Non Communicable Diseases

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Preparedness for Diabetes and Cardiovascular diseases service delivery in health facilities in Mangochi district, Malawi
(Kamuzu University of Health Sciences, 16-06-21) Lutala, Prosper
Type of the study: A mixed- methods. Problem statement: Diabetes and hypertension are steadily increasing in Sub-Sahara Africa and Malawi. However, preparedness and readiness in dealing with noncommunicable diseases (NCDs) were reported weak and inappropriate in several settings in Africa, including Malawi. Current level of availability and preparedness in the management of NCDs in general in few domains (NCDs’ referrals and community activities) s and perceptions of providers regarding NCDs services in Mangochi, as also perceptions of providers regarding NCDs services’ availability and preparedness remain unknown in Mangochi. Therefore, need for this study. Objectives: This study aim is to assess the preparedness through readiness of health facilities for diabetes and cardiovascular (CVDs) services in public and private health facilities in Mangochi district, Malawi. Specific objectives are: assess basic supplies for diagnostic, management, treatment, referral and community management of diabetes and cardiovascular diseases in health facilities in Mangochi district; to assess availability and preparedness of staff in managing diabetes and hypertension in health facilities in Mangochi district; to assess the perceptions of staff about the availability and readiness of diabetes’s and cardiovascular diseases’ services in health facilities in Mangochi district; and to identify factors associated with the preparedness of health facilities in Mangochi district for the outpatient’s management of diabetes and cardiovascular diseases Methodology: The study will be carried out in private and public health facilities in Mangochi. It will cover the period between March to September 2021. The sample will be selected among all the forty-two health facilities in Mangochi and their respective in-charges, and knowledgeable clinician, nurse and health surveillance assistant . Multistage Random sampling will be done for health centers, purposeful selection for the four hospitals and systematic sampling of in-charge in 16-Jun-2021 5 Study protocol Version 4 (June 5, 2021) selected facilities. Sample size: a computed sample of 32 facilities with for each, his in-charge and others staff needed. A local validated service availability and readiness assessment (SARA) self-administered questionnaire including a checklist will be carried out by a trained research assistant (quantitative), while a semi-structured interview will guide collection of qualitative data. Quantitative part will use simple descriptive statistics (means, percentages, chi-square and test-t of student for continuous and categorical, respectively; logistic regression for associations); and content analyses will be conducted to identify key themes for the qualitative data. Ethical considerations: Informed consent, confidentiality, anonymity, authorization from district and ethical clearance from COMREC. Expected findings: they are human resource by cadre and training, equipment, availability of guidelines, medicines and commodities, diagnostics, and education materials and states, referrals, community NCDs activities; perceptions of staff. determinants availability. Dissemination: Feedback to the facilities involved, study report to COMREC, College library, National Health Sciences Research Committee (through the COMREC Secretariat) presented as a policy brief, journal articles in peer-reviewed journals, and University of Malawi Research and Publication Committees.
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Point of Care Retinopathy Screening Study (PARROTS)
(Kamuzu University of Health Sciences, 2020-06-05) Burgess, Philip
Type of study A pilot of point of care cross-sectional (POC) screening for diabetic retinopathy (DR) delivered by ophthalmic clinical officers (OCOs) and optometrists will be undertaken at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. This study will investigate both the accuracy of the screening test and acceptability of the system of POC screening to patients and health care workers. The Problem Malawi has an adult population prevalence of diabetes of approximately 5% and a high prevalence of sight threatening diabetic retinopathy (STDR) in persons attending diabetes clinics. Visual loss from diabetes is preventable and treatable. Early detection is key but European style screening programmes would not be cost-effective or sustainable in Malawi. Low-cost fundus cameras used together with novel automated grading software could provide the means to provide effective point-of-care screening by health workers. Recent work in 2018/2019 has been undertaken to assess the quality of retinal photographs produced by 2 portable fundus cameras and to investigate the accuracy of an automated grading algorithm used together with a hand-held fundus camera for detection of DR. Automated grading addresses the problems of recruiting, training and cost for human grading of retinal photographs. A POC result overcomes the problem of communicating results at a distance. The planned next stage of this project is described below. Objectives Broad Objectives 1. To determine whether new and low cost portable screening cameras alongside a grading algorithm for diabetic retinopathy will benefit patients with diabetes Specific objectives 1. To investigate the accuracy of an automated grading algorithm used together with a low-cost fundus camera for detection DR which imminently threatens vision in 2 settings: a Central Hospital and a District Hospital. 2. To investigate the acceptability to patients of a system of POC DR screening using an automated grading algorithm used together with a low-cost fundus camera. 3. To investigate the acceptability to health care workers of a system of POC DR screening using an automated grading algorithm used together with a low-cost fundus camera This is a prospective pilot study of a screening intervention based at 2 sites. People living with diabetes (PLWD) attending a diabetes clinic at each site (n=246) will be recruited. DR screening with POC automated grading will be delivered by OCOs and optometrists. Digital fundus photography of 2 standard fields (disc-centred and macula-centred) will be performed through dilated pupils using 2 hand-held fundus cameras (Volk Pictor Plus and Volk InView). Photographs will be analysed using Eye Star automated grading software. Screen positive cases (DR which imminently threatens vision: LDES level 50+ and exudates within 500um of the central fovea) will be referred to a tertiary referral centre: Lions Sight First Eye Unit at Queen Elizabeth Central Hospital, Blantyre for assessment and, if necessary, treatment. All screen positive subjects will be examined by an ophthalmologist (PK) to determine the positive predictive value. A proportion of screen negative subjects will be examined by an ophthalmologist to determine the negative predictive value. The acceptability of the intervention will be assessed by qualitative methods. All patients and health care workers will be invited to complete a questionnaire. A sub-group of patients (n=28) and health care workers (n=10) will be interviewed. A separate sub-group of patients will be invited to participate in focus groups (n=20). The impact of distance, gender, and risk perception on acceptability of the POC DR screening to patients will be assessed. The study will be undertaken in a sequential manner: phase 1 at Queen Elizabeth Central Hospital; phase 2 at Chiradzulu District Hospital. After phase 1 of the study, a planned interim analysis will be undertaken, and any necessary changes made to the screening model. Expected results The results are expected to demonstrate the effectiveness of screening for sight threatening diabetic retinopathy using handheld cameras in a LMIC hospital setting. Results will also establish acceptability for patients and health care staff. Data from this pilot study will inform future large studies of this intervention. If the expected results are seen, implementing diabetic retinopathy screening at a district level would be sought. Approval would be sought for deployment of the fundus cameras and grading system at a national level, from the appropriate governing body. Dissemination of results The findings of the study will be disseminated through presentation at national and international meetings and through peer reviewed publication. The Committee of Medical Research and Ethics Committee (COMREC) will be notified of the findings in the first instance. Findings from the study will inform a phased introduction of diabetic retinopathy screening throughout Malawi.
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Assessing the burden of Diabetes Mellitus (DM) and risk factors among Blantyre city based Non-Governmental Organisation (NGO) drivers
(Kamuzu University of Health Sciences, 2020-06-05) Mtila, Yusuf
Type of Study The study is a cross-sectional study that will adopt the World Health Organization (WHO) STEPS survey design for NCD risk factors assessment with particular interest on Diabetes. Problem The prevalence of Diabetes Mellitus (DM) in Malawi was determined at 5.6% among adults aged 25-64 years by national wide STEPS survey in 2009. Sedentary life style which is a characteristic of driving population has been associated with increasing prevalence of Diabetes Mellitus. Studies on determinants and distribution of DM among different groups of driving populations including taxi drivers, bus drivers and truck drivers have been conducted. The results from the studies have informed effective programming on DM response interventions amongst the target populations. Currently epidemiology of DM among Non-Governmental Organization drivers in particularly is not known and documented. Knowledge on prevalence of DM and their associated risk factors among NGO drivers in Blantyre city will inform evidence-based interventions that specifically respond to diabetes burden among them. Objectives The main objective of the study is to assess the prevalence and risk factors of Diabetes Mellitus among NGO drivers in Blantyre city. Specific objectives include: Assess prevalence of lifestyle and behavior risk factors, Medical/ physiological risk factors and prevalence of DM among NGO drivers. Methodology A sample of 91 NGO drivers from Blantyre city will be interviewed, assessed on behavior, physical and biomedical risk factors. Two enumerators and two certified providers will be temporally employed to facilitate data collection process. The enumerators will be interviewing NGO drivers on background information, behavior risk factors using a questionnaire. The interviewees together with their partly filled questionnaires will next be directed to providers (Nurse/Clinician) for presence of DM, physical and biomedical factors assessment. All interviews will be recorded, entered into STATA 16 and hard copies filed in a file cabinet. Data will be processed and analyzed using STATA. Expected Findings It is expected that there will be significant associations between behavior, physical, physiological risk factors to prevalence of DM in Blantyre city-based NGO drivers. Dissemination of Findings Findings from the study will be shared with relevant authorities in Blantyre city council, CONGOMA, Ministry of Health and COMREC to reflect on the recommendations of the study. It is expected that findings from the study will be used by Malawi government for reference on development of comprehensive national NCDI /Diabetes policy.
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Lived experiences of patients with esopgageal cancer attending palliative care at clinic at Zomba Central Hospital
(Kamuzu University of Health Sciences, 2020-06-11) Chikhungwa, Sellina
Type of Research Lived experiences of patients with oesophageal cancer attending palliative care clinic at Zomba Central Hospital. Problem Oesophageal Cancer (OC) is one of the most serious gastrointestinal cancer in Malawi, owing to its rapid development and fatal prognosis in most cases (Mchembe, Rambu, & Chalya, 2013). In Malawi, Zomba Central Hospital is one of the referral hospitals in the eastern part of Malawi with high burden of oesophageal cancer. (Mathiass & Christliches, 2015). Most of the patients with oesophageal cancer at Zomba Central Hospital are diagnosed late while the cancer has already metastasised and palliation is the only option for these patients. Literature suggests that understanding the experiences of patients living with oesophageal cancer and are on palliative care is very important as it provides strategies for caring these patients. (Yeh Lee & Pilkington, 2014) . The proposed study therefore aims to explore how patients diagnosed with oesophageal cancer experience living with the incurable disease. The results of the study will provide insight and understanding of the patient’s situation, reality and phenomenon in their life world. The knowledge will help to meet the patients need for care and psychosocial support. Specific Objectives • To describe the experience regarding the diagnosis of oesophageal cancer. • To discuss the care, support and treatment offered to patients after the diagnosis of oesophageal cancer. • To identify the challenges faced by patients living with oesophageal cancer. 11-Jun-2020vii Proposal Version 3: May 6, 2020 Methodology The researcher proposes a qualitative descriptive design and it will follow a qualitative naturalistic approach (Polit & Beck, 2014). The research will be conducted at Zomba Central Hospital Palliative Care Clinic. Fifteen patients diagnosed with oesophageal cancer will be selected using purposive sampling technique to participate in the study. Data will be collected through in-depth interview using an interview guide and it will be recorded using an audio tape recorder. The recorded data will be analysed using Braun and Crake 2006 thematic analysis approach. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC) and permission from the director of Zomba Central Hospital (ZCH) to conduct the study at Zomba Central Hospital palliative care clinic. Participants will be informed that participation is voluntary and informed consent will be obtained through signing of consent forms. Privacy and confidentiality will be ensured. Expected findings The findings of this study will help nurses to have a rich understanding of the experience of patients living with incurable oesophageal cancer. It will provide knowledge about the problems and concerns patients encounter in their day to day life. The information will also help the ministry of health to develop improved supportive nursing care of patients living with oesophageal cancer. Dissemination Results of the study findings will be presented to academic staff at Kamuzu College of Nursing. The findings will also be presented to Zomba Central Hospital staff. A copy of the thesis will be sent to College of Medicine Ethical Committee being the ethical board ensuring ethical guidelines. Other copies will be sent to Palliative Care Association of Malawi (PCAM). The 11-Jun-2020viii results will also be published in Nursing and Midwifery Journals. In addition, the results will be presented at conferences both locally as well as international
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Assessing the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital, Mzuzu
(Kamuzu University of Health Sciences, 2020-09-02) Chikopa, Fryness
The topic of the study is to assess the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital. This will help health professionals to design interventions that will help to address the needs of the caregivers resulting into improved quality care to older clients. PROBLEM Currently, in Malawi there is scarcity of data on studies conducted on psychological, social and economic impact of caregiving on caregivers of mentally challenged patients who are also older persons above 60 years of age. A number of caregivers are affected psychologically, socially and economically due to their role of caregiving this affects quality of care and little is done in managing these effects. Hence the study will help to identify psychological, social and economic challenges that affect the care givers which can inform the development of appropriate strategies. OBJECTIVES The objectives will include; describing the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients, describing how the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients affects the quality of care of mentally challenged older patients and documenting recommendations to 02-Sep-2019 7 address psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients. TYPE OF STUDY This is a descriptive qualitative study design. METHODOLOGY The study will be conducted at St John of God Hospital in Mzuzu city. Purposive sampling will be used to select respondents. About 30 caregivers and 10 health care workers will be interviewed. However, the actual sample will depend on the saturation point: a point at which no new information is emerging from the data. The researcher will use in depth interviews. These will be administered to the caregiver and the health care workers who interact with caregivers of the older clients. The questionnaire/ topic guide will have three parts namely; demographic data of the care givers and questions assessing psychosocial and economic impact of caregiving on caregivers and how such impact affects the quality of care provided by caregivers. The other part of the topic guide will assess the health care workers perceptions of the psychosocial and economic impact of caregiving on caregivers. All interviews will be audio recorded. Study population will consists of two groups. First are caregivers of the patients who are aged 60 years and above. The second group will be health care workers who interact with the caregivers in order to assess the health workers perceptions of the psycho-social and economic impact of caregiving on the caregivers. Thematic data analysis will be used. The data will be analysed aided by a computer package called NVIVO 12. Descriptive statistics will be computed and reported for social demographic data. 02-Sep-2019 8 The study limitations will include bias as the study will be conducted at a hospital setting and therefore some participants may not be free to express themselves. Some caregivers may also feel coerced to participate. EXPECTED FINDINGS There will be psychosocial and economic impact of caregiving on caregivers of a mentally challenged older patients accessing services at St John of God hospital. DISSEMINATION Findings of the study will be shared during journal club meetings at St John of God and research conferences. The results will also be shared to COMREC. An article based on the findings will also be published in a peer –reviewed journal.
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Uptake of cervical cancer screening and associated factors among women in Nkhoma, Lilongwe Rural Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Kamanga, Ella; Banda, Nicholas; Fombe, Hillary
The study conducted in the period 2011-2015 by Msyamboza et al, showed an increase of cervical cancer screening uptake from 9.3% to 26.5%. However, the available estimates are from health facility-based data. Community-based coverage data is scarce. In addition, current data on the trend of cervical cancer screening uptake is not known. This quantitative cross-sectional study has been designed to come up with the 2016-2020current estimated uptake of cervical cancer screening services and determine its associated factors that hinder or stimulate the cervical cancer screening uptake. This study will be conducted at Nkhoma Lilongwe, rural Malawi. The community-based 2016-2020 uptake and its associated factors will be estimated by calculating the proportion of women aged 25-49 years who have undergone cervical cancer screening. The targeted population are all women aged 25-49 years old from Nkhoma Mission Hospital catchment area. Villages in the catchment area of Nkhoma Mission Hospital will be randomly selected using simple random method and households will be selected using systematic sampling technique. A sample size of 330 women will be drawn including adjustment of 10% for nonresponse. The data will be collected by administering a semi-structured questionnaire. Microsoft office Excel 2016 will be used for data entry and EPI INFO version 7 for data analysis. Data and information will be backed up in external and Google drives. There is an expectation that from 2016 to 2020, the uptake of cervical cancer screening might have increased following the extensive cervical cancer sensitization campaigns in the country. These findings will be presented using tables and graphs.
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Assessing diabetic lifestyle knowledge, attitude and practice and their associated factors in type II diabetic patients attending medical clinic at Nkhoma Mission Hospital
(Kamuzu University of Health Sciences, 2020-09-16) Chisepo, Patrick
The problem: Lifestyle Modification involves altering long-term habits, typically of eating and physical activity and maintaining the new behaviour for months or years.(3) Lifestyle Modification is known to treat or reverse a number of Non-communicable diseases(NCD) and plays an important role in the management of diabetes toward achieving good glycaemic control, as well as preventing or delaying micro-vascular complications in patients with type II diabetes. Though we give patient education and counselling at Nkhoma medical clinic regarding Lifestyle Modification, little is known about patients’ intention, attitude, and actual practice of these activities. This study will help us to identify patients’ stated intentions and attitude factors that relate to lifestyle behaviors. Understanding these motivating thought processes will help us better relate to counseling individual patients, as well as improve diabetes education and empowerment programs. 7.2 Study design: We will carry out a descriptive quantitative cross-section study 7.3 Objective: The study aims to assess patients’ intention, attitude and behaviour towards Lifestyle Modification among patients with type II diabetes. Specifically will assess level of the patients’ intentions to engage in Lifestyle Modification, factors that are associated with Intentions to engage in Lifestyle Modification and factors predictive of Lifestyle Modification. 7.4 Methodology: This will be a descriptive cross-section study of diabetic patients attending outpatient medical clinic. It will use Diabetes Intention, Attitude and Behaviour questionnaire (DIAB-Q) to measure diabetes-related cognitions and behaviours for engaging in health lifestyle. A sample of 50 patients with type II diabetes will be enrolled using convenience sampling during the study period of two months; since the medical clinic at Nkhoma is done once a week on Tuesdays, it will mean the data collection will be done in 8 days over the 2 month period. The study will include type II patients 18 years and above who consent and have been known to have diabetes for at least 1 week. It will exclude those who are below 18 years and those who have had diabetes for less than 1 week.
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Burden of chronic disease comorbidities among cancer patients attending oncology services at Queen Elizabeth and Kamuzu Central hospitals in Malawi
(Kamuzu University of Health Sciences, 2020-10-16) Chiwanda, Jonathan
Problem to be studied: This doctoral study is focusing on estimating burden of chronic diseases among cancer patients. In Malawi, cancers are increasingly contributing to high burden of diseases. There is also high burden of other chronic diseases, however, there is no available data on prevalence of specific comorbidities among cancer patients. Therefore, understanding the prevalence of chronic disease comorbidities among cancer patients will help in developing appropriate interventions for prevention, management and treatment of comorbidities with the aim of improving quality of life and survival. Type of study: The project has two study designs; cross-sectional and Randomized Control Trial (RCT) components at different phases. Broad objective/ aim: 1. Explore common chronic comorbid conditions among cancer patients at two main referral hospitals of Queen Elizabeth and Kamuzu Central. Objectives Phase one 1. To estimate prevalence of chronic disease comorbidities among cancer patients. 2. To compare prevalence of comorbidities across gender, age and urban versus rural settings among cancer patients. 3. To identify factors associated with disease comorbidities among cancer patients 4. To compare quality of life among cancer patients with chronic disease comorbidities to those without comorbidities. Phase two 5. To compare quality of life among cancer patients with chronic disease comorbidities between the intervention and control groups. 6. To estimate survival among cancer patients with comorbidities Methodology: The study has two phases. The initial phase which is formative will use a crosssectional study design to estimate the prevalence of comorbidities among cancer patients presenting at Queen Elizabeth and Kamuzu Central Hospitals. The sample size will be a minimum of one hundred and ten. This will be followed by a single-blinded randomized control trial involving delivery of SMS alerts delivery to participants. The study will have two arms namely; intervention and control. Individual participants from the intervention arm will know about their receiving of SMS alerts but they will not be given information about whether everyone is getting similar messages. The end line will measure the effectiveness of the intervention (use of SMS alerts) in terms of improving quality of life and estimate survival. Ethical Consideration: The permission to conduct the study will be sought from Kamuzu Central Hospital (KCH) and Queen Elizabeth Central Hospital (QECH). Ethics approval will be sought from the College of Medicine Research Ethics Committee (COMREC). Expected findings: We expect to have high burden of chronic diseases among cancer patients due to direct proportionality of high burden of cancers and other chronic diseases in Malawi. Results dissemination: All results will be disseminated through research dissemination conferences both at College of Medicine and other available international symposia. Copies of the findings will be shared with COMREC, QECH, KCH and Ministry of Health Headquarters.
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Evaluation of a pharmacist-led medication therapy management program for patients with hypertension at a tertiary hospital’s outpatient clinic in Malawi
(Kamuzu University of Health Sciences, 2020-10-16) Msowoya, Denise
Type of Study: Prospective Parallel Cohort Study Problem: Non-Communicable Diseases (NCDs) are causing significant morbidity and mortality within Malawi’s population. In particular, hypertension is a chronic health problem that often is under prioritized due to high prevalence of infectious diseases. The pharmacy profession is underutilized in efforts to address hypertension in the public health system due to gaps in data supporting ambulatory pharmacists’ inclusion in treatment. Objectives: This parallel cohort study intends to evaluate blood pressure control and adherence in patients receiving standard of care compared to patients receiving standard of care in addition to an ambulatory care pharmacist’s services in a hypertension clinic. Secondary objectives include evaluating goal blood pressure met in both study arms, determining types and quantity of pharmacist interventions, and collecting data on satisfaction and feedback from other healthcare professionals and patients. Methodology: A trained ambulatory care pharmacist will be incorporated into the hypertension clinic at Queen Elizabeth Central Hospital (QECH) from November 2020 to November 2021. There will be two arms of the study: the control arm being standard of care offered at the clinic, the intervention arm being standard of care plus the services of the aforementioned ambulatory care pharmacists. This pharmacist will collect baseline demographic data and treatment status along with treatment progression at follow-ups per the hypertension clinic’s guidelines. Medication adherence will also be monitored between both groups by the pharmacist. Patient satisfaction scores and feedback from the other members of the healthcare team will be collected throughout the study. Analysis of blood pressure changes, patients achieving goal blood pressure, and change in medication adherence will be conducted at 6 months and 12 months. Expected Findings: The expected outcomes will display a statistically significant benefit in health outcomes and adherence through the incorporation of an ambulatory pharmacist compared to the current standard of care. These results will also reveal patient satisfaction scores and healthcare provider feedback that will promote future inclusion of pharmacists in NCD outpatient treatment. Dissemination: The results will be presented at the 2021 International Pharmaceutical Federation (FIP) World Congress of Pharmacy and Pharmaceutical Sciences in Seville, Spain. The associated manuscript will be submitted to the peer reviewed Journal of Pharmacy Practice for publication. In addition, the results will be presented to the Malawi Ministry of Health by the pharmacy department at the College of Medicine to open discussion about creating ambulatory pharmacist positions. Finally, the results will be shared with COMREC upon the completion of the study.
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critical analysis of hypertension care delivered in Balaka, Machinga, Mchinji and Rumphi Health Care facilities
(Kamuzu University of Health Sciences, 2020-11-11) Mbulanje, Lucia
Problem: Quality care services play an important role in the prevention, management and control of diseases as far as health promotion is concerned. Availability of resources and guidelines are among other things that contribute to achieve quality. However, despite adopting guidelines that promotes quality and universal access for hypertension care in Malawi, the intervention has not been formally assessed in these districts. Objectives: To explore whether and in what ways is hypertension care delivered in health care facilities consistent with WHO and Malawi guidelines for hypertension management. Specifically, this secondary review will assess health care provider’s qualification and expertise in delivering hypertension care, explore availability of guidelines for the management of hypertension at health facilities, explore the availability of the infrastructure and equipment essential for diagnosing and managing hypertension, explore the availability of drugs for the treatment of hypertension and compare the service delivered with what is stipulated in the guidelines. Methodology: This is a cross sectional study utilizing data from the Malawi Longitudinal Study for Families and Health (MLSFH). This secondary review will look into MLSFH data from 4 districts namely Machinga, Balaka, Mchinji and Rumphi. Data was collected from Health Facility managers of the facilities using interviews guided by a structured questionnaire. Data will be analyzed using STATA version 14 and descriptive statistics will be applied to summarize frequencies and proportions. Expected findings: The study will provide information on the extent the health care system is responding to hypertension management in Malawi. Dissemination: Research findings will be disseminated to COMREC, Rumphi, Mchinji and Balaka district health offices. Further manuscripts will be prepared for submission to appropriate journals.
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The prevalence of cardiac complications among children with sickle cell disease, attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Moyo, Dominic
Study design: This is a Cross- sectional study. Problem statement Cardiovascular diseases like pulmonary hypertension, cardiomyopathy and left and right ventricular systolic and diastolic dysfunction are important complications and cause for morbidity and mortality among patients with Sickle Cell Disease. Routine monitoring for detection of these complications is recommended for early detection and institution of measures to mitigate them. The magnitude of these complications and how they present at Queen Elizabeth Central Hospital, paediatric Sickle Cell Disease clinic is not known. Over 120 children are routinely followed up in this clinic and monitoring for cardiovascular complications in not routinely done. This study aims at establishing the prevalence of cardiovascular complications in our cohort and characterising their presentation. Objectives: Primary objective: To characterise describe the prevalence of cardiac complications among children aged 2 to 16 years, attending paediatric sickle cell clinic. at Queen Elizabeth Central hospital. Secondary Objectives: 1. To determine the prevalence of characterise the cardiac complications among children aged 2 to 16 years, attending paediatric sickle cell clinic at Queen Elizabeth central hospital. 2. To determine the risk factors associated with cardiac complications among children aged 2-16-year, attending paediatric sickle cell clinic. at Queen Elizabeth Central Hospital. 3. To evaluate the clinical features of cardiacovascular complications among children aged 2- 16-year-old children attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital. Research questions to be answered 1. What is the prevalence of cardiovascular complications of children ages 2-16 years attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital? 2. What are the risk factors associated with these complications among these children? Methodology The study will be conducted at Queen Elizabeth Central Hospital paediatric Sickle cell clinic. 117 children aged 2-16 years will be recruited after screening and obtaining informed consent and assent from the guardian and the children who are able to give assent respectively. Data on medical history of the child will be collected from the health passport book and interviews. A comprehensive physical examination of the child will also be performed. This will be followed by an echocardiographic examination of the heart using an ultrasound machine. Data will be collected on a tablet fitted with an Open Data Kit (ODK) platform. The outcome variable of interest will be whether a child attending the clinic has cardiac complications. Descriptive analysis to obtain the prevalence of the cardiovascular complications and their characterisation will be done. This will be followed by bivariate and multivariate logistic regression analysis to identify the risk factors associated with these complications at a P-value of <0.05. Expected findings The prevalence of cardiovascular complications among children attending paediatric Sickle Cell clinic at Queen Elizabeth Central Hospital and the risk factors associated with them. Results dissemination The study report of all results will be submitted to the funders of the study and the College of Medicine – University of Malawi. College of Medicine Research Ethics Committee (COMREC) will also receive a copy as well as the participating patients that wish to receive the results. The results will further be submitted to a peer-reviewed journal for publication.
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Association between knowledge and adoption of healthy living practices among hypertensive patients at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2020-11-11) Kakowa, Zinenani; Matsimbe, Thokozani; Kankhuni, Maranatha
Hypertension remains the most rapidly rising cardiovascular disease in Africa. It is a highly prevalent Non-Communicable Disease (NCD) in Malawi with nearly a third of 25-to-64-year-olds having raised blood pressure or taking antihypertensive medication. Lifestyle modification is the first step in hypertension management. The high prevalence of hypertension calls for implementation of healthy living practices. In Malawi there is limited or no data on the knowledge and practice of healthy living practices among hypertensive patients hence this study. Therefore, this study will focus on the association between knowledge and adoption of healthy living practices among hypertensive patients at QECH. The chief objective is to assess the association between knowledge and adoption of healthy living practices amongst hypertensive patients. This study is necessary because it will enlighten the Ministry of Health on how many hypertensive patients are aware and adopt healthy living practices. Depending on the percentage of those who are aware and those who are not, the Ministry will be able to put in place interventions that will educate people on the healthy living practices hence managing and preventing hypertension. This will be a cross sectional descriptive study and will use mixed methods, both quantitative and qualitative. The study will be conducted at QECH in Blantyre, Malawi as captioned in the title. The study participants will be any patient within the age range of 25 to 64 years old admitted in the medical ward but has hypertension and those hypertensive patients coming to the general clinic. Convenience sampling method will be used to identify possible study participants and 126 participants are expected to be enrolled. The study participants will be only those hypertensive patients that are found at the hospital at that particular time. Data will be collected by doing indepth interviews with the study participants using an interview guide and the data will be analyzed using Epi-info. It is expected that not all the hypertensive patients that are aware of the healthy living practices adopt them, some are aware and adopt the healthy living practices and some who are not aware at all. All ethical regulations will be followed to ensure that the information assembled in this study is acceptable and probable limitations of this study will be managed to ensure that the data is precise. Finally, the data collected from this study will be presented at the CoMREC research dissemination.
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Synthesis and anticancer evaluation of pyridazine derivatives
(Kamuzu University of Health Sciences, 2020-11-11) Lengwe, Chilufya
Type of Study Synthetic and Characterization Problem Statement The WHO reports that cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.1 The global burden of cancer has increased significantly such that, according to WHO, it estimated that the number of new cases in the next 20 years is expected to rise to approximately 70%.2Drug resistance in the treatment of cancer is a frequent clinical challenge for cancer patients.68 Several drug resistance mechanisms have emerged such that some drugs can be prevented from entering the cell; they can be pumped out of the cells; drug activity can also be compromised by mutations or altered expression of the target. Although some therapies have shown remarkable clinical success, emergence of drug resistance has posed problems more especially in advanced stages of cancer.69,70 Therefore, it is paramount that efforts to understand the principle underlining mechanisms of cancer resistance and identifying therapies that can treat cancers no longer susceptible to the current treatments are explored.71Unwanted toxicity profiles of the current therapiesis also another motivating factor for the need to develop alternative chemotherapeutic regimens.72 Furthermore, the cost of cancer drugs, has risen concomitantly with the shift from the use of conventional cytotoxic chemotherapy to newer targeted agents -from about $12,000 before 2000 to more than $120,000 median annual price by 2015.73 Therefore, there is a critical need for structurally novel and cheaper anticancer drugs with new mechanisms of action. Aim of the Study To utilize the pyridazine scaffold as a template for the design and synthesis of novel anticancer agents. Specific Objectives i) To perform synthesis and characterization of target compounds using physical andspectroscopic techniques. ii) To perform in vitro antitumor structure-activity relationship (SAR) studies of various pyridazine analogues. iii) Undertake in vitro profiling with respect to solubility, permeability and metabolic stability: include standard deviations. iv) To evaluate the most promising compounds for in vivo efficacy in relevant disease models and pharmacokinetics Methodology Two classes of pyridanzine compounds will be synthesized. In the first case 6- chloropyridazin-3-amine will be coupled with substituted benzoic acids to form N-(6- chloropyridazin-3-yl)-substituted benzamide which will be then coupled with asubstituted boronic acid to formthe target compounds. The second class involves the dichlorinated pyridazine starting material, 3,6-dichloropyridanze,been coupled with excess boronic acid. Expected Findings IC50 values for all the compounds to be synthesized will be determined. Spectroscopy data i.e. NMR, MS and IR as well as the Physical properties such as melting points of all compounds will be generated. Solubility and permeability data of all promising compounds will be generated. Efficacy data of all promising compounds in animals will be generated Dissemination The report of this research will be submitted to the COM and UNZA as host institutions and also presented to College of Medicine Research and Ethics Committee (COMREC). Further, the results of this research will be disseminated through local conferences, workshops and symposia. If possible, a dissemination workshop will be organized.
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Experiences of caregivers of children living with sickle cell disease in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Ngutwa, Nellie
Type of study This is a descriptive qualitative study that will explore experiences of caregivers of children living with sickle cell disease. Problem statement In Malawi it has been reported that confirmed cases of Sickle cell disease in children have reported increased number of admissions, pain episodes and anaemia (Heimlich et al., 2016).To improve outcomes, early therapeutic interventions are recommended, however trends have shown poor attendance of children at the QECH sickle cell clinic. There is need to explore issues surrounding the poor turnover. These can be solicited where the experiences of the caregivers are known. There are no published studies on experiences of caregivers living with sickle cell children in Malawi. As such it is important to explore experiences of these caregivers. Study objective Broad objective To explore experiences of caregivers of children living with sickle cell disease. Specific objective 5. To describe the emotional impact of learning SCD diagnosis in their children 6. To describe the caregiver’s role in the care of their Sickle cell Children 7. To identify challenges experienced and coping strategies used in the care of their Sickle Cell children 8. To identify the forms of support caregivers, receive when caring for their Sickle Cell children Methodology The study will be conducted in Blantyre, Malawi under QECH 15 participants who are caregivers to children with sickle cell will be included. The study will utilize qualitative data collection and analysis method Expected findings The study is expected to report experiences of caregivers living with sickle cell children specifically challenges relating to their psychosocial aspect of life. Dissemination The results will be disseminated through meetings at institutions departmental level and Continuous Professional Development session. Written reports will be sent to the Hospital Director, the unit Matron, head of Sickle cell clinic and College of Medicine Research Committee. A manuscript will be submitted to a peer reviewed journal for publication. The results will also be shared at conferences both national and international.
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The feasibility and acceptability of asthma self-management delivered through a mobile phone application. A pilot study (Asthma m-health)
(Kamuzu University of Health Sciences, 2020-11-11) Laher, Beverly
Type of study: Mixed methods pilot study Problem: Despite the high rates of mortality and morbidity due chronic respiratory diseases (CRDs), attention to this group of diseases is arguably insufficient both at global, regional and country level. Globally asthma is a significant cause of reduced quality of life and death in all age groups across the life span. Asthma ranks number 28 on the global burden of disease list and contributes substantially to years lived with disability. In children is it the most common NCD and has devastating socioeconomic consequences. Asthma management requires a long-term approach due its chronic nature and the variability of asthma symptoms, triggers and exacerbations. Current guidelines advocate for self-management as part of standard care. However low-income countries like Malawi struggle to accommodate this practice due to shortage of resources. Emerging literature suggest that LMICs particularly in Africa are experiencing an increase in the burden of disease which hinders delivery of self-management services. Malawi is no exception to the escalating burden of asthma amidst insufficient resources. Mobile phone health application (MHealth) have been reported to be an effective and cost-effective tool in the monitoring and management of chronic disease like asthma. This study therefore aims to determine the feasibility and acceptability of an asthma selfmanagement mobile phone application in a resource-limited environment. Methodology: This will be a mixed methods pilot study assessing the feasibility and acceptability of using a mobile phone application (AsthMWa) for asthma self-management. The study will recruit a sample of 20 asthma patient aged 10-years and above, from the paediatric general clinic at Queen Elizabeth Central Hospital. Participants will be issued a phone with a pre-installed application (AsthMWa) which will collect information on medication use, self-assessment of symptoms and a personal asthma action plan. Participants will also participate in semi structured interviews, collecting data on acceptability, barriers to using the app and suggestions for modifications. We will take informed consent and assent and adhere to strict data protection procedures. Expected findings and dissemination: The study will determine the feasibility and acceptability of the asthma mobile health in the self-management of asthma in a low resource setting. The qualitative and quantitative results from this study will explore the ability of the application to collect the intended information and the patients capability to use the app to manage their Asthma. These results will also for a probable baseline for future research. The findings will be presented to COMREC and the College of Medicine Research Dissemination Conference. In addition, findings will also be presented at Malawi Liverpool Welcome Trust and published in a peer-reviewed journal.
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Evaluation of gestation Diabetes Mellitus at Zomba Central Antenatal Hospital Clinic
(Kamuzu University of Health Sciences, 2021-01-13) Chimwaza, Nelson
Gestational Diabetes Mellitus (GDM) was earlier defined as “hyperglycemia first recognized during pregnancy” and has more recently been described by the American Diabetes Association as diabetes diagnosed during pregnancy that is not clearly overt diabetes. GDM is associated with a wide range of adverse outcomes for women and their babies. Having GDM can increase the risk of high blood pressure during pregnancy. It can also increase the risk of having a large baby that needs to be delivered by cesarean section. Therefore results of this research can help in development of policies, management of antenatal mothers and used as basis for other studies. The objective of the study is to evaluate the prevalence rate of GDM and determine risk factors. This will be a cross sectional prospective study where by 300 participants shall be randomly selected through convenience sampling method. Women of 24-28 weeks gestation who pass the inclusion and exclusion criteria and have given their written consent shall be included in the study and their height, weight and age shall be recorded. Thereafter 75-g Oral Glucose Tolerance Test shall be performed in the morning after an overnight fast of at least 8 hours. The diagnosis of GDM is made if at least two of the following is met or exceeded i) fasting: 95 mg/dl ii) 1 hour: 180 mg/dl iii) 2 hour: 155 mg/dl. After centrifuging the blood sample in an anticoagulant tube, plasma shall be put in a BS 360 E Chemistry Analyzer to test for the client’s plasma glucose level. We expect a low GDM prevalence rate and association between GDM and maternal obesity as well as age. To compare the proportion of GDM across the age groups, Body Mass Index and gravida Chi Square test shall be used. Results of the research shall be available to College of Medicine Research Ethics Committee, Zomba Central Hospital and college of medicine library. Ethical clearance for this research project shall be sought from College of Medicine Research Ethics Committee.
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Assessment of quality of life among patients with type II diabetes mellitus at Kamuzu Central Hospital in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Chisalunda, Alinafe Venancio
Study type This is a convergent mixed methods study with both quantitative and qualitative methods. Quantitatively, a cross section descriptive study design will be employed. For qualitative data, a phenomenological approach will be used The Problem to be studied Diabetes mellitus is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Unfortunately, Majority of guidelines on diabetes care focus on the medical aspects of initial management without addressing other needs e.g. psychological well-being. This results in poor outcomes in diabetes patient management and hence poor quality of life. Current studies have found that health related quality of life is instrumental to the delivery of care and it is recognized as being an inclusive term that assesses both self-reported mental and physical functioning of an individual. However health related quality of life assessment is not incorporated in diabetes management in Malawi. Furthermore, no study on assessment of quality of life among type II diabetes mellitus patients has been conducted in Malawi. Objectives The main objective of this study is to assess the quality of life among patients with type II diabetes mellitus receiving treatment at Kamuzu Central Hospital in Lilongwe, Malawi. The specific objectives are to describe physical, psychological and social challenges faced by patients with type II diabetes mellitus and to determine ways of addressing the challenges to improve quality of life. Methodology This will be a convergent mixed methods study in which both qualitative and quantitative data will be collected. Quantitatively, cross section design will be employed and data will be collected using the Modified Diabetes Quality of Life (MDQoL) -17 questionnaire. Phenomenological approach will be used for qualitative data and will be collected through in-depth interviews with patients and guardians using an interview guide. The interviews will be tape recorded. Diary method and emotional mapping will also be used to capture qualitative data. Demographic characteristics for example age and gender will be collected as well as duration of diabetes history, body weight and presence or absence of complications. The common diabetes complications are; nephropathy, retinopathy, erectile dysfunction, peripheral neuropathy, heart problems for example coronary artery disease, myocardial infarction, congestive heart failure and peripheral vascular disease. These variables will be collected using a demographic data form. Quality of life values as given by the MDQoL-17 questionnaire will also be collected. This questionnaire has 17 diabetic specific questions that are classified into 8 concepts. These concepts are; physical, social functioning, role limitations due to personal and emotional problems, psychological impact, energy/fatigue, bodily pain and general health perceptions. After data collection, STATA software will be used for analysis. Furthermore, multiple regression model will be employed to draw conclusions from the quantitative data. Analysis for qualitative data will be done manually using thematic content analysis. Expected findings and dissemination It is expected that the results of this study will reveal: physical, psychological and social challenges that diabetes patients encounter. It will further identify precipitating factors to these problems and come up with evidence-based policies to help solve the problems. Furthermore, the results will act as an eye opener to incorporate health related quality of life assessment in diabetes management. Results from this study will be disseminated at College of Medicine Research Ethics Committee (COMREC), at the students’ research dissemination conference in the health systems and policy department at College of Medicine, College of Medicine Research Dissemination Conference, and Kamuzu Central hospital as well as published in the Malawi Medical Journal (MMJ). A copy of the dissertation will also be submitted to College of Medicine’s Library.
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Assessment of lipid profile patterns of diabetic patients at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-03-04) Filisa, Florence Anna
Study type: This is a descriptive cross-sectional study assessing lipid profile patterns of diabetic patients at Kamuzu Central Hospital. The problem: The burden of diabetes continues to increase globally and in Malawi with a prevalence of 9.3 and 5.6% respectively. Diabetes is a known high risk factor for Atherosclerotic cardiovascular disease ASCVD. The elevated risk of ASCVD in diabetic patients is a product of lipid abnormalities (dyslipidaemias) typical in people with diabetes. Insulin resistance in diabetes has been shown to contribute to the pathophysiology of dyslipidaemia in diabetes. Dyslipidaemia is a modifiable risk factor for ASCVD and can be managed by lowering the lipid blood levels through low lipid diet, exercises and statin therapy, thereby reducing the risk for developing adverse complications such as stroke in diabetics. The screening and monitoring of dyslipidaemia is recommended for people with diabetes to assess the risk and manage the condition effectively. Assessment of lipid profile patterns and its relationship to other risk factors to ASCVD can help suggest individual specific management of diabetic dyslipidaemia. The individualised patient management approach ensures success in patient lipid control. This would in turn reduce the ASCV-related morbidity and mortality in diabetic patients. Despite the recommendations, Malawi is still lagging behind in lipid profile screening and monitoring for diabetic patients. This may be due to various health system challenges that hinder availability and consistent provision of this essential service. Current clinical practice at Kamuzu Central hospital includes a 10mg/day prescription of statin to all diabetes patients. This is done without a lipid test, despite the facility having these tests available. Underutilization of these relevant tests by the diabetic clinic requires further investigation. Furthermore, due to the limited lipid profile data in Malawi, the study aims to assess the lipid patterns and related risk factors associated with dyslipidaemia among patients being treated for diabetes at Kamuzu Central Hospital. Study objectives: The main aim of the study is to describe the prevalence, biochemical characteristic and risk factors associated with dyslipidemia in diabetic patients aged 18-72 years attending the diabetic clinic at KCH. The specific objectives are to 1. Determine lipid profiles of the adult diabetic participants attending the diabetic clinic. 2. Calculate the prevalence of dyslipidemia in the study participants using HbA1c. 3. Determine blood HbA1c levels of study participants. 4. Determine the relationship between dyslipidemia and other variables such as age, sex, body mass index and HbA1c. Methodology: This will be a descriptive cross-sectional quantitative study. The study population will be diabetic patients aged 18-72years attending the KCH diabetic clinic. The sample size will be 388 participants. The sample size was calculated using the Conchran formula, based on an expected prevalence of dyslipidaemia of 40% in this patient population, with a power of 80% and 5% standard error and 5% attrition). A self-developed data collection tool (attached in Appedix) will be used to collect participant information including socio-demographic data (age and sex), information on cardiovascular risk factor such as smoking and alcohol consumption, and medication history will also be collected. We will perform anthropometric measures and collect vital signs. Weight and height scales will be used to obtain participants weight (kg) and height (m) readings. These readings will be documented on the same self-developed data collection too. BMI will be calculated using the weight and height readings using the formula: weight divide by square root of the height. Two blood samples will be collected, one in EDTA tube for HBA1c tests and another in red topped plane tubes for biochemical lipid profile testing. Whole blood will be used to measure HBA1c using the NycoCard. Serum will be used to measure lipid levels. Results will be captured in the data tool developed as well. Data will then be entered in Microsoft Excel sheet. SPSS and Stata will be used for data analysis. Descriptive statistics will be presented in a table to describe the general characteristics of the participants. Chi square test and Fischers test will be used analyse categorical and independent variables respectively. Stratification of data will be applied to handle confounders such as smoking and age. The t-test will be used to test the differences between two means. Correlations between the variables will be tested using Pearson‟s Product or Spearman‟s test of correlation depending on data normality. In all cases, a pvalue ≤0.05 will be considered significant. Possible Constraints A possible constraint to this study could be Covid-19 pandemic. Due to the special risk this pandemic has on individuals with diabetes, we assumed patient turnout at the clinics would decline. However, at KCH, the patient turnout at the clinic has not been significantly affected. So, we envisage that enrolling patients in the study will not be affected. During the study activities, we will ensure that all Covd-19 preventive measures are strictly adhered to throughout the course of the study. Clinic staff will monitor and ensure social distancing, wearing of masks as well as hand washing for clinic staff and patients. Nurses will hand sanitize before and after attending to each patient to ensure a Covid-19 safety for our clinic patients. Expected Findings and Dissemination: The results will aid in providing information on whether maintenance of the 10mg/day statin therapy for all diabetics being practiced at KCH is justifiable and adequate or there should be adjusted based on individual patient lipid results and additional risk factors. The results once analysed will subsequently be published in an international scientific journal and copies will be presented to the following: The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, The Health Sciences Research Committee (through the COMREC Secretariat), The University Research and Publication Committee (URPC) (through the COMREC Secretariat). Results will also be presented to KCH during monthly ground rounds. A copy will also be shared with the Malawi Ministry of Health NCD commission.
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Comorbidity of depression with diabetes in noncommunicable diseases clinics in southern Malawi
(Kamuzu University of Health Sciences, 2021-03-17) Udedi, Micheal Mphatso
Type of study: Cross-sectional study design will be used in this project. Problem: This research project will focus on prevalence and detection of depression in the context of non-communicable diseases. Malawi, like many low- and middle income countries, is faced with the growing challenge of non-communicable diseases (NCDs). Depression is one of the shared risk factors for physical NCDs however there is currently no routine practice to identify and manage mental illnesses in the physical NCDs clinics in Malawi. Broad Objective: We aim at estimating the prevalence of depression among patients with type 2 diabetes mellitus attending to NCDs clinics in the two districts of southern Malawi. Methodology: The project will be a cross sectional study and will involve validated Chichewa version of the PHQ-9. A minimum calculated sample size of 323 participants will be recruited consecutively at the NCDs clinics of Mwanza and Blantyre districts. The permission to conduct the study has been sought from the heads of the facilities where the study will be conducted. The ethical approval will be sought from the College of Medicine Review and Ethics Committee (COMREC) and informed consent will be sought from the study participants before administering the questionnaire. All filled questionnaires will be handled by the research assistants and the PI and will be kept in a safe place before and after data entry. The computers for data entry will be protected by passwords. Data will be analyzed statistically using a statistical package for social sciences. Patients’ characteristics by age, sex and condition will be described using frequency tables. Expected findings: This study might uncover the prevalence and detection of depression in NCDs clinics in the district of southern Malawi. The findings of this study therefore may be relevant in advocating for the integration of depression management into NCDs clinics in Malawi. Dissemination: The findings from this research project will be accessible by academicians and researchers through the College of Medicine library. Furthermore, the findings will be submitted to the COMREC secretariat, the University Research and Publication Committee (URPC) through COMREC secretariat and the National Health Sciences Research Committee (NHSRC). The results will be shared through presentations at national and international research or policy conferences as well as submission to peer reviewed publications. The results will be shared with the participating health facilities and furthermore the results will also be shared with policy makers and other local stakeholders in form of policy briefs as part of evidence on prevalence and detection of depression in NCD clinics in Malawi.
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Assessing prevalence of diabetes for patients who are on Hydrochlorothiazide and Propranolol in Blantyre
(Kamuzu University of Health Sciences, 2021-03-17) Shaba, Alice; Harrison, Chikondi
Hypertension and diabetes are the most common co-morbidities which are increasingly becoming a great public health risk to most developing countries including Malawi. This is attributed to physical inactivity, urbanization, obesity and nutritional transitions. Hypertension is managed by different drug classes which include; diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and beta blockers. The use of diuretics and beta blockers has been associated with a new onset of diabetes. This quantitative cross sectional study aims at assessing the prevalence of diabetes for patients who are on hydrochlorothiazide (HCTZ) and propranolol in Blantyre. The objectives of the study include identifying hypertensive patients who are on HCTZ and propranolol; determining prevalence of diabetes in these patients; and lastly determining blood sugar control. This study will be conducted at Queen Elizabeth Central Hospital in Blantyre with 177 sample size. Study population will be both male and female hypertensive adults who have been on HCTZ and propranolol for a year. It is expected that there will be high prevalence of diabetes among hypertensive patients who are on HCTZ and propranolol. Also there will be high percentage of diabetes patients having their blood sugar not controlled. Results of the study will be presented to College of Medicine and possibly published in peer reviewed medical journal