Adamson Muula

• PhD, MBBS, MPH, CPH
• Professor at Kamuzu University of Health Sciences

Background Poor glycemic control and medical complications are common among people living with diabetes in Malawi. The healthcare system is part of an environment in which people with diabetes manage themselves and can act as facilitators or barriers to diabetes self-management. This study aimed to explore the effects of diabetes health service use...

Background Atherosclerotic Cardiovascular diseases (ASCVD) are the leading cause of death globally and disproportionately affect developing countries such as Malawi. Screening and management of significant ASCVD risk factors is essential. In Malawi, the prevalence of ASCVD risk factors among university staff, an economically important population, h...

Background and Objectives In many countries, including Africa, the widespread gap between national blood requirements and actual blood supplies contributes to unnecessary deaths. This scoping review explores common facilitators and barriers to blood donation in sub‐Saharan Africa (SSA) and strategies that are used to increase and maintain repeat bl...

sec> BACKGROUND Chemotherapy to prevent TB is a core component of care for persons living with HIV (PLHIV). There are few reports describing adherence to TB prevention under programmatic conditions in high TB burden settings. METHODS We measured adherence to daily isoniazid (INH) preventive treatment (IPT) using a commercially available colourimetr...

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Background and Objective Despite the Malawi Blood Transfusion Service (MBTS) increasing the amount of blood collected since its inception in 2004, Malawi remains with a 27% deficit in required blood supplies nationally. We sought to understand the facilitators and barriers to blood donation among secondary school students in Malawi. Methods We uti...

Abstract Background: The global burden of multimorbidity – the co-existence of two or more long-term conditions – is increasing. Limited access to primary care in sub-Saharan Africa means acute hospital admission is often the sentinel multimorbidity presentation. This multicentre prospective cohort study aims to describe the burden, constituent di...

Background There is limited access to diabetes care services at primary care facilities in Malawi. Assessing the capacity of facilities to provide diabetes care is an initial step to integrating services at primary care. Aim To assess the preparedness for delivering diabetes services at primary care level within the Blantyre District Health Office...

Introduction Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in low-and middle- income countries (LMICs). Despite this, a lack of funding, training and mentorship for NCD investigators in LMICs exists. In an effort to gain knowledge and skills to address these gaps, participants from the Global Research on Implementa...

Background Voluntary non‐remunerated blood donors (VNRBDs) are essential to sustain national blood supplies. Expanding testing capacity for the major transfusion‐transmitted infections (TTI) is crucial to ensure safe blood products. Understanding trends in TTIs can inform prioritisation of resources. Methods We conducted a retrospective cohort dat...

Cardiovascular diseases are the leading causes of morbidity and mortality worldwide, but implementation of evidence-based interventions for risk factors such as hypertension is lacking, particularly in low and middle income countries (LMICs). Building implementation research capacity in LMICs is required to overcome this gap. Members of the Global...

Background: Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longi...

The joint occurrence of diabetes and hypertension conditions in a patient is common. The two diseases share a number of risk factors, and are hence usually modelled concurrently using bivariate logistic regression. However, the postestimation assessment for the model, such as analysis of outlier observations, is seldom carried out. In this article,...

Malawi (2023) is experiencing significant health challenges resulting from lack of access to potable water, sanitation and hygiene, consequences of the effects of Cyclone Freddy and a critical shortage of in-post skilled human resources. The country has been battling a cholera outbreak since April 2022 which has claimed at least 1,733 lives as at 1...

Background In 2007 WHO and UNAIDS recommended communication interventions as a key strategy for creating demand for Voluntary Medical Male Circumcision (VMMC) in Southern Africa. In Malawi, VMMC communication interventions, implemented by health communication agencies, have effectively raised awareness of services. However, high awareness of VMMC h...

Background Despite the expected prevalence rise of 98.1% for diabetes between 2010 and 2030 in sub-Saharan Africa (SSA) and the anticipated rise of both diabetes and cardiovascular diseases (CVDs) in Malawi from their current figures ( 5.6 and 8.9%; respectively), data on the readiness of health facilities to provide diabetes and cardiovascular dis...

The aim of this guide is to translate scientific research into easy-to-implement precautionary measures and actions adoptable by homeowners, builders, and regulatory bodies to reduce human exposure to in-kitchen pollution in LMIC homes. This document offers 10 generic and 10 specific recommendations for three target audiences: homeowners, builder...

Patients living with cancer and their families experience several challenges that affect their health-related quality of life (HRQOL). Perceived factors affecting quality of life (QOL) among people living with cancer have rarely been studied. We aimed at exploring the factors perceived to be associated with health-related quality of life among peop...

Objective To assess the prevalence and factors associated with substandard and falsified (SF) medicines among antibiotic, antimalarial, antihypertensive and antidiabetic medicines in Malawi. Methods We conducted a cross-sectional study in 23 public, faith-based and private health facilities in Zomba, Machinga and Nsanje districts. We analyzed oral...

Abstract Background Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical...

AimMalawi officially launched Voluntary Male Medical Circumcision (VMMC) in 2012 after the 2007 joint WHO /UNAIDSrecommendation that VMMC be a key HIV prevention strategy for Sub-Sahara African region. Malawi data, however, contradicted thefindings of three randomized studies conducted in Uganda, Kenya and South Africa between 2005 and 2007. While...

Background Dyslipidaemia is a significant risk factor for cardiovascular events but is often neglected in most resource-poor settings. Aim We aimed to investigate the prevalence, biochemical characteristics, screening and management practice for dyslipidaemia among patients with DM, hypertension, and both DM and hypertension at a tertiary teaching...

Background Dyslipidaemia, obesity and vitamin D insufficiency are important risk factors for cardiovascular disease and may increase the risk for severe COVID-19 among individuals with Diabetes mellitus. Objective To investigate the prevalence of dyslipidaemia, obesity and vitamin D insufficiency among patients attending the diabetes clinic at Que...

Biomedical studies may collect longitudinal and survival data in follow-up studies. In randomised controlled trials for malaria treatment, longitudinal parasite count and hemoglobin level and survival outcomes, time to fever resolution or time to parasite clearance, are recorded. The longitudinal and survival data are analysed separately, yet longi...

Background Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical character...

Introduction: Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi. Methods: The study was conducted among 398 cancer patients using semi-structured questionnaire. Q...

Despite the widespread availability of lifesaving antiretroviral drugs, demand for HIV testing is low. Antiretrovirals have a positive externality: they prevent HIV transmission. We use an experiment in Malawi to show that informing communities about this externality can shift beliefs and increase HIV testing in the short term, with a larger effect...

Background: The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated w...

In-kitchen air pollution is a leading environmental issue, attributable to extensive cooking, poor ventilation and the use of polluting fuels. We carried out a week-long monitoring of CO2, temperature and relative humidity (RH) in five low-income residential kitchens of 12 global cities (Dhaka, Chennai, Nanjing, Medellín, São Paulo, Cairo, Sulayman...

Background Evidence suggests that Malawi continues to register substantial progress on key Family Planning (FP) indicators. However, FP adoption is still low among married youth (15–24 years old), only 38% of married girls use modern contraceptive methods coupled with high-unmet needs (22%) in the same age group. Objective Identifying factors asso...

Background: Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. Aim: With a focus on the theory of planned behaviour as...

After 30 years of no polio cases reported in Malawi, on 17th February 2022, the government declared a polio outbreak following a confirmed 4-year-old child case of the disease in the nation’s capital, Lilongwe. This was the first case of wild poliovirus in Africa in more than five years after Africa was declared free of indigenous wild polio in Aug...

Background: There are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi. Methods: In a cross sectional s...

Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand...

Background Schistosomiasis is a parasitic infectious disease caused by flatworms of the Schistosoma genus. The global burden of schistosomiasis is high. In Malawi, schistosomiasis is among the top 20 causes of outpatient department visits in health facilities. Schistosomiasis is among the most important but neglected causes of non-communicable dise...

Background In 2007 WHO and UNAIDS recommended communication interventions as a key strategy for creating demand for Voluntary Medical Male Circumcision (VMMC) in Southern Africa. In Malawi, VMMC communication interventions, implemented by health communication agencies, have effectively raised awareness of services. Ironically, high awareness of VMM...

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under...

Background Schistosomiasis is a parasitic infectious disease caused by flatworms of the Schistosoma genus. The global burden of schistosomiasis is high. In Malawi, schistosomiasis is among the top 20 causes of outpatient department visits in health facilities. Schistosomiasis is among the most important but neglected causes of non-communicable dise...

Earlier this year (2022), the world witnessed sporadic outbreaks of monkeypox disease in countries other than those in which the disease is endemic. For instance, as of June 10, the United Kingdom had witnessed as least 7 cases of the disease; the first case having been reported on the 7th May 2022 and thought to have been brought into the country...

Background: Type II diabetes mellitus (T2DM) significantly impacts the quality of life (QoL) yet data on quality of life among these patients in Malawi are lacking. This study was conducted to assess QoL among patients with T2DM. Methods: A mixed-method cross-section study was carried out at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. A system...

Background Type II diabetes mellitus (T2DM) significantly impacts quality of life (QoL) yet data on quality of life among these patients in Malawi are lacking. This study was conducted to assess QoL among patients with T2DM. Methods A mixed-method cross-section study was conducted at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. A systematic sa...

Background Pellagra is caused by niacin (vitamin B3) deficiency and patients with pellagra present with a characteristic rash. Isoniazid disrupts intracellular niacin synthesis and might induce niacin deficiency. In 2017, Malawi scaled up continuous isoniazid preventive treatment (IPT) for tuberculosis prevention among people living with HIV. In ad...

Poor ventilation and polluting cooking fuels in low-income homes cause high exposure, yet relevant global studies are limited. We assessed exposure to in-kitchen particulate matter (PM2.5 and PM10) employing similar instrumentation in 60 low-income homes across 12 cities: Dhaka (Bangladesh); Chennai (India); Nanjing (China); Medellín (Colombia); Sã...

In 1992, I interviewed for both medical school and the Malawi Army to join my country’s medical corps in preparation for a military hospital that was soon to be established. From that time many things changed. Although I graduated from medical school, I did not become a military doctor. I have fond images of what it would have been, had my dreams o...

Introduction Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in low-and middle-income countries (LMICs). Despite this, a lack of funding, training and mentorship for NCD investigators in LMICs exists. In an effort to gain knowledge and skills to address these gaps, participants from the Global Research on Implementat...

Introduction Brief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As a...

Background Depressive disorders, with prevalence varying widely by setting, are among the common debilitating mental health disorders in patients with cancer worldwide. An understanding of the prevalence of depressive disorders among a specific patient population group should inform both their prevention and management. We conducted this study to e...

Background Patient participation in decision making is a basic tenet for a patient centred care experience and, has potential to improve care experiences and responsiveness in chronic diseases such as Diabetes Mellitus (DM). However, documented experiences show that patient participation in decisions making is wanting. As Malawi strives to institut...

Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential heal...

Purpose: Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and respon...

Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 with the vision and mission to eliminate occupational accidents, injuries, diseases, and fatalities and to promote Occupational Safety and Health (OSH). This study was therefore aimed at exploring the individual- and organizational-level determinants of Z...

Reverse transcription–quantitative polymerase chain reaction (RT-qPCR) is used worldwide to test and trace the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). “Extraction-less” or “direct” real time–reverse transcription polymerase chain reaction (RT-PCR) is a transparent and accessible qualitative method for SARS-CoV-2 dete...

Background: The coronavirus disease-19 (COVID-19) pandemic affected blood banks globally. We sought to examine how COVID-19 affected blood supply and transfusion in our institution. Method: The study was conducted at the Queen Elizabeth Central Hospital (QECH) and the Malawi Blood Transfusion Service (MBTS) in Malawi. Data from April to November...

Background: Self-management is key to the control of glycaemia and prevention of complications in people with diabetes. Many people with diabetes in Malawi have poorly controlled glucose and they experience diabetes-related complications. This study aimed to assess diabetes self-management behaviours and to identify factors associated with it among...

We, at the Malawi Medical Journal (www.medcol.mmj.mw) were saddened by the demise of Professor Malcolm Molyneux, former Editor-in-Chief (EIC) of our journal on 17th November 2021. Malcolm passed away in the UK where he had been since 2015 after almost three decades of service to Malawi and our journal. The Malawi Medical Journal started off as the...

The Malawi College of Medicine and its partners are building non-communicable diseases’ (NCDs’) research capacity through a grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. Several strategies are being implemented including research mentorship for junior researchers interested to build careers in...

Background By August 2021, the COVID-19 pandemic has been less severe in sub-Saharan Africa than elsewhere. In Malawi, there have been three subsequent epidemic waves. We therefore aimed to describe the dynamics of SARS-CoV-2 exposure in Malawi. Methods We measured the seroprevalence of anti-SARS-CoV-2 antibodies amongst randomly selected blood tr...

Introduction: chronic disease comorbidities are common among cancer patients in most parts of the world, however; there are limited data on the same for Malawi. Comorbidities worsen clinical outcomes and are associated with lower quality of life among cancer patients. We aimed at estimating chronic disease comorbidities and associated factors amon...

OBJECTIVE Handgrip strength, a simple measure of muscle strength, has been reported as a predictor of both prediabetes and type 2 diabetes mellitus (T2DM) and has been suggested for screening prediabetes and T2DM risk. This study examined the relationship of handgrip strength with prediabetes and T2DM among rural‐ and urban‐dwelling adults in Malaw...

Background: Pregnant women are at risk of pregnancy if they have unprotected sex, do not use or poorly use contraceptives in the context of penile-vaginal sex. We therefore developed an educational toolkit based on the Health Belief Model (HBM) to assist FSWs to make informed sexual and reproductive decision for safer sex before and/or after hetero...

We sought to assess stakeholder acceptability of a risk reduction behavioural model [RRBM] designed for adolescent HIV risk reduction and whose efficacy we tested in selected schools in Northern Malawi. We used qualitative procedures in sampling, data collection and data analysis. Our data collection instrument was the semi-structured interview and...

The Qualitative data was collected in form of structured interviews constituting phase 3 component of a PhD project targeting HIV risk reduction and sexual behaviour change among school going adolescents in Northern Malawi [Sub-Saharan Africa]. An RRBM model or risk reduction model designed involving adolescent primary beneficiaries, a bottom -up m...

Background Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. Methods In this prospective study, the primary objective was to investigate t...

In this September 2021 issue of the Malawi Medical Journal, three articles which attracted my attention are those by Mbali et al, Zimba et al, and Pfaff et al. Perhaps as Editor-in-Chief of the Journal, I should endeavor to be impartial and “love” all the articles the same. This time however, I have selected these articles because they touch on imp...

Background: Patient-centred care (PCC) is one of the pillars of Malawi’s quality of care policy initiatives. The role of PCC in facilitating quality service delivery is well documented, and its importance may heighten in chronic disease management. Yet, PCC conceptualisation is known to be context specific. Aim: The study aimed to understand the c...

Background: As at end of July 2021, the COVID-19 pandemic has been less severe in sub-Saharan Africa than elsewhere. In Malawi, there have been two subsequent epidemic waves. We therefore aimed to describe the dynamics of SARS-CoV-2 exposure in Malawi. Methods: We measured the seroprevalence of anti-SARS-CoV-2 antibodies among randomly selected blo...

Background: Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential hea...

Background Diabetes and hypertension and their lifestyle risk factors are on the increase in sub-Saharan Africa. Despite positive effects of behavioural intervention such as brief behaviour change in some African countries, there has not been significant implementation of the same in Malawi. We therefore decided to conduct this study aimed at imple...

Community Health Workers (CHWs) have been identified On 4th May 2021, a new university, the Kamuzu University of Health Sciences (KUHeS) started its operations in Malawi following the notice of its commencement by the Ministry of Education. The (semi) new university emerged from the amalgamation of two (former) constituent colleges of the Universit...

Car microenvironments significantly contribute to the daily pollution exposure of commuters, yet health and socioeconomic studies focused on in-car exposure are rare. This study aims to assess the relationship between air pollution levels and socioeconomic indicators (fuel prices, city-specific GDP, road density, the value of statistical life (VSL)...

Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as...

Background: Non-communicable diseases (NCDs) are significant causes of morbidity and mortality in Malawi and are the second leading cause of deaths in adults after HIV and AIDS. The purpose of this assessment was to identify human, infrastructural and systems requirements in implementation research to support the response to the NCD epidemic in the...

Background Nurses have multiple roles in medication management. In relation to antibiotics, nurses are recommended to be active in antibiotic stewardship that ensures proper management of antibiotics to minimize antibiotic resistance. Some of the roles of nurses include administering antibiotics, monitoring its effectiveness and educating the patie...

RT-qPCR is used world-wide to test and trace the spread of SARS-CoV-2. Extraction-less or direct RT-PCR is an open-access qualitative method for SARS-CoV-2 detection from nasopharyngeal (NP) or oral pharyngeal (OP) samples with the potential to generate actionable data more quickly, at a lower cost, and with fewer experimental resources than full R...

Background Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect AR...

Background Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, whi...

Objective: The objective of this research was to assess physical and sexual violence experienced by sexual and gender minorities in nine African countries, and to examine factors associated with violence. Methods: We conducted an exploratory multi-country cross-sectional study among self-identifying sexual and gender minorities, using a survey too...

An amendment to this paper has been published and can be accessed via the original article.

Background: Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods: We used systematic...

Background Africa’s economic transformation relies on a radical transformation of its higher education institutions. The establishment of regional higher education Centres of Excellence (CoE) across Africa through a World Bank support aims to stimulate the needed transformation in education and research. However, excellence is a vague, and often in...

Background: Patient participation in their own care has potential to improve experiences and responsiveness in chronic disease situations. Patient participation is a basic tenet for a patient centred care experience. However, the documented experiences show that patient participation in care decisions making is wanting. As Malawi strives to imbibe...

Background The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further. Purpose It is...

Background: Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, wh...

The quality and success of postgraduate education largely rely on effective supervision. Since its inception in 2008, the Consortium for Advanced Research Training in Africa (CARTA) has been at the forefront of providing training to both students and supervisors in the field of public and population health. However, there are few studies on supervi...

Introduction: We conducted a study to explore the impact of adolescent exposure to HIV and AIDS behaviour change Interventions (BCI) on their HIV risk reduction and sexual behaviour change in some selected secondary schools in the district of Mzimba, district of Nkhata Bay and Mzuzu city in Northern Malawi. Methods: We used mixed methods in a desc...

Background Little is known about actions taken by female sex workers (FSWs) after male condom failure during male–female sexual intercourse. The objective of this study was to investigate the actions taken by FSWs after condom failure among FSWs in semi-urban, Blantyre in Malawi. Methods A cross sectional, qualitative study was conducted among FSW...

Background: Pellagra is caused by niacin (vitamin B3) deficiency and manifested by a distinctive dermatitis. Isoniazid is critical for treating tuberculosis globally and is a component of most regimens to prevent tuberculosis. Isoniazid may contribute to pellagra by disrupting intracellular niacin synthesis. In 2017, Malawian clinicians recognized...

BACKGROUND Integrated community case management (CCM) has led to reductions in child mortality in Malawi from illnesses such as malaria, pneumonia and diarrhoea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and outcomes. OBJECTIVE We determined the impact of an electronic version of CC...

Background Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the ref...

Background Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level...