slowing HIV progression and preventing perinatal transmission; however, there have been risks of adverse reactions with ART, including immune responses to both the fetus and mother. This study sought to estimate the incidence of HIV-IRIS cumulatively and by type either paradoxical or unmasking IRIS, determine the baseline maternal and HIV clinical markers as predictors of, and analyze the log-rank test for survival time to IRIS outcome assessed by relying on an increase in CD4 count and/or a rapid decrease in viral load. Methods: An active records study was conducted between June 2019 and March 2020 among ARTnaïve pregnant women attending the antenatal care units (ANCu) at the Kenyatta National and Mbagathi Hospitals, Nairobi, Kenya. Participants were aged between 20 and 49 years and had a confirmed HIV-positive test. To ascertain a true case of IRIS, the diagnosis was adjudicated for accuracy and consistency by an independent review committee. Plasma HIV viral load, CD4 counts, and routine laboratory evaluations (hemoglobin, white blood cell count (WBC)) were performed by each hospital's clinical laboratory. The IRIS incidence was assessed using the International Network for Studies Against HIV-Associated IRIS (INSHI) during the first three months after ART initiation. Multivariate Cox regression with IRIS as the outcome, using the SPSS Survival package, examined the relationship between baseline maternal characteristics and HIV clinical markers before ART initiation and IRIS, and finally, decision-tree analysis for predicting IRIS was performed. Results: From a pool of 532 ART-naïve pregnant women, 133 (25%) developed IRIS, and 97 (72.9%) were in the unmasking category. The accumulated risk of experiencing IRIS symptoms increased from week two (hazard ratio (HR)=0.0287) to week 12 (HR=3.6158). Participants with a maternal BMI (MBMI) of 25-29.9 kg/m 2 at baseline were at a higher risk of unmasking IRIS (HR=2.478; P=0.010). The WHO-HIV clinical stages 1 and 2 skewed towards paradoxical IRIS (regression coefficients =-0.111 and-0.276 (P<0.05)), while stage 4 skewed towards unmasking IRIS (regression coefficient=0.047, HR=1.048, P=0.941). A CD4 count > 500 cells/mm^3 skewed towards unmasking IRIS (regression coefficient=0.192, HR=1.211, P=0.416), while RNA-HIV viral loads >50 copies/ml towards paradoxical IRIS (regression coefficient=-0.199, HR=0.820, P=0.360. On decision tree analysis, 85% (P=0.001) of ART-naïve pregnant women with a baseline CD4 count below 500 copies/mm^3 presented with unmasking IRIS. Conclusion: For ART-naïve pregnant women, unmasking IRIS is the most common type, and an MBMI of 25-29.9 kg/m 2 , advanced HIV infection, a CD4 count <500 cells/mm^3, and a higher parity at baseline may be clinically useful predictors. The higher proportion of ART-naïve pregnant women experiencing unmasking as compared to paradoxical IRIS supports the need for earlier assessment based on potential predictors.
Book Publisher International (a part of SCIENCEDOMAIN International), Jul 30, 2021
While millions of men have been circumcised cumulatively under the mass male circumcision campaig... more While millions of men have been circumcised cumulatively under the mass male circumcision campaigns for the prevention of HIV, the uptake of male circumcision (MC) is below the set targets. This suggests that prevention of HIV is not a convincing motive for circumcision to the majority of men. Notably some men are undergoing male circumcision for other psychosocial motives, rather than the primary public health motive of preventing HIV transmission. These motivations have not been explicitly studied in order to determine their potential impact on the HIV prevention strategy of male circumcision. This study aimed at assessing the psychosocial motives for undergoing male circumcision in Swaziland and determines their potential impact on the success of the mass male circumcision strategy. A qualitative study design was used, in which in-depth individual face-to-face unstructured interviews were conducted with 17 men seeking health care services at the Family Life Association of Swaziland clinic in Mbabane, Swaziland. All men aged 18 years and above were eligible. Results indicate that some men are undergoing circumcision primarily for psychosocial reasons rather than for HIV prevention. These psychosocial motives include: giving in to pressure from public health advocates, sexual partners and peers; to perceived sexual benefits of the procedure; to demonstrate one’s manhood, as well as to utilise the free and readily available male circumcision services. However, subsequent safe post-MC sexual behaviour is not guaranteed. Nevertheless, it was recommended that these motives be emphasised in the mass male circumcision campaigns, along with appropriate health education, in order to complement HIV prevention in promoting uptake of male circumcision and ensuring safe post-circumcision sexual behaviour.
HIV & AIDS Review
Introduction: Chronic non-communicable diseases (NCDs) constitute a health problem worldwide. Thi... more Introduction: Chronic non-communicable diseases (NCDs) constitute a health problem worldwide. This problem is particularly important in people living with human immunodeficiency virus (PLHIV) in sub-Saharan countries where the prevalence of NCDs is expected to increase due to the epidemiological transition of life spans for PLHIV as treatment outcomes for HIV continue to improve. This study is the first to assess the occurrence and quality of care (QoC) of NCDs in PLHIV and to identify the contextual issues underpinning the QoC in Lesotho-a sub-Saharan country with the second highest prevalence of HIV globally. Material and methods: Based on the Donabedian (2005) model for assessing QoC, the study used a trian gulation of quantitative patient responses on QoC of NCDs, their treatment outcomes and qualitative interviews with hospital staff in Maseru, Lesotho. Results: Two hundred and forty-six PLHIV with a median survival time of 7 years since the first diagnosis of HIV (IQR: 3-9 years) and 25 hospital staff were included in the study. Forty-two percent (42%) of the patients had at least one diagnosed NCD, and 33% of these were diagnosed outside of the antiretroviral treatment (ART) centers. Overall, the QoC of NCDs was inadequate. Only 32% of patients with NCDs had records on NCD treatment outcomes in the ART centers. Shortage and disrepair of equipment, along with inadequate staff were the major barriers affecting the orga nizational structure for the care of NCDs. Inadequate screening for NCDs, disintegrated checkup schedules for NCDs/HIV co-morbid conditions, and inadequate patient education were the major issues affecting the treatment processes. Conclusions: The longer life spans of PLHIV in this study emphasises the need to scale up the diagnosis of NCDs while improving their QoC in PLHIV in Lesotho. The issues underpinning the QoC of NCDs should thus be prioritised in the interventions aimed at improving QoC of NCDs in PLHIV.
American Journal of Field Epidemiology
Background. Long COVID is a wide range of new, returning, or ongoing health problems experienced ... more Background. Long COVID is a wide range of new, returning, or ongoing health problems experienced after primary COVID-19 infection, with a possibility of broad adverse outcomes. The aim of this study was to determine the case fatality of of post-acute sequelae of COVID-19 (PASC) and assess possible covariates. Population and Methods. We conducted a systematic review and meta-analysis from 43 studies (367,236 patients), (June, 2020 - August, 2022). PASC mortality was assessed from six studies. With random-effects model, the pooled case fatality was measured. Publication bias was ascertained and meta-regression analysis done on predetermined covariates. Results. The estimated prevalence of PASC was 42.5% (95% CI = 36.0 % - 49.3%). The pooled case fatality was 7.4% (95% CI = 7.4% to 11.2%). The funnel plot suggested the presence of publication bias. Hospital re-admission (P = 0.0034) (R² = 1.00) and the year 2021 (P = 0.0309) (R² = 0.55) were associated with fatalities from PASC. Discu...
Africa journal of nursing and midwifery, 2013
Following recommendations by the world Health Organization, Swaziland has adopted mass male circu... more Following recommendations by the world Health Organization, Swaziland has adopted mass male circumcision in an effort to reduce sexual transmission of HIV. Few Swazi men request circumcisions despite nation-wide circumcision campaigns. This implies that the reduction of the probability of HIV transmission, through circumcision, might not be a sufficient cause to convince people to undergo circumcision. It is thus necessary to reinforce this drive with other motives, such as medical reasons, to boost the acceptance of circumcision. However, it was uncertain whether there were any prevalent medical problems warranting adult male circumcisions in Swaziland. This study aimed at identifying medical reasons that motivated men to undergo circumcisions in Swaziland. A generic qualitative study was conducted, in which 17 men were interviewed individually. Data were coded, grouped and themes identified. Results showed that medical problems warranting circumcision included congenital abnormali...
Africa Journal of Nursing and Midwifery, 2015
Lesotho has one of the highest maternal mortality ratios in Southern Africa. Notwithstanding the ... more Lesotho has one of the highest maternal mortality ratios in Southern Africa. Notwithstanding the efforts to reduce maternal deaths in Lesotho, unsafe use of medicinal herbs during pregnancy remains a threat to achieving that goal. This study assessed the reasons and promoters of medicinal herb usage during pregnancy in Maseru, Lesotho, with the aim of establishing a baseline for intervention. This was a semi-structured questionnaire-based cross-sectional quantitative study on 72 purposively sampled pregnant women who attended antenatal care at one referral district hospital in Maseru District between March and April 2014. Overall, 34 (47.2%, n=72) women conceded use of herbs during pregnancy. The majority (52.9%) of the participants had no specific reasons for using the herbs except as a tradition. Besides unspecified reasons, three (8.8%, n=34) women cited prevention of placenta praevia, while leucorrhoea of pregnancy, prevention of abortion and promoting foetal growth were each cited by two women (5.9%) as the main reasons for using herbs. By proportion of pregnant women, grandmothers (52.9%), traditional healers (26.5%), mothers-in-law (14.7%) and traditional birth attendants (5.9%) were cited as the major promoters and providers of traditional herbs. Use of herbs was not significantly associated with age (p=0.233), marital status (p=0.113), literacy level (p= 0.719), previous loss of pregnancy (p=0.490), parity (p=0.147) and gravida (p=0.234). Grandmothers, traditional healers, mothers-inlaw and traditional birth attendants (TBAs) are the main promoters of herb use during pregnancy. There is need to incorporate information on potential dangers of using medicinal herbs during pregnancy into the training curriculum for TBAs and midwives. Further qualitative research is necessary to unveil the precise cultural reasons for using herbs.
Africa Journal of Nursing and Midwifery, 2018
Over the past decade, efforts have been made to promote the uptake of male circumcision (MC) in 1... more Over the past decade, efforts have been made to promote the uptake of male circumcision (MC) in 14 selected high HIV epidemic countries, following reports that MC reduces the risk of female-to-male HIV transmission by about 60 per cent. Despite these efforts, the uptake of MC remains low, partly due to poor and/or subjective understanding of the concept “promote the uptake of MC†in the context of HIV prevention. This study aimed at clarifying the conceptual meaning of “promote the uptake of MC†for HIV prevention in high HIV and low MC prevalent settings. Walker and Avant’s eight-step method of concept analysis was used. An integrative review of literature was conducted. An open online search was conducted using Google and Google Scholar, targeting all relevant literature, grey and scientific. Specific databases were also explored, which included PubMed, Science Direct, SCORPUS, and CINAHL. Accessible relevant hard copy literature was also considered. Data were analysed ...
Africa Journal of Nursing and Midwifery, 2016
Circumcision has been practised for centuries among various groups of people world-wide, mainly f... more Circumcision has been practised for centuries among various groups of people world-wide, mainly for religious, traditional, hygienic or medical reasons. However, this practice was rare in Swaziland. Following recommendations by the World Health Organisation that circumcision should be added as an additional strategy for HIV prevention, the country embarked on mass male circumcision campaigns, aimed at scaling up the practice nationwide. Apparently the turnup for the procedure is below the set targets. Knowledge of factors that influence the uptake of circumcision is necessary in order to maximise the success of the strategy. This study aimed at assessing the influence of religion and/or culture on perception and hence uptake of circumcision in Swaziland. An explorative qualitative research design was used, in which in-depth face-toface interviews were conducted on seventeen participants individually. Results showed that Christianity and African Traditional Religion are the dominant ...
Southern African Journal of Infectious Diseases, 2017
Tuberculosis is a global public health problem. Lesotho, a sub-Saharan country with high HIV and ... more Tuberculosis is a global public health problem. Lesotho, a sub-Saharan country with high HIV and tuberculosis burden, launched the Three I's programme of the World Health Organization in 2013. However, the outcomes of this intervention are scarcely known. This study evaluated the profile of tuberculosis diagnostic techniques used, treatment outcomes and the associated factors across the baseline period (2010-2012) and after the launch of the Three I's programme (2013-2015) based on a retrospective cohort review of patient records at a major clinic in Maseru, Lesotho. In total, 812 cases with complete records from 1 066 randomly selected cases treated (every second case from the sampling frame) were included in the study. Factor analysis was based on logistic regression analysis. The use of the GeneXpert MTB/RIF technique remained below 20% throughout the study period. Overall, 28.9% (n = 812) cases had unsuccessful tuberculosis treatment. Male gender (p = 0.046), extra-pulmonary tuberculosis (p = 0.002) and treatment observation by community health workers (p = 0.001) were significantly associated with unsuccessful treatment outcome. Overall, treatment outcomes did not differ significantly (p = 0.636) before and after the launch of the intervention. These findings indicate the need to strengthen the implementation of the Three I's programme, taking into account the significant factors in this study.
Health SA Gesondheid, 2019
A model to promote the uptake of male circumcision as an HIV-preventive measure in high HIV and l... more A model to promote the uptake of male circumcision as an HIV-preventive measure in high HIV and low male circumcision prevalence settings', Health SA Gesondheid 24(0), a1070.
Journal of AIDS & Clinical Research, 2017
While millions of men have been circumcised cumulatively under the mass male circumcision campaig... more While millions of men have been circumcised cumulatively under the mass male circumcision campaigns for the prevention of HIV, the uptake of male circumcision (MC) is below the set targets. This suggests that prevention of HIV is not a convincing motive for circumcision to the majority of men. Notably some men are undergoing male circumcision for other psychosocial motives, rather than the primary public health motive of preventing HIV transmission. These motives have not been explicitly studied in order to ascertain their potential impact on the male circumcision strategy of HIV prevention. This study aimed at assessing the psychosocial motives for undergoing male circumcision in Swaziland and determines their potential impact on the success of the mass male circumcision strategy. A qualitative study design was used, in which in-depth individual face-to-face unstructured interviews were conducted with 17 men seeking health care services at the Family Life Association of Swaziland clinic in Mbabane, Swaziland. All men aged 18 years and above were eligible. Results indicate that some men are undergoing circumcision primarily for psychosocial reasons rather than for HIV prevention. These psychosocial motives include: giving in to pressure from public health advocates, sexual partners and peers; to perceived sexual benefits of the procedure; to demonstrate one's manhood, as well as to utilise the free and readily available male circumcision services. However, subsequent safe post-MC sexual behaviour is not guaranteed. Nevertheless, it was recommended that these motives be emphasised in the mass male circumcision campaigns, along with appropriate health education, in order to complement HIV prevention in promoting uptake of male circumcision and ensuring safe post-circumcision sexual behaviour.
Health research policy and systems, Jan 21, 2017
Given the well documented undesired impacts of HIV/AIDS globally, there is a need to create a sta... more Given the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles. A bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were...
The demand for circumcision in Swaziland has dramatically increased since it was reported that ci... more The demand for circumcision in Swaziland has dramatically increased since it was reported that circumcision ensures 60% protection against HIV infection. The aim of this study was to explore the reasons for, and the motives behind, this increasing interest in undergoing circumcision. A generic qualitative research design was used, in which 17 circumcised men selected by convenience sampling at FLAS Clinic, Mbabane, participated. In-depth unstructured face-to-face interviews were used to collect data. The results showed that the main reasons for circumcision are perceived health, hygiene and sexual benefits, community influences, as well as medical reasons. It was concluded that the major motives underlying circumcision are personal and partner safety and satisfaction during sex. These motives were found to be both promotive and threatening to the interests of public health. After evaluating the risks and benefits, it was recommended that mass circumcision be promoted alongside reinforced and accurate health education on circumcision.
CIN: Computers, Informatics, Nursing, 2016
Health systems worldwide are moving toward use of information technology to improve healthcare de... more Health systems worldwide are moving toward use of information technology to improve healthcare delivery. However, this requires basic computer skills. This study assessed the computer literacy of nurses in Lesotho using a crosssectional quantitative approach. A structured questionnaire with 32 standardized computer skills was distributed to 290 randomly selected nurses in Maseru District. Univariate and multivariate logistic regression analyses in Stata 13 were performed to identify factors associated with having inadequate computer skills. Overall, 177 (61%) nurses scored below 16 of the 32 skills assessed. Finding hyperlinks on Web pages (63%), use of advanced search parameters (60.2%), and downloading new software (60.1%) proved to be challenging to the highest proportions of nurses. Age, sex, year of obtaining latest qualification, computer experience, and work experience were significantly (P < .05) associated with inadequate computer skills in univariate analysis. However, in multivariate analyses, sex (P = .001), year of obtaining latest qualification (P = .011), and computer experience (P < .001) emerged as significant factors. The majority of nurses in Lesotho have inadequate computer skills, and this is significantly associated with having many years since obtaining their latest qualification, being female, and lack of exposure to computers. These factors should be considered during planning of training curriculum for nurses in Lesotho.
neuromuscular (myoneural) junction……………………… 2.3.3 The skeletal muscle……………………………………………… 2.4. CONT... more neuromuscular (myoneural) junction……………………… 2.3.3 The skeletal muscle……………………………………………… 2.4. CONTROL AND REGULATION OF MUSCLE CONTRACTION….. 2.4.1 Central Control……………………………………………………. 2.4.2 Local Control: Muscle length and tension……………………… • The structure and role of muscle spindles……………………….... • The role of golgi tendon organs…………………………………….. vi 2.5. ABNORMAL MUSCLE TONE ………………………………………… 2.5.1 Spasms and Cramps…………………………………………….. • Causes of Spasms and Cramps……………………………………. • Complications of Spasms and Cramps……………………………. • Treatment of Spasms and Cramps………………………………… 2.6 ETHANOL AS A NEUROLYTIC AND ANTISPASTIC AGENT ……. 2.6.1 Ethanol and the nerve fibre …………………………………….. 2.6.2 Ethanol and the neuromuscular junction ……………………… 2.6.3 Ethanol and the muscle …………………………………………. 2.6.4 Ethanol and the treatment of muscle spasms ………………… 2.6.5 Dose-phamarcodynamic relations of ethanol ………………….
Tanzania journal of health research
Background: For years, male circumcision (MC) has been known to reduce the risk of sexually trans... more Background: For years, male circumcision (MC) has been known to reduce the risk of sexually transmitted infections (STIs). Of late, MC has been recognised and recommended as a complementary HIV preventive measure in high prevalent areas. The objective of this study was to to assess the perceptions of Swazi men about the protective effect of circumcision against STIs including HIV, and its implication to the mass MC strategy. Methods: An explorative qualitative study was conducted targeting men aged ≥18 years seeking services at Family Life Association of Swaziland clinic in Mbabane, Swaziland. Unstructured individual face-to-face interviews were conducted for 17 men. Results: Results showed that Swazi men perceived the protective effect of MC differently, ranging from perceptions of ineffectiveness and unworthy, especially against HIV, to perceptions of total protection and a solution to all STIs. Perceptions were influenced by the ongoing circumcision campaigns, individual knowledg...
African Journal of AIDS Research, 2014
Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world.... more Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus, the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years, the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used, in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic, Mbabane. In-depth, individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome, perception of no significant benefit of the procedure, impatience about waiting for the procedure or the healing process, religious/cultural beliefs, and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help.
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Papers by Charles Maibvise