The Burden of Malaria at the Pothawira Clinic Malawi, Africa Devin Kennedy International Health Rotation University of Kansas Medical Center

Malawi, Africa Nickname: Warm Heart of Africa Population: 17,250,000 Gross National Income Per Capita: $750 Third Poorest Country in the World Highest Mortality Causes: HIV/AIDS Malaria Other Infectious diseases Maternal/Neonatal complications

Pothawira Pothawira means “safe haven” in Chichewa, the indigenous Bantu language of Malawi Consists of a school, orphanage, and outpatient clinic 123 orphans housed on the property with 10 mothers and 3 cooks living there to take care of them Clinic sees between 150-250 patients every day, with two prescribing clinical officers, 4 nurses for med dispensing, and a small procedure room Coming soon: birthing center has been built on the property and will be open in Summer 2017

Pothawira Orphans Pictured are a few of the 123 orphans of all ages that live at Pothawira

Burden of Malaria on Pothawira Clinic Malaria is one of the highest causes of mortality in Malawi, and especially in children 5 years old and younger. The amount of time, testing supplies, medications, and staffing needed to treat Malaria on a daily basis places a large burden on the Pothawira clinic, and other clinics and hospitals throughout Malawi Malaria is treated for free at government hospitals or for a small fee at private clinics like Pothawira, which also includes medication 1000 Kwatcha per adult ($1.35) 500 Kwatcha per child ($0.68) EXAM ROom at pothawira

Representation of the Top 5 clinical diagnosis at Pothawira Clinic

Burden of Malaria at Pothawira- (Data collected from Jan. 3- Feb In the first two months of 2017, the clinic saw 8,517 patients 4,064 (48%) of those patients were children 5 years old or younger That’s an average of 177 patients per day 62% of patients were tested for Malaria using MRDT That’s 5,239 MRDT tests used in two months 49% of patients tested were 5yo or younger 50% of the tests were positive 3130 patients were treated for Malaria in Jan and Feb of 2017 Meaning that 37% of all patients that came into the clinic in those months were treated for Malaria.

Malaria in Malawi Record keeping at Pothawira Specifically at Pothawira, one of the largest issues with the burden of malaria is funding for all of the testing and medical supplies needed on a monthly basis to keep treating the disease. An estimated 627,000 died from Malaria in 2012 with the largest number of deaths being in children under the age of 5 in sub-Saharan Africa Further efforts and foreign aid are being put towards prevention. Bed nets are still the most widely used source of prevention, but many families use those nets for other purposes such as fishing, as eating is a more immediate need than preventing malaria Although progress is being made in reducing the prevalence of Malaria, it is still one of the leading causes of morbidity and mortality with an estimated 6 millions cases of Malaria treated each year in the country Record keeping at Pothawira

Clinical Experience Clinical Case: A middle age woman presented with fatigue to the clinic and was found positive for Malaria. We also tested her hemoglobin which was found to be 1.7! She then picked up her medication, put her child on her back, and walked to the local government hospital for a blood transfusion. She walked about 2 miles, with a hemoglobin of 1.7 for that blood, and was told to come back the next day because they were out of blood for that day Most important things learned included more experience with low resource medicine, and solidifying my knowledge in detection and treatment of Malaria

“You do not have the sun in the US?” Cultural Experience Story Time! - I was sun burnt badly one day working outside in Malawi. A few days later some of the orphans asked me what had happened to my skin because it was peeling. I explained that I was burned from the sun. This was followed by puzzled faces, and finally someone asked the question “You do not have the sun in the US?” While it seemed off, if you had never seen a sun burn before in your life, wouldn’t that seem like a perfectly logical question?

A few younger girls that life at the orphanage as well as the newest family member, Chikambutso

Pothawira staff and Maseko Family They are pictured here in front of the shipping containers that arrived holding the new equipment for the soon to open birthing center

Pictured: In the center is Peter Maseko, the director of Pothawira and primary clinical officer On his left is Dr. Jonathan Philippe, a family physician and graduate of the KU family medicine residency

References "Global Health-Malawi." Centers for Disease Control and Prevention. CDC, n.d. Web. 15 Mar. 2017. https://www.cdc.gov/globalhealth/countries/malawi/ "Malawi." World Health Organization. WHO, n.d. Web. 15 Mar. 2017. http://www.who.int/countries/mwi/en/