Papers by Humphrey Misiri
Journal of the International AIDS Society, 2012
ABSTRACT: BACKGROUND: Incidence is a better measure than prevalence for monitoring AIDS, but it i... more ABSTRACT: BACKGROUND: Incidence is a better measure than prevalence for monitoring AIDS, but it is not often used because longitudinal HIV data from which incidence can be computed is scarce. Our objective was to estimate the force of infection and incidence of HIV in Malawi using cross-sectional HIV sero-prevalence data from the Malawi Demographic and Health Survey conducted in 2004. METHODS: We formulated a recurrence relation of population prevalence as a function of a piecewise-constant force of HIV infection. The relation adjusts for natural and HIV-induced mortality. The parameters of the recurrence relation were estimated using maximum likelihood, and confidence intervals of parameter estimates were constructed by bootstrapping. We assessed the fit of the model using the Pearson Chi-square goodness of fit test. We estimated population incidence from the force of infection by accounting for the prevalence, as the force of infection applies only to the HIV-negative part of the population. RESULTS: The estimated HIV population incidence per 100,000 person-years among men is 610 for the 15-24 year age range, 2700 for the 25-34 group and 1320 for 35-49 year olds. For females, the estimates are 2030 for 15-24 year olds, 1710 for 25-34 year olds and 1730 for 35-49 year olds. CONCLUSIONS: Our method provides a simple way of simultaneously estimating the incidence rate of HIV and the age-specific population prevalence for single ages using population-based cross-sectional sero-prevalence data. The estimated incidence rates depend on the HIV and natural mortalities used in the estimation process.
receiving home based care in Bangwe, Malawi: a descriptive study
African health sciences, 2004
OBJECTIVE To describe the current status of continued professional development (CPD) of healthcar... more OBJECTIVE To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi. DESIGN A cross-sectional descriptive study utilizing an interviewer-administered questionnaire. SUBJECTS Healthcare workers in public health centers in Blantyre District, Malawi. RESULTS Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for...
Kaposi sarcoma, non-Hodgkin lymphoma, esophageal cancer, eye cancer, breast cancer, cervical canc... more Kaposi sarcoma, non-Hodgkin lymphoma, esophageal cancer, eye cancer, breast cancer, cervical cancer and all other cancers combined in the population of Blantyre district of Malawi during 1996-2005, and predict the cancer burden for 2015 in the area. Three papers constitute this thesis. In Paper I, a mathematical model for estimating HIV has reduced mortality in Malawi [19, 20]. In fact, AIDS mortality which was initially at 22,000 deaths in 1985 rose to 76,000 deaths in 2005 after which it decreased to 43,000 in 2011. By 2014, the number of deaths due to HIV was 33,000 [10]. This is due to the scale up of the provision of ART from 3,000 people on ART in 2003 to 382,953 people on ART in 2011 [15]. In 2012, the HIV incidence was 48,000 per 100,000 person-years (95%CI :41,000-46,000) [10]. In 2013, according to the The Global Burden of Disease 2013 [21], the HIV incidence rate among males age 15-49 was 7,370 per 100,000 person-years (95% CI:6,519-8,387). The HIV mortality rate [21] for the same age band was 4,849 per 100,000 person-years (95%:3,792-6,091). Among women, the HIV incidence rate [21] for the age range 15-49 was 6,189 per 100,000 person-years (95% CI:5,510-7,018). The HIV mortality rate (per 100,000 person years) for the same age band was 3,453 (95% CI:2,663-4,392). HIV has reversed the gains achieved through immunization in Malawi and has wreaked havoc in many countries of the world. AIDS continues to be a menace in many developing countries. It is therefore essential to discover cost-effective measures Due to logistical and financial challenges, longitudinal HIV studies are not often conducted even in the so-called rich countries. In the first place, a longitudinal study is very expensive to conduct as it has to be conducted over a long period of time. Any shortage of funds midway through the project will automatically lead to the cessation of the study and incomplete data. Furthermore, tracking people through time is a challenge. Migration may lead to loss to follow up. Some people may voluntarily drop out of the study and this may create the problem of missing data. It is also difficult to convince people to be undergoing HIV tests on a regular basis without proper motivation.
Statistical Journal of the IAOS, 2020
Seventeen Sustainable Development Goals (SGDs) were adopted by the World Health Organization (WHO... more Seventeen Sustainable Development Goals (SGDs) were adopted by the World Health Organization (WHO) in 2015 for the 2030 Agenda for Sustainable Development. Sustainable Development Goal 3 (SDG3) is ‘Better health and well-being by 2030’. According to WHO, good health in the context of SDG3 is assessed with respect to the level and distribution of individuals’ and communities’ healthy life, conditions that affect health and well-being and risk factors whose presence would affect health and well-being. The overall aim is that each SDG target is achieved by 2030. In 2018 the WHO used statistical methods to assess the state of health in Africa in the context of SDG3. Their analysis revealed successes and shortfalls towards attaining SDG3. Backed by public health and other activities, statistics play an important role in improving the health and well-being of Africa. This paper explains how statistics can be used to help African countries to attain SDG3, in its role in modeling event hist...
Malawi Medical Journal, Aug 16, 2013
African Health Sciences, Dec 1, 2004
Objectives: To determine potential partners for pregnant women in the prevention of mother to chi... more Objectives: To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women's perceptions towards selected potential HIV prevention efforts Design: Cross sectional, questionnaire-administered study Setting: Antenatal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi Subjects: A total of 321 pregnant women attending antenatal clinics Results: Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse. Conclusion: Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.
South African Medical Journal, Dec 1, 2003
To the Editor: Malawi is among the countries in the sub-Saharan region heavily affected by the HI... more To the Editor: Malawi is among the countries in the sub-Saharan region heavily affected by the HIV/AIDS pandemic. At least 10% of the 10 million population is estimated to be HIV-infected. 1 HIVrelated illnesses are among the major causes of mortality and morbidity in both children and adults. There has been an increased clinical load from tuberculosis, 2,3 Pneumocystis carinii pneumonia, 4 non-typhoid salmonellosis 5 and other infections as a result of HIV/AIDS. HIV prevalence rates in selected groups such as estate workers and antenatal women have exceeded 20% in some areas.
Cancer which is one of the leading causes of death worldwide is emerging as a serious public heal... more Cancer which is one of the leading causes of death worldwide is emerging as a serious public health problem in Malawi due to the AIDS pandemic. Research has shown that HIV causes the syndrome of premature aging and accelerates carcinogenesis. The objective of this study was to describe age at cancer diagnosis and to fit the age distribution of childhood and adult cancer diagnosis in Malawi. We therefore fitted the normal, gamma, lognormal and inverse Gaussian probability distributions to the data for the 1996-2005 period from the Malawi National Cancer Registry and selected the model of best fit using the Akaike Information Criterion. Additionally, a finite mixture distribution of lognormals was also fitted to the data. According to the analysis for this study, the median ages at diagnosis are at most 42 years for AIDS-defining cancers and at least 46 years for non-AIDS defining cancers. Furthermore, the ages at childhood and adult cancer diagnosis follow lognormal distributions and the distribution of age at cancer diagnosis (all cancers) is a finite mixture distribution of lognormals with estimated mixing proportions equal to 0.071 and 0.929. The estimated means of the mixture distribution are 5.1 and 45.1 years and the corresponding estimated standard deviations are 1.211 and 2.842 years. This analysis suggests that age at cancer diagnosis in Malawi is relatively low and has a bimodal distribution. Therefore, to achieve maximum impact, cancer prevention and control activities should target the 15-50 year age range.
Research, 2015
Prevalence and incidence are measures that are used for monitoring the occurrence of a disease. P... more Prevalence and incidence are measures that are used for monitoring the occurrence of a disease. Prevalence can be computed from readily available cross-sectional data but incidence is traditionally computed from longitudinal data from longitudinal studies. Longitudinal studies are characterised by financial and logistical problems where as cross-sectional studies are easy to conduct. This paper introduces a new method for estimating HIV incidence from grouped cross-sectional sero-prevalence data from settings where antiretroviral therapy is provided to those who are eligible according to recommended criteria for the administration of such drugs.
Research, 2014
The 2010 Malawi Demographic and Health Survey (MDHS) is a large, nationally representative sample... more The 2010 Malawi Demographic and Health Survey (MDHS) is a large, nationally representative sample survey conducted by the National Statistical Office (NSO). The 2010 MDHS covered a total of 27,000 households, involving 24,000 female and 7,000 male respondents. The primary objective of the 2010 MDHS is to provide up-to-date information for policymakers, planners, researchers, and programme managers on fertility levels, nuptiality, fertility preferences, knowledge and use of family planning methods, breastfeeding practices, nutritional status of mothers and children, childhood illnesses and mortality, use of maternal and child health services, malaria, maternal mortality, and HIV and AIDS-related knowledge and behaviour. The survey also provides the anaemia status of women age 15-49 and children age 6-59 months. There have been four rounds of the MDHS conducted-in 1992,2000,2004, and 2010. This preliminary report presents tables showing the status and trends for a selected number of indicators current fertility, current use of contraception, vaccinations, nutritional status of children, and knowledge of HIV and AIDS among others.
Abstract The aim of this longitudinal study was to assess the effect of rotating shift work on pe... more Abstract The aim of this longitudinal study was to assess the effect of rotating shift work on perceived sleep quality and sleep duration of nurses at Queen Elizabeth Central Hospital, Blantyre, Malawi. Twenty four female nurses were recruited at random from among personnel engaged in rotating shift work. The nurses worked a three-phase schedule: five day shifts (7.00 – 17.00) followed by three night shifts (17.00 – 7.00) and five days off. Controls were 22 female nurses who did not perform night duties. Sleep quality and dura-tion was assessed using standardized and validated question-naires on sleep duration and subjective sleep quality (SSQ). One-way analysis of variance revealed a significant effect of shift phase on total sleep duration (F = 36.8, d.f. = 8, P < 0.000) and perceived sleep quality (F = 8.81, d.f. = 3, P < 0.000). Night shift work was associated with reduction of sleep quality and duration. The after effects of night shifts persisted during days of the recov...
In countries lacking reliable vital registration, our knowledge of adult mortality depends largel... more In countries lacking reliable vital registration, our knowledge of adult mortality depends largely on cross-sectional data from censuses or surveys providing us information on recent deaths in the households or on specific relatives (spouse, siblings, etc.). While such information remains invaluable to assess levels and trends of adult mortality, comparison with data from small rural areas monitored through demographic surveillance systems suggests frequent under-reporting of adult deaths in censuses and surveys. Existing datasets, however, do not easily allow systematic comparison and evaluation of these differences because information is almost always collected only for one set of deaths (either spouse, parents, siblings, household members) and associated cohort data are unavailable to compare the accuracy and reliability of direct and indirect estimates from census or survey data. This paper aims to fill this gap by analyzing a longitudinal household survey conducted in 1998-2006...
As in many sub-Saharan countries, communicable diseases have been given greater public health pri... more As in many sub-Saharan countries, communicable diseases have been given greater public health priority in Malawi, although the magnitude of the cancer burden is increasing as a result of demographic changes, as well as the impact of the HIV pandemic. To be able to describe the patterns of cancer between 1996 and 2005 and to predict the incidence and total burden of cancer for 2015,we analysed data from the Malawi National Cancer Registry for the period from 1996 to 2005. We obtained age standardized incidence rates for the most common cancers in Malawi. Linear trend models were used to predict incidence rates and the burden of cancer for Blantyre for 2015. The most common cancers, in terms of age-standardized (world) incidence rates were Kaposi sarcoma (50.5 per 100,000 for males, 26.4 for females), cervical cancer (49.3 per 100,000), oesophageal cancer (22.3 for males, 14.6 for females), non-Hodgkin lymphoma (6.6 for males, 5.3 for females), eye cancer (4.4 for males, 5.4 for femal...
The Central African journal of medicine
To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informat... more To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity. Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity. Blantyre Adventist Hospital Outpatient Clinic. Non-emergency patients over 18 years old attending during consulting hours. All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout. Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity. 490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one....
Croatian medical journal, 2004
To determine factors influencing voluntary counseling and premarital testing on human immunodefic... more To determine factors influencing voluntary counseling and premarital testing on human immunodeficiency virus (HIV) in Malawi. We analyzed the data collected by the Malawi Demographic and Health Survey (MDHS) 2000 to determine the likelihood of Malawi population to accept HIV testing. The MDHS was a nationwide cross-sectional study where cluster sampling technique and an interviewer-administered questionnaire were used. We applied the Logit model of analysis to determine the HIV testing likelihood according to the following parameters: age, place of residence (urban vs. rural), belief that sexual abstinence protects from HIV infection, knowledge of a location of HIV testing, belief that diagnosis of HIV should be kept secret, and knowledge of anyone with AIDS. Out of 3,092 participants, 23.3% lived in urban and 76.7% in rural areas. Willingness to have premarital HIV counseling and testing was positively associated with increased age, urban residence, and wish to keep one's own H...
African health sciences, 2005
Mis-reporting of data by study participants in a questionnaire-based study is an important source... more Mis-reporting of data by study participants in a questionnaire-based study is an important source of bias in studies. To determine the prevalence and factors influencing mis-reporting of gravidity among rural women in Malawi. Data from cross sectional study conducted in 2004 were analysed using logistic regression analysis and the logit modeling. 7118 women were in the reproductive age group, 2387(33.5%) had ever attended school, 4556 (64.0%) had never and results for 175 (2.5%) were missing. Of those who attended school, 94.9% (2297) had attained a maximum primary level, 5.04% (122) secondary level and 0.08% (2) tertiary level. 81.6% of the women were aged between 12 and 36 years of age, mean was 26.1 years (SD 10.05 years). The remaining 18.4% were aged between 37 and 49 years of age. The mean number of pregnancies attained was 4.0 (SD 3.4), live births was 3.0 (SD 3.2), mean number of stillbirths was almost zero (SD 0.9) and the mean number of children alive was 2.0 (SD 2.3). The...
Nutrition journal, Jan 21, 2005
The effect of food supplementation provided by the World Food Programme to patients and their fam... more The effect of food supplementation provided by the World Food Programme to patients and their families enrolled in a predominantly HIV/AIDS home based care programme in Bangwe Malawi is assessed. The survival and nutritional status of patients and the nutritional status of their families recruited up to six months before a food supplementation programme started are compared to subsequent patients and their families over a further 12 months. 360 patients, of whom 199 died, were studied. Food supplementation did not improve survival but had an effect (not statistically significant) on nutritional status. Additional oil was given to some families; it may have improved survival but not nutritional status. Food supplementation to HIV/AIDS home based care patients and their families does not work well. This may be because the intervention is too late to affect the course of disease or insufficiently targeted perhaps due to problems of distribution in an urban setting. The World Food Progr...
International Archives of Medicine, 2009
Background: Physical trauma is an important cause of childhood morbidity and mortality in Africa.... more Background: Physical trauma is an important cause of childhood morbidity and mortality in Africa. There are however, few community-based reports on the subject on the continent. The present study was conducted to explore school children's experience of physical trauma in a disadvantaged periurban area of Blantyre, in Malawi. Methods: A cross sectional questionnaire study was carried out among school children in Ndirande-Blantyre, Malawi in 2004. Data were obtained to describe the following aspects of trauma experience: being a victim or observer of motor vehicular accidents involving pedestrians; history of falls from heights; and knowledge about road safety. Sex differences were determined for some of the variables in order to gain insights as to whether there is a difference in trauma experience between boys and girls. Results: A total of 217 school children, 99 (45.6%) boys and 118 (54.4%) girls participated in the study. Eight of them reported to have ever been hit by a motor vehicle, 87 (40.1%) had witnessed a road accident where a pedestrian had been hit and 83 (38.2%) had witnessed a pedestrian they knew having been hit by a motor vehicle. Of those that reported to have ever been hit by motor vehicle, 2 (25%) reported that they had been hospitalized as a result of injury. With regard to falling from heights, 86 reported to have ever fallen from tree, 44 of these (51.2%) were injured from the fall and 14 (16.3%) were hospitalized as a result of injury sustained from the fall. Girls were more likely to fall from trees and getting injured as compared to males (p = 0.04 for both situations). Just under half (41.9%) of the study participants were able to report the correct procedure of crossing the road despite the fact that the majority (80%) reported having been taught road safety at home or school. Conclusion: Many school children in Blantyre, Malawi have been exposed to trauma either involving themselves or someone they observed. Prevention, including education, supervision and management of trauma must receive the necessary attention they deserve in terms of resources, surveillance and impact mitigation.
International Archives of Medicine, 2009
Background: Pain is a leading symptom which influences patients to seek medical attention. The ma... more Background: Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods: A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results: A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. Conclusion: Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value.
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Papers by Humphrey Misiri