Kamuzu Central Hospital is a tertiary referral hospital in the city of Lilongwe, (capital of Malawi). It is estimated to have 780 beds, although the true number of patients always exceeds the number of beds. It serves approximately 5 million people, referred from five district hospitals and from other parts of Malawi and parts of neighboring Tanzania, Zambia, Mozambique and Zimbabwe.
Genome-wide association studies (GWAS) have identified over 200 genetic risk loci for breast cancer, yet the target genes in these loci remain largely unknown. To address this knowledge gap, we conducted a series of multi-ancestry transcriptome-wide association studies (TWAS) to discover potential breast cancer susceptibility genes. We developed and validated ancestry-specific genetic models to predict levels of gene expression, alternative splicing, and 3' UTR alternative polyadenylation, using genomic and transcriptomic data from normal breast tissue samples of 652 females of African, Asian, or European ancestry. These models were then applied to GWAS data of 178,534 breast cancer cases and 248,300 controls from these ancestry groups for association analyses. We identified 290 genes associated with breast cancer risk, including 103 previously unreported in TWAS and 46 located at least 500Kb away from any previously identified risk variants. Among them, 39 genes exhibited distinct associations with breast cancer risk by estrogen receptor status. The identified genes were enriched in pathways related to homologous recombination, apoptosis, p53, PI3K/AKT/mTOR, estrogen, and IL-2/STAT5 signaling. Single-cell RNA sequencing and in vitro experiment data provided additional functional evidence for 169 genes. Our study uncovered large numbers of candidate breast cancer susceptibility genes and contributed valuable insights into the genetics and biology of this common cancer.
Malnutrition is a leading risk factor for community-derived Enterobacterales bacteremia, which has a high rate of mortality in children in sub-Saharan Africa (SSA). International guidelines recommend the use of antibiotics, such as amoxicillin, for children with uncomplicated severe acute malnutrition (SAM), as well as parenteral broad-spectrum antibiotics, such as cephalosporins, for children with SAM who are admitted to the hospital. However, rising rates of infection with extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) in SSA call this practice into question. To determine ESCR-E colonization rates, culture-based screening was performed on stool specimens collected from a cohort of children admitted to a hospital in Lilongwe, Malawi, for SAM. Of 188 individuals screened, 80.3% were positive for ESCR-E colonization, and 38.3% were colonized with multiple ESCR-E species. These findings reveal that high rates of ESCR-E colonization exist in some populations of malnourished children in SSA, and guideline-directed empiric antibiotic treatment may need to be reevaluated in this setting.
Antimicrobial resistance threatens global health and is largely driven by inappropriate antimicrobial use. In Malawi, infectious diseases remain the leading health burden, fueling high antibiotic consumption. However, systematic data on antibiotic prescribing practices are scarce. This study evaluated the prevalence and pattern of antibiotic use for inpatients admitted in hospitals participating in Malawi’s antimicrobial resistance sentinel surveillance network. A multisite point prevalence survey on antibiotic use was conducted in June 2021 across seven hospitals in the sentinel surveillance network: Queen Elizabeth Central Hospital, Zomba Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, Mangochi District Hospital, Mzimba South District Hospital, and Malamulo Adventist Hospital. Antibiotic prescription data was collected from randomly selected patient medical records using the World Health Organization methodology for point prevalence surveys on antibiotic use. Four domains were described: antibiotic-use prevalence, patterns of antibiotic use, local guideline compliance, and microbiology diagnostic service use. A total of 1,030 eligible patient files were reviewed across the surveyed hospitals, of which 46.1
Childhood and adult obesity are emerging public health concerns in sub-Saharan Africa, driven by rapid nutrition transition and changing food environments. To prevent the rising rate of childhood obesity and overweight/obesity among women in sub-Saharan Africa, and to understand factors influencing food consumption in this population, this study aimed to examine the associations between overweight/obesity and dietary intake among children and mothers in urban and rural Malawi. A cross-sectional survey was conducted in Lilongwe City (an urban area) and Mzimba District North (a rural area) from November to December 2022. Anthropometric measurements were taken for children aged 2.0–4.9 years and their mothers. Questionnaire interviews were conducted with mothers of children. The dietary survey consisted of a 24-h recall and a food frequency questionnaire (FFQ). Participants' mothers were classified as overweight/obese (body mass index: BMI ≥ 25 kg/m2) or normal weight (18.5≦BMI < 25 kg/m2). Associations between overweight/obesity and dietary factors (nutrient intake, food consumption, FFQ, Minimum dietary diversity for women [MDD-W], Minimum dietary diversity 6–23 months [MDD], and questionnaire variables) were assessed using chi-square tests, independent t-tests, and multivariable logistic regression analyses adjusted for age, education, and income. Of the 229 mother–child pairs that participated, the data of 200 pairs were included in the final analysis. Consequently, 37.5
