Læknaneminn - 01.04.2008, Page 92

Conclusion:
Hypocalcaemia and lowT cells are common in infants with
22ql 1 deletion and cardiac defects. Individual assessment
and management is cruicial in these patients due to the
varying and complex clinical picture. Consensus based
clinical guidelines would aid in optimal care of children
with this disorder.
Malaria and its prevention in Monkey
Bay, Malawi
Þorkell Snæbjörnssonl, Geir Gunnlaugssonl,2, Sigurður
Guðmundsson3, Frederick Kapinga4
University of Icelandl, Centre for Child Health Ser-
vices2, ICEIDA, Malawi3, Monkey Bay Community
Hospital4
Introduction:
Malaria is the most important parasitic disease of
humans, with close to half of the world’s population at
risk. Annually 300-500 million episodes are reported
around the globe and around 1.2 million people die each
year. Over 95% percent of all malaria related deaths occur
in sub-Saharan Africa, 65% of these are children. The
main reasons for death are lack of preventive actions and
medicines. One of eight Millennium Development Goals
(MDGs) aim to reduce the burden of malaria. The aim of
the present study is to describe and analyze the malaria
situation and preventive actions against malaria in a sub-
Saharan African country.
Materials and Methods:
The study was conducted in the Monkey Bay health zone
in the southern part of Malawi in the period March-April
2007. The health services in the area have since 2000 been
supported by the Icelandic International Development
Agency (ICEIDA). There are five health facilities, two
run by the government, that does not charge user-fees,
and three are run by the Christian Health Association
of Malawi (CHAM) that apply user-fees. Documents on
malaria in Malawi were collected, out-patient (OPD)
and out-reach sessions were observed, interviews were
conducted with health professionals, and local data from
the Health Management Information System (HMIS)
were analyzed and evaluated. The study was approved
and conducted with the support of ICEIDA.
Results:
Malaria is endemic in Malawi but the prevalence varies
according to geographical location. Out of more than
100.000 out-patients in Monkey Bay area in the years
2005-06, average ratio of malaria compared to all other
disease classifications varied from 32 to 46%. About 3/4 of
all out-patients in the area chose governmental facilities.
The diagnosis of malaria was confirmed in less than
10% of cases in Monkey Bay Community Hospital, the
only place where malaria parasitaemia can be confirmed
in the area. The first line of drug for uncomplicated
malaria was sulphadoxine-pyrimethamine (SP) while
complicated malaria was treated with quinine. All febrile
children were treated with antimalarials, irrespective
of disease classification. Children under the age of five
(U5s) account for approximately one half of all malaria
patients in the area. During the rainy season, 19% of all
out-patients were U5s classified with malaria compared
to 13% during the dry season. Preventive actions include
prophylaxis to pregnant women with antimalarials and
distribution of a small number of insecticide treated
bednets (ITNs), either in out-reach or in a special
community programme.
Conclusion:
Malaria is a major threat to the health and well-being
of Malawians, in particular pregnant women and
children. It is important to guarantee access to prompt
classification and treatment but application of user-fees
may be an obstacle. Distribution of ITNs can and should
be strengthened.
Diagnosis and treatment of HIV/AIDS
in Monkey Bay Community Hospital,
Malawi
Lilja Rut Arnardóttirl, Geir Gunnlaugssonl,2, Sigurður
Guðmundsson3 and Ruth Nkana4.
lUniversity of Iceland, 2Centre for Child Health Ser-
vices, 3ICEIDA, Malawi and 4Monkey Bay Community
Hospital, Malawi.
Introduction:
By the end of 2006 it was estimated that just less than 40
million people were living with HIV/AIDS, among them
17.7 million women and 2.3 million children. About
60% of infected persons live in sub-Saharan Africa. The
main route of transmission is heterosexual relation. HIV
prevalence in pregnant women varies from 1% up to 37%
and mother-to-child transmission is consequently high.
The epidemic impacts severely on the society, culture,
economy, and the health system. Halting and reversing
the spread of HIV is one of the targets of the Millennium
Developmental Goals (MDG).
Voluntary counselling and testing (VCT) is considered
to be a key method to decrease the transmission of HIV.
Further, antiretroviral treatment (ARV) is the main
strategy to prevent progression to AIDS and mother-to-
child transmission (PMTCT). The objective of the study
is to observe, describe and analyse preventive actions
and treatment for HIV/AIDS in a sub-Saharan African
country, in particular in a rural setting.
Material and Methods:
The research took place at Monlcey Bay Community
Hospital (MBCH), in Mangochi district in southern
Malawi in the period March 9 to April 10, 2007. MBCH
is a referral hospital for Monkey Bay Health Area which
has a population of 113.000, and four health centres. The
Icelandic International Developmental Agency (ICEIDA)
has been supporting the health sector in the area since