Andrew Kumitawa - Academia.edu (original) (raw)

Papers by Andrew Kumitawa

Research Square (Research Square), Aug 12, 2019

PLOS global public health, Mar 6, 2024

Research Square (Research Square), Jan 29, 2020

Research Square (Research Square), Jan 24, 2020

Background: Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to... more Background: Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60% protective e cacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identi ed socio-demographic factors associated with risky sexual practices. Method: A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18-49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson's chi square test and logistic regression. Results: Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants selfreported continued use of condoms post VMMC. Overall 23.7%-38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n=187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p <0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex. Conclusion: Risky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas. Background HIV and AIDS pose a major threat to health and livelihood worldwide. Of the 37 million people living with HIV worldwide, 70% of these live in sub-Saharan Africa and Malawi accounts for 4% [1-3]. Malawi has an HIV prevalence of 8.8% among men and women aged 15-49 [2]. Approximately 5,600 people worldwide contract HIV daily [1, 4] and 790,000 adults and children died of AIDS related illnesses, accounting for 66% of AIDS related deaths worldwide [1, 4]. An estimated 1 million people in the Sub Saharan region contract HIV annually as of 2017 [1, 4]. In 2017, Malawi registered 39,000 new HIV infections and 17,000 deaths due to AIDS related illnesses in all ages [1, 4]. Heterosexual contact is the major mode of HIV transmission and accounts for 88% of the infections [2]. Access to prevention and treatment from this incurable disease is limited in sub-Saharan Africa and the disease affects mostly the productive age group [6]. In this regard, efforts tailored at reducing HIV transmission and averting deaths is a welcome development. However, there are several types of prevention strategies to reduce the risk of acquiring or transmitting HIV such as behavioral, biomedical and structural that are complementary [7, 8]. Voluntary medical male circumcision (VMMC) is one of the biological interventions and is an effective strategy in reducing sexual transmission of HIV from women to men [9-11]. In 2007, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) recommended scale up of male circumcision (MC) and has been adopted as one of the HIV preventive strategies in countries with low levels of MC [12]. Globally, the estimated prevalence rate of male circumcision is around 38.7% with half of the circumcisions conducted for religious and cultural reasons [13, 14]. Only 28% of the men aged 15-49 in Malawi are circumcised [3]. This gure includes 18% circumcised by traditional practitioners and 9% by medical professionals [3]. Hence the percentage for those that underwent VMMC is signi cantly low. Male circumcision is effective when done between the ages of 15 to 20 years and its effect declines with increase in age as the risk of contracting HIV decreases [15]. Evidence of male circumcision on HIV prevention came from meta-analysis of three randomized controlled trials involving 11,050 men that were conducted in South Africa, Kenya, and Uganda which showed a relative risk reduction for contracting HIV infection in circumcised men to be around 60 % (95% CI 40-67%)[16,17]. Consequently, recommendations were made by WHO and UNAIDS to countries with low rates of male circumcision and high HIV prevalence rate to adopt VMMC as a measure to prevent HIV transmission alongside other preventive strategies such as condom use. Following this development, Malawi as one of 14 prioritized countries according to WHO and UNAIDS, adopted and rolled out VMMC in 2011 as one of its HIV preventive strategies [18, 19]. A total of 266,176 VMMCs have so far been performed as of 2015 representing 13% of the target that was set in 2011 [20]. Circumcising more than 80% of males aged 15 to 49 in a high HIV prevalent region could avoid 3.36 million infections and 386,000 deaths by 2025 [21]. VMMC clients undergo counselling and HIV testing prior to the circumcision procedure where they are informed about the advantages of VMMC and the need to use other HIV prevention strategies including being faithful to one partner, abstaining from sex for a period of six weeks following VMMC, and also consistent and correct condom use [22, 23]. During counselling, the protective effect of VMMC which is at 60% (as a scienti c explanation) is interpreted as a lowered risk of contracting HIV if circumcised [22, 23]. This explanation creates and leaves room for misconceptions and poses a considerable threat to the main preventive effort [23]. It was also noted that the media utilizes this '60%' protection in promoting VMMC messages against HIV infection, which was observed in a trial by Auvert et al[9]. A study conducted in Kenya involving 1,344 men showed that 30.7% were involved in early resumption of sex [24]. This is one of the risky sexual practices following VMMC, which may be as a result of the misunderstanding of the protective effect of VMMC [24]. Furthermore, the desire to be circumcised was associated with knowledge of the perceived protective effect of VMMC among the uncircumcised individuals who were practicing risky sexual behaviours as well as high incidence of STIs in circumcised clients [21, 25]. In this case, the motivation to get circumcised could be associated with the desire to freely engage in risky sexual practices due to the perceived protective effect of VMMC. This may point to the lack of understanding as regards the protective effect of VMMC which may contribute to further risky sexual practice among circumcised men hence putting them at risk of contracting HIV.

Research Square (Research Square), Oct 8, 2019

PLOS Global Public Health

Economic consequences of COVID-19 illness and healthcare use for households in low income countri... more Economic consequences of COVID-19 illness and healthcare use for households in low income countries are not well known. We estimated costs associated with COVID-19 care-seeking and treatment from a household perspective and assessed determinants of treatment costs. A cross-sectional household survey was conducted between December 2020 and November 2021 in urban and peri-urban areas of Blantyre district. Adults (age ≥18 years) with confirmed COVID-19 were asked to report the symptoms they experienced or prompted them to seek COVID-19 tests as well as healthcare seeking behaviors preceding and following COVID-19 diagnosis. For individuals who sought healthcare, information on out-of-pocket expenditures incurred while seeking and receiving care including on transport, food etc. by both the patients and their guardians was collected. Finally, data on time use seeking, receiving care and during convalesces was recorded. Multivariate Generalized Linear Models were used to evaluate associa...

BMC Anesthesiology

Background Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in childre... more Background Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi. Methodology This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%. Results Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of ana...

Background Postnatal care (PNC) ensures early assessments for danger signs during the postpartum ... more Background Postnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 hours of birth, 48-72 hours, 7-14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies Methods A concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study were conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with Midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 hours of birth, at 48-72 hours, 7-14 days, and six weeks after birth was conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach Results The uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 hours of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded utilization of PNC services. The enablers included the mothers' level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities. Conclusion Optimization of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, timepoints, and services that need to be delivered to create demand for the services.

BMC Pregnancy and Childbirth, 2013

Background: Exclusive breastfeeding is an important component of child survival and prevention of... more Background: Exclusive breastfeeding is an important component of child survival and prevention of mother-tochild transmission of HIV in resource-poor settings like Malawi. In Malawi, children under the age of six months are exclusively breastfed for an average duration of 3.7 months. This falls short of the recommendations by the World Health Organization as well as the Malawi Ministry of Health that mothers exclusively breastfeed for the first six months of the child's life. Understanding factors that influence exclusive breastfeeding duration among HIV-positive mothers is important in promoting exclusive breastfeeding among these mothers. An exploratory study was therefore conducted to determine factors that influence HIV-positive mothers' prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months. Methods: This paper is based on data from a longitudinal, descriptive and correlation study that was conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi between May 12, 2009 and March 22, 2010. Theory of Planned Behavior guided the study. A face-to-face survey was utilized to collect data from a convenience sample of 110 HIV-positive mothers who were at least 36 weeks pregnant at baseline. A modified and pre-tested breastfeeding attrition prediction tool was used to measure exclusive breastfeeding beliefs, intentions and external influences at baseline. Data were analyzed using descriptive and association statistics. Additionally, multiple regressions were run to determine significant predictors of HIV-positive mothers' prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months. Results: Results revealed high exclusive breastfeeding prenatal intentions among HIV-positive mothers. Prenatal intended duration of exclusive breastfeeding was positively associated with normative, control beliefs and negatively associated with positive beliefs, maternal education and disclosure of HIV status. Conclusions: Current results suggest that assessment of mothers' level of education and their positive beliefs towards exclusive breastfeeding may help to identify mothers who are at risk of discontinuing exclusive breastfeeding. Interventions to promote exclusive breastfeeding could include provision of appropriate skills, support and information to help HIV-positive mothers gain control over exclusive breastfeeding.

breastfeeding among women taking

BMC Public Health

Background Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to ... more Background Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices. Method A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18–49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and ...