Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

PubMed Central

Blaauw, Duane; Ditlopo, Prudence; Maseko, Fresier; Chirwa, Maureen; Mwisongo, Aziza; Bidwell, Posy; Thomas, Steve; Normand, Charles

2013-01-01

Background Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. Objective The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. Results There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. Conclusions We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less

Persistent C3 vegetation accompanied Plio-Pleistocene hominin evolution in the Malawi Rift (Chiwondo Beds, Malawi).

PubMed

Lüdecke, Tina; Schrenk, Friedemann; Thiemeyer, Heinrich; Kullmer, Ottmar; Bromage, Timothy G; Sandrock, Oliver; Fiebig, Jens; Mulch, Andreas

2016-01-01

The development of East African savannas is crucial for the origin and evolution of early hominins. These ecosystems, however, vary widely in their fraction of woody cover and today range from closed woodland to open grassland savanna. Here, we present the first Plio-Pleistocene long-term carbon isotope (δ(13)C) record from pedogenic carbonate and Suidae teeth in the southern East African Rift (EAR). These δ(13)C data from the Chiwondo and Chitimwe Beds (Karonga Basin, Northern Malawi) represent a southern hemisphere record in the EAR, a key region for reconstructing vegetation patterns in today's Zambezian Savanna, and permit correlation with data on the evolution and migration of early hominins in today's Somali-Masai Endemic Zone. The sediments along the northwestern shore of Lake Malawi contain fossils attributed to Homo rudolfensis and Paranthropus boisei. The associated hominin localities (Uraha, Malema) are situated between the well-known hominin bearing sites of the Somali-Masai Endemic Zone in the Eastern Rift and the Highveld Grassland in southern Africa, and fill an important geographical gap for hominin research. Persistent δ(13)C values around -9‰ from pedogenic carbonate and suid enamel covering the last ∼4.3 Ma indicate a C3-dominated closed environment with regional patches of C4-grasslands in the Karonga Basin. The overall fraction of woody cover of 60-70% reflects significantly higher canopy density in the Malawi Rift than the Eastern Rift through time. The discrepancy between the two savanna types originated in the Late Pliocene, when the Somali-Masai ecosystem started to show increasing evidence for open, C4-dominated landscapes. Based on the Malawi δ(13)C data, the evolution of savanna ecosystems in Eastern Africa followed different patterns along the north-south extent of the EAR. The appearance of C4-grasses is considered a driver of evolutionary faunal shifts, but despite the difference of ecosystem evolution in the north, similar

Lake Chad, Chad, Africa

NASA Technical Reports Server (NTRS)

1988-01-01

The fluctuating water levels of Lake Chad, (13.0N, 15.0E) at the intersection of the borders of Chad, Niger and Cameroon in the Sahara Desert, is an index of the drought in Africa. The lake level continues to decrease as indicated by the growing number and extent of emerging islands as previously submerged ancient sand dunes become visible. The water impounded between the dunes is probably because of local rainfall rather than a reversal of desertification.

A Revised Holocene History of Lake Kivu, East Africa

NASA Astrophysics Data System (ADS)

Votava, J. E.; Johnson, T. C.; Hecky, R. E.

2013-12-01

The great lakes of the East African Rift valley are a vast chain of lakes formed in a region of active tectonics. These large, deep lakes are relatively old and many (e.g. Tanganyika, Malawi, and Turkana) have greatly influenced our understanding of terrestrial, tropical East African paleoclimate. Lake Kivu (max depth, 485m) sits at the heart of these rift lakes, north of Lake Tanganyika between the Democratic Republic of the Congo and Rwanda (roughly 250 km west of Lake Victoria). At over 1,400 meters in elevation, this 2,060 km2 mesotrophic lake has a complex stratification regime imposed by hydrothermal springs and deep waters supersaturated at STP in CO2 and CH4 gasses. The active Virunga Volcanoes to the north of the lake supply heated, high-salinity waters below 280 meters water depth maintaining the modern crenogenic meromixis. Based on detailed studies of diatom assemblages and bulk sedimentology, previous workers have suggested this hydrothermal activity began roughly 5,000 years BP. Unfortunately, dating and stratigraphic correlations of these original cores from the 1970 Woods Hole Oceanographic Institution's expedition have been problematic. Here we offer an improved chronology and new carbonate analyses from cores recovered in 2012 and 2013. Our AMS radiocarbon ages come from six terrigeneous macrofossils spanning the last 9,100 years (cal BP). These ages suggest a rather high sedimentation rate on the order of 70cm/kyr, and hence, our 8 m-long core provides us with a high-resolution lake history for the past 10,000 years. Most notable over the past 5,000 years in the lake history is the repeated onset and cessation of carbonate deposition, punctuated by organic-rich intervals. Earlier studies of the Woods Hole cores placed the onset of carbonate deposition at ca. 11,000 years BP suggesting changes in lake hydrology (i.e. closed to open), while the abrupt cessation of carbonate was dated at ca. 5,000 years BP and attributed to the beginning of

Escalation and Resolution of Border Disputes and Interstate Conflicts in Africa: The Malawi-Tanzania Case

DTIC Science & Technology

2011-06-01

struggle in the region. They cause relentless strife, including refugee problems, environmental degradation, deforestation , small arms proliferation...human and natural resources, extreme poverty and hunger abound on the continent.”42 Furthermore, a snapshot of Africa reveals deforestation , fast...Malawi, while Tanzania is disadvantaged . Since players selfishly attempt to maximize their outcomes, via ‘maximin theorem,’ the outcome is BD that

Active intra-basin faulting in the Northern Basin of Lake Malawi from seismic reflection data

NASA Astrophysics Data System (ADS)

Shillington, D. J.; Chindandali, P. R. N.; Scholz, C. A.; Ebinger, C. J.; Onyango, E. A.; Peterson, K.; Gaherty, J. B.; Nyblade, A.; Accardo, N. J.; McCartney, T.; Oliva, S. J.; Kamihanda, G.; Ferdinand, R.; Salima, J.; Mruma, A. H.

2016-12-01

Many questions remain about the development and evolution of fault systems in weakly extended rifts, including the relative roles of border faults and intra-basin faults, and segmentation at various scales. The northern Lake Malawi (Nyasa) rift in the East African Rift System is an early stage rift exhibiting pronounced tectonic segmentation, which is defined by 100-km-long border faults. The basins also contain a series of intrabasinal faults and associated synrift sediments. The occurrence of the 2009 Karonga Earthquake Sequence on one of these intrabasinal faults indicates that some of them are active. Here we present new multichannel seismic reflection data from the Northern Basin of the Malawi Rift collected in 2015 as a part of the SEGMeNT (Study of Extension and maGmatism in Malawi aNd Tanzania) project. This rift basin is bound on its east side by the west-dipping Livingstone border fault. Over 650 km of seismic reflection profiles were acquired in the Northern Basin using a 500 to 1540 cu in air gun array and a 1200- to 1500-m seismic streamer. Dip lines image a series of north-south oriented west-dipping intra-basin faults and basement reflections up to 5 s twtt near the border fault. Cumulative offsets on intra-basin faults decrease to the west. The largest intra-basin fault has a vertical displacement of >2 s two-way travel time, indicating that it has accommodated significant total extension. Some of these intra-basin faults offset the lake bottom and the youngest sediments by up to 50 s twtt ( 37 m), demonstrating they are still active. The two largest intra-basin faults exhibit the largest offsets of young sediments and also correspond to the area of highest seismicity based on analysis of seismic data from the 89-station SEGMeNT onshore/offshore network (see Peterson et al, this session). Fault patterns in MCS profiles vary along the basin, suggesting a smaller scale of segmentation of faults within the basin; these variations in fault patterns

Human Melioidosis, Malawi, 2011

PubMed Central

Katangwe, Thembi; Purcell, Janet; Bar-Zeev, Naor; Denis, Brigitte; Montgomery, Jacqui; Alaerts, Maaike; Heyderman, Robert Simon; Dance, David A.B.; Kennedy, Neil; Feasey, Nicholas

2013-01-01

A case of human melioidosis caused by a novel sequence type of Burkholderia pseudomallei occurred in a child in Malawi, southern Africa. A literature review showed that human cases reported from the continent have been increasing. PMID:23735189

National and Local Sources of Power: Important Considerations for Teacher Education Reforms in Rural Malawi

ERIC Educational Resources Information Center

Chazema, Jacqueline; O'Meara, James

2011-01-01

The establishment of formal teacher training systems is a relatively new innovation in some parts of Africa. Formal training of secondary teachers in Malawi commenced when the government of Malawi opened the University of Malawi in 1965. The contribution of Malawi's ruling parties to the development of teacher education in Malawi since then is an…

The uppermost mantle shear wave velocity structure of eastern Africa from Rayleigh wave tomography: constraints on rift evolution

NASA Astrophysics Data System (ADS)

O'Donnell, J. P.; Adams, A.; Nyblade, A. A.; Mulibo, G. D.; Tugume, F.

2013-08-01

An expanded model of the 3-D shear wave velocity structure of the uppermost mantle beneath eastern Africa has been developed using earthquakes recorded by the AfricaArray East African Seismic Experiment in conjunction with data from permanent stations and previously deployed temporary stations. The combined data set comprises 331 earthquakes recorded on a total of 95 seismic stations spanning Kenya, Uganda, Tanzania, Zambia and Malawi. In this study, data from 149 earthquakes were used to determine fundamental-mode Rayleigh wave phase velocities at periods ranging from 20 to 182 s using the two-plane wave method, and then combined with the similarly processed published measurements and inverted for a 3-D shear wave velocity model of the uppermost mantle. New features in the model include (1) a low-velocity region in western Zambia, (2) a high-velocity region in eastern Zambia, (3) a low-velocity region in eastern Tanzania and (4) low-velocity regions beneath the Lake Malawi rift. When considered in conjunction with mapped seismicity, these results support a secondary western rift branch striking southwestwards from Lake Tanganyika, likely exploiting the relatively weak lithosphere of the southern Kibaran Belt between the Bangweulu Block and the Congo Craton. We estimate a lithospheric thickness of ˜150-200 km for the substantial fast shear wave anomaly imaged in eastern Zambia, which may be a southward subsurface extension of the Bangweulu Block. The low-velocity region in eastern Tanzania suggests that the eastern rift branch trends southeastwards offshore eastern Tanzania coincident with the purported location of the northern margin of the proposed Ruvuma microplate. Pronounced velocity lows along the Lake Malawi rift are found beneath the northern and southern ends of the lake, but not beneath the central portion of the lake.

Retroposition of the AFC family of SINEs (short interspersed repetitive elements) before and during the adaptive radiation of cichlid fishes in Lake Malawi and related inferences about phylogeny.

PubMed

Takahashi, K; Nishida, M; Yuma, M; Okada, N

2001-01-01

Lake Malawi is home to more than 450 species of endemic cichlids, which provide a spectacular example of adaptive radiation. To clarify the phylogenetic relationships among these fish, we examined the presence and absence of SINEs (short interspersed repetitive elements) at orthologous loci. We identified six loci at which a SINE sequence had apparently been specifically inserted by retroposition in the common ancestor of all the investigated species of endemic cichlids in Lake Malawi. At another locus, unique sharing of a SINE sequence was evident among all the investigated species of endemic non-Mbuna cichlids with the exception of Rhamphochromis sp. The relationships were in good agreement with those deduced in previous studies with various different markers, demonstrating that the SINE method is useful for the elucidation of phylogenetic relationships among cichlids in Lake Malawi. We also characterized a locus that exhibited transspecies polymorphism with respect to the presence or absence of the SINE sequence among non-Mbuna species. This result suggests that incomplete lineage sorting and/or interspecific hybridization might have occurred or be occurring among the species in this group, which might potentially cause misinterpretation of phylogenetic data, in particular when a single-locus marker, such as a sequence in the mitochondrial DNA, is used for analysis.

Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine

PubMed Central

2014-01-01

Background There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students’ perspectives on specialization training in Malawi. Methods We conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an “editing approach” to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants. Results We interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training. Conclusions Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country’s healthcare workforce and the needs of their

Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine.

PubMed

Sawatsky, Adam P; Parekh, Natasha; Muula, Adamson S; Bui, Thuy

2014-01-06

There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students' perspectives on specialization training in Malawi. We conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an "editing approach" to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants. We interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training. Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country's healthcare workforce and the needs of their graduating medical students to be able to

Investigation of the Fisheries of Africa, Buck, and Judd Lakes, Louisiana.

DTIC Science & Technology

1987-10-01

D-A188 978 INVESTIGATION OF THE FISHERIES VVW NJ 7 LAKES LOUISIA A(U) ARMY ENGINEER UATERWiAYS EXPERIMENT STATION VICKSBURG MS ENVIR L G SANDERS ET...MISCELLANEOUS PAPER EL-87-10 INVESTIGATION OF THE FISHERIES OF AFRICA, S BUCK, AND JUDD LAKES, LOUISIANA by AD-A188 978 Larry G. Sanders, John A...0060 ELEMENT NO. NO NO. rCCESSION NO 11 TITLE (Include Security Classification) Investigation of the Fisheries of Africa, Buck, and Judd Lakes

A progressively wetter climate in southern East Africa over the past 1.3 million years.

PubMed

Johnson, T C; Werne, J P; Brown, E T; Abbott, A; Berke, M; Steinman, B A; Halbur, J; Contreras, S; Grosshuesch, S; Deino, A; Scholz, C A; Lyons, R P; Schouten, S; Damsté, J S Sinninghe

2016-09-08

African climate is generally considered to have evolved towards progressively drier conditions over the past few million years, with increased variability as glacial-interglacial change intensified worldwide. Palaeoclimate records derived mainly from northern Africa exhibit a 100,000-year (eccentricity) cycle overprinted on a pronounced 20,000-year (precession) beat, driven by orbital forcing of summer insolation, global ice volume and long-lived atmospheric greenhouse gases. Here we present a 1.3-million-year-long climate history from the Lake Malawi basin (10°-14° S in eastern Africa), which displays strong 100,000-year (eccentricity) cycles of temperature and rainfall following the Mid-Pleistocene Transition around 900,000 years ago. Interglacial periods were relatively warm and moist, while ice ages were cool and dry. The Malawi record shows limited evidence for precessional variability, which we attribute to the opposing effects of austral summer insolation and the temporal/spatial pattern of sea surface temperature in the Indian Ocean. The temperature history of the Malawi basin, at least for the past 500,000 years, strongly resembles past changes in atmospheric carbon dioxide and terrigenous dust flux in the tropical Pacific Ocean, but not in global ice volume. Climate in this sector of eastern Africa (unlike northern Africa) evolved from a predominantly arid environment with high-frequency variability to generally wetter conditions with more prolonged wet and dry intervals.

Mental health of carers of children affected by HIV attending community-based programmes in South Africa and Malawi

PubMed Central

Skeen, Sarah; Tomlinson, Mark; Macedo, Ana; Croome, Natasha; Sherr, Lorraine

2015-01-01

There is strong evidence that both adults and children infected with and affected by HIV have high levels of mental health burden. Yet there have been few studies investigating carer mental health outcomes in the context of HIV in Malawi and South Africa. The objective of this study was to assess the mental health of carers of children affected by HIV as a part of the Child Community Care study, which aims to generate evidence on the effectiveness of community-based organisation (CBO) services to improve child outcomes. In a cross sectional study, we interviewed 952 carers of children (aged 4 to 13 years) attending 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Psychological morbidity was measured using the Shona Symptom Questionnaire (SSQ) and suicidal ideation was measured using an item from the Patient Health Questionnaire (PHQ). Carers were asked about care-seeking for emotional problems. Overall, 28% of carers scored above the clinical cut-off for current psychological morbidity and 12.2% reported suicidal ideation. We used logistic regression models to test factors associated with poor outcomes. Household unemployment, living with a sick family member, and perceived lack of support from the community were associated with both psychological morbidity and suicidal ideation in carers. Reported child food insecurity was also associated with psychological morbidity. In addition, carers living in South Africa were more likely to present with psychological morbidity and suicidal ideation than carers in Malawi. Rates of help-seeking for mental health problems were low. Carers of children affected by HIV are at risk for mental health problems as a result of HIV, socio-economic, care-giving and community factors. We call for increased recognition of the potential role of CBOs in providing mental health care and support for families as a means to improve equity in mental health care. Specifically, we highlight the need for increased

Speciation in rapidly diverging systems: lessons from Lake Malawi.

PubMed

Danley, P D; Kocher, T D

2001-05-01

Rapid evolutionary radiations provide insight into the fundamental processes involved in species formation. Here we examine the diversification of one such group, the cichlid fishes of Lake Malawi, which have radiated from a single ancestor into more than 400 species over the past 700 000 years. The phylogenetic history of this group suggests: (i) that their divergence has proceeded in three major bursts of cladogenesis; and (ii) that different selective forces have dominated each cladogenic event. The first episode resulted in the divergence of two major lineages, the sand- and rock-dwellers, each adapted to a major benthic macrohabitat. Among the rock-dwellers, competition for trophic resources then drove a second burst of cladogenesis, which resulted in the differentiation of trophic morphology. The third episode of cladogenesis is associated with differentiation of male nuptial colouration, most likely in response to divergent sexual selection. We discuss models of speciation in relation to this observed pattern. We advocate a model, divergence with gene flow, which reconciles the disparate selective forces responsible for the diversification of this group and suggest that the nonadaptive nature of the tertiary episode has significantly contributed to the extraordinary species richness of this group.

What are the constraints and opportunities for HIVST scale-up in Africa? Evidence from Kenya, Malawi and South Africa.

PubMed

van Rooyen, Heidi; Tulloch, Olivia; Mukoma, Wanjiru; Makusha, Tawanda; Chepuka, Lignet; Knight, Lucia C; Peck, Roger B; Lim, Jeanette M; Muturi, Nelly; Chirwa, Ellen; Taegtmeyer, Miriam

2015-01-01

HIV self-testing (HIVST) has the potential to increase uptake of HIV testing among untested populations in sub-Saharan Africa and is on the brink of scale-up. However, it is unclear to what extent HIVST would be supported by stakeholders, what policy frameworks are in place and how variations between contexts might influence country-preparedness for scale-up. This qualitative study assessed the perceptions of HIVST among stakeholders in three sub-Saharan countries. Fifty-four key informant interviews were conducted in Kenya (n=16), Malawi (n=26) and South Africa (n=12) with government policy makers, academics, activists, donors, procurement specialists, laboratory practitioners and health providers. A thematic analysis was conducted in each country and a common coding framework allowed for inter-country analysis to identify common and divergent themes across contexts. Respondents welcomed the idea of an accurate, easy-to-use, rapid HIV self-test which could increase testing across all populations. High-risk groups, such as men, Men who have sex with men (MSM), couples and young people in particular, could be targeted through a range of health facility and community-based distribution points. HIVST is already endorsed in Kenya, and political support for scale-up exists in South Africa and Malawi. However, several caveats remain. Further research, policy and ensuing guidelines should consider how to regulate, market and distribute HIVST, ensure quality assurance of tests and human rights, and critically, link testing to appropriate support and treatment services. Low literacy levels in some target groups would also need context-specific consideration before scale up. World Health Organization (WHO) policy and regulatory frameworks are needed to guide the process in those areas which are new or specific to self-testing. Stakeholders in three HIV endemic sub-Saharan countries felt that HIVST will be an important complement to existing community and facility

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation

PubMed Central

Pintye, Jillian; Jacob, Sheena; Chung, Michael H.; Middleton, Lyn; Iliffe, Jill; Kim, H. Nina

2017-01-01

Background As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Methods Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Results Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. Conclusion To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation.

PubMed

Feldacker, Caryl; Pintye, Jillian; Jacob, Sheena; Chung, Michael H; Middleton, Lyn; Iliffe, Jill; Kim, H Nina

2017-01-01

As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together

The Rebellion of Enlisted Personnel and Democratization in Malawi

DTIC Science & Technology

2011-12-01

presidentialism” in Africa )3 to push for free and fair democratic elections. D. METHODS AND SOURCES For this research, process tracing was conducted to...3 Michael Bratton and Nicolas van de Walle, Democratic Experiments in Africa : Regime Transitions in Comparative Perspective...Nandini Patel, “Political Parties: Development and Change in Malawi,” Electoral Institute of Southern Africa Research Report 21 (Johannesburg: EISA

Subdecadal phytolith and charcoal records from Lake Malawi, East Africa imply minimal effects on human evolution from the ∼74 ka Toba supereruption.

PubMed

Yost, Chad L; Jackson, Lily J; Stone, Jeffery R; Cohen, Andrew S

2018-03-01

The temporal proximity of the ∼74 ka Toba supereruption to a putative 100-50 ka human population bottleneck is the basis for the volcanic winter/weak Garden of Eden hypothesis, which states that the eruption caused a 6-year-long global volcanic winter and reduced the effective population of anatomically modern humans (AMH) to fewer than 10,000 individuals. To test this hypothesis, we sampled two cores collected from Lake Malawi with cryptotephra previously fingerprinted to the Toba supereruption. Phytolith and charcoal samples were continuously collected at ∼3-4 mm (∼8-9 yr) intervals above and below the Toba cryptotephra position, with no stratigraphic breaks. For samples synchronous or proximal to the Toba interval, we found no change in low elevation tree cover, or in cool climate C 3 and warm season C 4 xerophytic and mesophytic grass abundance that is outside of normal variability. A spike in locally derived charcoal and xerophytic C 4 grasses immediately after the Toba eruption indicates reduced precipitation and die-off of at least some afromontane vegetation, but does not signal volcanic winter conditions. A review of Toba tuff petrological and melt inclusion studies suggest a Tambora-like 50 to 100 Mt SO 2 atmospheric injection. However, most Toba climate models use SO 2 values that are one to two orders of magnitude higher, thereby significantly overestimating the amount of cooling. A review of recent genetic studies finds no support for a genetic bottleneck at or near ∼74 ka. Based on these previous studies and our new paleoenvironmental data, we find no support for the Toba catastrophe hypothesis and conclude that the Toba supereruption did not 1) produce a 6-year-long volcanic winter in eastern Africa, 2) cause a genetic bottleneck among African AMH populations, or 3) bring humanity to the brink of extinction. Copyright © 2017 Elsevier Ltd. All rights reserved.

The underwater photic environment of Cape Maclear, Lake Malawi: comparison between rock- and sand-bottom habitats and implications for cichlid fish vision.

PubMed

Sabbah, Shai; Gray, Suzanne M; Boss, Emmanuel S; Fraser, James M; Zatha, Richard; Hawryshyn, Craig W

2011-02-01

Lake Malawi boasts the highest diversity of freshwater fishes in the world. Nearshore sites are categorized according to their bottom substrate, rock or sand, and these habitats host divergent assemblages of cichlid fishes. Sexual selection driven by mate choice in cichlids led to spectacular diversification in male nuptial coloration. This suggests that the spectral radiance contrast of fish, the main determinant of visibility under water, plays a crucial role in cichlid visual communication. This study provides the first detailed description of underwater irradiance, radiance and beam attenuation at selected sites representing two major habitats in Lake Malawi. These quantities are essential for estimating radiance contrast and, thus, the constraints imposed on fish body coloration. Irradiance spectra in the sand habitat were shifted to longer wavelengths compared with those in the rock habitat. Beam attenuation in the sand habitat was higher than in the rock habitat. The effects of water depth, bottom depth and proximity to the lake bottom on radiometric quantities are discussed. The radiance contrast of targets exhibiting diffused and spectrally uniform reflectance depended on habitat type in deep water but not in shallow water. In deep water, radiance contrast of such targets was maximal at long wavelengths in the sand habitat and at short wavelengths in the rock habitat. Thus, to achieve conspicuousness, color patterns of rock- and sand-dwelling cichlids would be restricted to short and long wavelengths, respectively. This study provides a useful platform for the examination of cichlid visual communication.

Distributions of Heterocyst Glycolipids in Settling Particulate Matter Record Ecological and Environmental Parameters in a Tropical Lake

NASA Astrophysics Data System (ADS)

Meegan Kumar, D.; Hopmans, E.; S Sinninghe Damsté, J.; Schouten, S.; Bauersachs, T.; Werne, J. P.

2017-12-01

Temperature is a critical component of paleoenvironmental reconstructions, yet it is notoriously difficult to measure in terrestrial archives. Presented here is an investigation of unique glycolipids produced by heterocystous cyanobacteria, so-called heterocyst glycolipids (HGs), in the water column of Lake Malawi (East Africa). The goal of the study is to evaluate the potential of HGs to function as a paleotemperature proxy in tropical lacustrine environments. HGs in Lake Malawi were extracted from settling particulate matter (SPM) collected at bi-monthly intervals from 2011 - 2013. Sediment traps were moored in the metalimnion of both the north and south basins of the lake in order to evaluate the spatial and the temporal trends in lipid production and export. This study is the first to analyze HGs in SPM and contains the longest time-series of HG production in a natural environment to date. HGs are consistently present throughout the three-year study period, but maximum fluxes occur annually in December, coincident with the timing of cyanobacterial blooms in the lake. HGs in SPM appear to be sourced from living cyanobacteria populations, indicating rapid export of the lipids through the water column. Temperatures reconstructed with published HG-based indices, which are derived from the relative abundances of HG diols and triols to HG keto-(di)ols, do not accurately reflect the seasonal variability in measured surface water temperatures. Rather, the production of C28 HG keto-ols appears to be related to the timing of heterocyst differentiation. Heterocystous cyanobacteria in Lake Malawi may instead respond to growth temperatures by elongating the alkyl side chain of HG diols, as indicated by increases in the abundance of the C28 HG diol relative to the C26 HG diol with warmer surface water temperatures. Distributions of HGs thus may indeed provide a novel tool for paleotemperature reconstructions in tropical lakes.

Riparian ecosystem resilience and livelihood strategies under test: lessons from Lake Chilwa in Malawi and other lakes in Africa.

PubMed

Kafumbata, Dalitso; Jamu, Daniel; Chiotha, Sosten

2014-04-05

This paper reviews the importance of African lakes and their management challenges. African inland lakes contribute significantly to food security, livelihoods and national economies through direct exploitation of fisheries, water resources for irrigation and hydropower generation. Because of these key contributions, the ecosystem services provided are under significant stress mainly owing to high demand by increasing populations, negative anthropogenic impacts on lake catchments and high levels of poverty which result in unsustainable use. Climate variability exacerbates the stress on these ecosystems. Current research findings show that the lakes cannot sustain further development activities on the scale seen over the past few decades. Millions of people are at risk of losing livelihoods through impacts on livestock and wildlife. The review further shows that the problems facing these lakes are beyond the purview of current management practices. A much better understanding of the interactions and feedbacks between different components of the lake socio-ecological systems is needed to address the complex challenges of managing these ecosystem services. This review suggests that the three small wetlands of Chad, Chilwa and Naivasha provide an opportunity for testing novel ideas that integrate sustainability of natural resource management with livelihoods in order to inform policy on how future land use and climatic variability will affect both food security and the ecosystem services associated with it.

Projected changes in Malawi's growing season

NASA Astrophysics Data System (ADS)

Vizy, Edward K.; Cook, Kerry H.; Chimphamba, James; McCusker, Brent

2015-09-01

Regional climate model projections at 30-km resolution are used to predict future mid-century and late-century growing season changes over Malawi due to global warming under the Representative Concentration Pathway 8.5 business-as-usual emissions forcing scenario. Three different methods for estimating growing season characteristics are applied and evaluated. All three methods yield reasonable growing season length, onset, and demise date estimates over Malawi given the wide range of uncertainty of the observations. The projections indicate the likelihood for a shorter growing season in the future over Malawi south of 13.5°S. At mid-century the growing season length is predicted to be 20-40 % (20-55 days) shorter over the southernmost districts and 5-20 % (5-30 days) shorter over the central districts. By late-century the length is predicted to be 25-55 % (20-70 days) shorter with significant differences extending into northern Malawi. The shorter growing season is primarily associated with an earlier demise date, as no significant change in the onset date is predicted. Analysis of the regional circulation and horizontal moisture flux transport indicates that the earlier demise is associated with an intensification of the thermal low over the Kalahari Desert to the south and west of Malawi and an expansion of the mid-tropospheric Kalahari anticyclone over southern Africa. The stronger thermal low/anticyclone enhances the moisture flux divergence over Malawi suppressing the convective activity at the end of the wet season.

Sub-Saharan Africa Report.

DTIC Science & Technology

1987-04-21

south of the Save River, In the .north, the MNR benefited in 1982 from-its absorption >of groups. of Africa Livre fighters operating out of Malawi (AC...Vol 23 Nos 15, 16). One of the Africa Livre leaders was businessman Gimo; ;Phiri, ’who became the MNR’s chief representative in Malawi, operating...Zambezia province for health reasons. The president of the republic has meanwhile appointed (Hermano Gildo Queda Gamito) as BPD chair- man, Antonio

ROLE OF GRASSROOTS ENVIRONMENTAL LITERACY: The case of water security at Bwaila Secondary School in Malawi

NASA Astrophysics Data System (ADS)

Chasukwa Mwalwenje, Yvonne; Chasukwa, Steria

2015-04-01

Malawi is popularly known as the Warm Heart of Africa. Malawi has a total land area of 45,747 sq. miles. Of the total area, 80 % is covered by fresh water from Lake Malawi and other rivers. The country boasts that it holds large amounts of fresh water and has the third largest lake in Africa. Ironically, the number of households with reliable water access is low (Water Aid, 2014, UNDP, Human Development Report 2008). Regardless of signs of economic development, water security still remains a challenge in the Warm Heart of Africa. The problem with access to water prompted the Government of Malawi to introduce a National Water Policy in 1994 with the vision of 'Water and Sanitation for All'. Since then, other water access interventions have impacted on the ability to manage water sustainably. Over the past few years, more inclusive and diversified interventions have been put in place to reverse the situation. For instance, the government of Malawi has taken action to increase the number of water tanks in schools (UNICEF 2005). Several stakeholders' support the government in their role provides policy direction and coordinate management of the water sector. The outlined National Water and Sanitation Policy strategies includes promoting water conservation and catchment protection; incorporating local governments and communities in planning, development and management of water supplies and sanitation services; rehabilitating the existing infrastructure; creating an enabling environment for public-private partnerships in water supply and sanitation activities; undertaking rehabilitation and reduction of unaccounted-for-water of existing urban, peri-urban, as a priority; promoting economic incentives and opportunities to encourage the participation of small-scale water and sanitation service providers; and promoting water recycling and re-use. Despite of all these interventions, Malawi still continues to face significant challenges with issues of access and quality of

Monitoring the water balance of Lake Victoria, East Africa, from space

NASA Astrophysics Data System (ADS)

Swenson, Sean; Wahr, John

2009-05-01

SummaryUsing satellite gravimetric and altimetric data, we examine trends in water storage and lake levels of multiple lakes in the Great Rift Valley region of East Africa for the years 2003-2008. GRACE total water storage estimates reveal that water storage declined in much of East Africa, by as much as 60 {mm}/{year}, while altimetric data show that lake levels in some large lakes dropped by as much as 1-2 m. The largest declines occurred in Lake Victoria, the Earth's second largest freshwater body. Because the discharge from the outlet of Lake Victoria is used to generate hydroelectric power, the role of human management in the lake's decline has been questioned. By comparing catchment water storage trends to lake level trends, we confirm that climatic forcing explains only about 50decline. This analysis provides an independent means of assessing the relative impacts of climate and human management on the water balance of Lake Victoria that does not depend on observations of dam discharge, which may not be publically available. In the second part of the study, the individual components of the lake water balance are estimated. Satellite estimates of changes in lake level, precipitation, and evaporation are used with observed lake discharge to develop a parameterization for estimating subsurface inflows due to changes in groundwater storage estimated from satellite gravimetry. At seasonal timescales, this approach provides closure to Lake Victoria's water balance to within 17 {mm}/{month}. The third part of this study uses the water balance of a downstream water body, Lake Kyoga, to estimate the outflow from Lake Victoria remotely. Because Lake Kyoga is roughly 20 times smaller in area than Lake Victoria, its water balance is strongly influenced by inflow from Lake Victoria. Lake Kyoga has been shown to act as a linear reservoir, where its outflow is proportional to the height of the lake. This model can be used with satellite altimetric lake levels to estimate a

Lilongwe, Malawi

NASA Image and Video Library

2016-08-10

Lilongwe is the capital city of Malawi. Like many cities in Africa, it has seen phenomenal growth in the last 50 years. In 1966 the population was about 19,000; in 1987 the census counted 223,000 inhabitants; and in 2015 1,080,000 residents called Lilongwe home. . The Landsat image was acquired 27 August 1984, and the ASTER image on 31 July 2015. The images cover an area of 20 by 33 km, and are located at 14 degrees south, 33.8 degrees east. http://photojournal.jpl.nasa.gov/catalog/?IDNumber=pia20804

Lessons from the recent rise in use of female sterilization in Malawi.

PubMed

Jacobstein, Roy

2013-03-01

Although female sterilization is the most widely used modern contraceptive method in the world, most family planning programs in Africa have had difficulty providing it. Malawi, however, despite daunting constraints, has made female sterilization widely and equitably accessible, thereby increasing method choice and helping its citizens better meet their reproductive intentions. Ten percent of currently married Malawian women of reproductive age rely on female sterilization for contraceptive protection, compared with less than 2 percent across Africa, and demand to limit births now exceeds demand to space births. Malawi's female sterilization prevalence surpasses that of some high-resource countries. Key service-delivery factors enabling this achievement include supportive policies, strong public-private partnerships, and mobile services delivered at no cost by dedicated providers. Challenges remain, but Malawi's achievement offers lessons for other countries with low availability of female sterilization and similar resource constraints. © 2013 The Population Council, Inc.

Remarkable rates of lightning strike mortality in Malawi.

PubMed

Mulder, Monique Borgerhoff; Msalu, Lameck; Caro, Tim; Salerno, Jonathan

2012-01-01

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.

School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease.

PubMed

Sims Sanyahumbi, Amy; Sable, Craig A; Beaton, Andrea; Chimalizeni, Yamikani; Guffey, Danielle; Hosseinipour, Mina; Karlsten, Melissa; Kazembe, Peter N; Kennedy, Neil; Minard, Charles G; Penny, Daniel J

2016-12-01

Rheumatic heart disease (RHD) is the largest cardiac cause of morbidity and mortality in the world's youth. Early detection of RHD through echocardiographic screening in asymptomatic children may identify an early stage of disease, when secondary prophylaxis has the greatest chance of stopping disease progression. Latent RHD signifies echocardiographic evidence of RHD with no known history of acute rheumatic fever and no clinical symptoms. Determine the prevalence of latent RHD among children ages 5-16 in Lilongwe, Malawi. This is a cross-sectional study in which children ages 5 through 16 were screened for RHD using echocardiography. Screening was conducted in 3 schools and surrounding communities in the Lilongwe district of Malawi between February and April 2014. Children were diagnosed as having no, borderline, or definite RHD as defined by World Heart Federation criteria. The primary reader completed offline reads of all studies. A second reader reviewed all of the studies diagnosed as RHD, plus a selection of normal studies. A third reader served as tiebreaker for discordant diagnoses. The distribution of results was compared between gender, location, and age categories using Fisher's exact test. The prevalence of latent RHD was 3.4% (95% CI = 2.45, 4.31), with 0.7% definite RHD and 2.7% borderline RHD. There was no significant differences in prevalence between gender (P = .44), site (P = .6), urban vs. peri-urban (P = .75), or age (P = .79). Of those with definite RHD, all were diagnosed because of pathologic mitral regurgitation (MR) and 2 morphologic features of the mitral valve. Of those with borderline RHD, most met the criteria by having pathological MR (92.3%). Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi. © 2016 Wiley Periodicals, Inc.

Incidence of induced abortion in Malawi, 2015.

PubMed

Polis, Chelsea B; Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert

2017-01-01

In Malawi, abortion is legal only if performed to save a woman's life; other attempts to procure an abortion are punishable by 7-14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi's high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15-44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. We estimate that approximately 141,044 (95% CI: 121,161-160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15-49 (95% CI: 32 to 43); which varied by geographical zone (range: 28-61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34-35). Over half of pregnancies in Malawi are unintended. Our

"Can Anything Good Come Out of This Mouth?" Female Experiences of Disability in Malawi

ERIC Educational Resources Information Center

Braathen, Stine Hellum; Kvam, Marit Hoem

2008-01-01

The aim of this article is to give an overview of the daily life stories of 23 women with disabilities in Malawi. The stories were gained through qualitative interviews that covered aspects of being a woman and living with a disability in Malawi. Recent studies from countries in southern Africa have documented how people with disabilities…

STS-65 Earth observation of Lake Chad, Africa, taken aboard Columbia, OV-102

NASA Technical Reports Server (NTRS)

1994-01-01

STS-65 Earth observation taken aboard Columbia, Orbiter Vehicle (OV) 102, shows Lake Chad, Africa. This is another long term ecological monitoring site for NASA scientists. Lake Chad was first photographed from space in 1965. A 25-year length-of-record data set exists for this environmentally important area. A number of these scenes have been digitized, rectified, classified and results show that the lake area has been shrinking and only 15% to 20% of the surface water is visible on space images. NASA's objective in monitoring this lake is to document the intra- and interannual areal changes of the largest standing water body in the Sahelian biome of North Africa. These areal changes are an indicator of the presence or absence of drought across the arguably overpopulated, overgrazed, and over biological carrying capacity limits nations of the Sahel.

Remarkable Rates of Lightning Strike Mortality in Malawi

PubMed Central

Borgerhoff Mulder, Monique; Msalu, Lameck; Caro, Tim; Salerno, Jonathan

2012-01-01

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area. PMID:22253708

Incidence of induced abortion in Malawi, 2015

PubMed Central

Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert

2017-01-01

Background In Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. Methods We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. Results We estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. Conclusions The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over

Monogamy in the maternally mouthbrooding Lake Tanganyika cichlid fish Tropheus moorii

PubMed Central

Egger, Bernd; Obermüller, Beate; Phiri, Harris; Sturmbauer, Christian; Sefc, Kristina M

2006-01-01

Supported by evidence for assortative mating and polygynandry, sexual selection through mate choice was suggested as the main force driving the evolution of colour diversity of haplochromine cichlids in Lakes Malawi and Victoria. The phylogenetically closely related tribe Tropheini of Lake Tanganyika includes the genus Tropheus, which comprises over 100 colour variants currently classified into six morphologically similar, polyphyletic species. To assess the potential for sexual selection in this sexually monochromatic maternal mouthbrooder, we used microsatellite-based paternity inference to investigate the mating system of Tropheus moorii. In contrast to haplochromines in Lake Malawi, multiple paternity is rare or even absent in broods of T. moorii. Eighteen of the 19 analysed families were consistent with genetic monogamy, while either a mutation or more than one sire explained the genotype of one offspring in another brood. We discuss the differences in breeding behaviour between T. moorii and the Lake Malawi haplochromines, and evaluate additional factors or alternatives to sexual selection as promoters of colour diversification. A preliminary survey of other Tropheini species suggested that multiple paternity is infrequent in the entire tribe. PMID:16790413

Constraints on the 3D Sediment and Crustal Architecture of the Weakly Extended Malawi Rift from the Onshore/Offshore Wide-Angle Refraction Experiment

NASA Astrophysics Data System (ADS)

Accardo, N. J.; Shillington, D. J.; Scholz, C. A.; McCartney, T.; Ebinger, C. J.; Gaherty, J. B.; Nyblade, A.; Eatmon, A.; Chindandali, P. R. N.; Kamihanda, G.; Ferdinand, R.; Salima, J.; Mruma, A. H.

2016-12-01

Current models of continental rifting increasingly point to the important role of weakening mechanisms like the addition of magmatic products in overcoming the disparity between the magnitude of tectonic forces available for rifting and the forces required to break strong, cold lithosphere. However, many rifts have limited volcanism. To understand the controls on rifting in magma-poor systems, we conduct 3D first arrival time tomography from active-source wide-angle refraction data collected in the Malawi Rift to constrain crustal structure along and across the rift. The Malawi Rift represents a weakly extended rift system located within the southernmost portion of the EARS. The only surface magmatism present occurs within the Rungwe Volcanic Province (RVP) located at the northern termination of the Malawi Rift. We utilize active-source data collected in Lake Malawi as a part of SEGMeNT (Study of Extension and maGmatism in Malawi aNd Tanzania). Over 86,000 unique air gun shots were recorded on an array of 33 offshore "lake" bottom seismometers and 55 onshore seismometers. The resulting ray-coverage encompasses the entire northern section of the Malawi Rift spanning the North and Central basins of Lake Malawi, portions of the surround plateaus, as well as the RVP. First arrivals are picked for all shot-receiver pairs with sufficient signal-to-noise ratio and included in a 3D first-arrival tomography model. Direct arrivals (Ps and Pg) and reflections (PmP) are observed on the majority of instruments, with clear arrivals observed to offsets >220 km. Data and preliminary models indicate variations in fault structure and overall sediment thickness between and within rift basins. The North Basin is characterized by a series of synthetic intrabasin faults and sediments thickening to the east along the Livingstone border fault. The Central Basin is characterized by sediments thickening to the west along the Nkhata border fault in the south near Usisya, Malawi and then

The cost-effectiveness of rotavirus vaccination in Malawi.

PubMed

Berry, Stephen A; Johns, Benjamin; Shih, Chuck; Berry, Andrea A; Walker, Damian G

2010-09-01

Rotarix (GlaxoSmithKline), a newly licensed rotavirus vaccine requiring 2 doses, may have the potential to save hundreds of thousands of lives in Africa. Nations such as Malawi, where Rotarix is currently under phase III investigation, may nevertheless face difficult economic choices in considering vaccine adoption. The cost-effectiveness of implementing a Rotarix vaccine program in Malawi was estimated using published estimates of rotavirus burden, vaccine efficacy, and health care utilization and costs. With 49.5% vaccine efficacy, a Rotarix program could avert 2582 deaths annually. With GAVI Alliance cofinancing, adoption of Rotarix would be associated with a cost of $5.07 per disability-adjusted life-year averted. With market pricing, Rotarix would be associated with a base case cost of $74.73 per disability-adjusted life-year averted. Key variables influencing results were vaccine efficacy, under-2 rotavirus mortality, and program cost of administering each dose. Adopting Rotarix would likely be highly cost-effective for Malawi, particularly with GAVI support. This finding holds true across uncertainty ranges for key variables, including efficacy, for which data are becoming available.

Geostatistical modelling of household malaria in Malawi

NASA Astrophysics Data System (ADS)

Chirombo, J.; Lowe, R.; Kazembe, L.

2012-04-01

Malaria is one of the most important diseases in the world today, common in tropical and subtropical areas with sub-Saharan Africa being the region most burdened, including Malawi. This region has the right combination of biotic and abiotic components, including socioeconomic, climatic and environmental factors that sustain transmission of the disease. Differences in these conditions across the country consequently lead to spatial variation in risk of the disease. Analysis of nationwide survey data that takes into account this spatial variation is crucial in a resource constrained country like Malawi for targeted allocation of scare resources in the fight against malaria. Previous efforts to map malaria risk in Malawi have been based on limited data collected from small surveys. The Malaria Indicator Survey conducted in 2010 is the most comprehensive malaria survey carried out in Malawi and provides point referenced data for the study. The data has been shown to be spatially correlated. We use Bayesian logistic regression models with spatial correlation to model the relationship between malaria presence in children and covariates such as socioeconomic status of households and meteorological conditions. This spatial model is then used to assess how malaria varies spatially and a malaria risk map for Malawi is produced. By taking intervention measures into account, the developed model is used to assess whether they have an effect on the spatial distribution of the disease and Bayesian kriging is used to predict areas where malaria risk is more likely to increase. It is hoped that this study can help reveal areas that require more attention from the authorities in the continuing fight against malaria, particularly in children under the age of five.

Evaluating the Impact of Gilgel Gibe Dam on the Lake Turkana Water Levels: An Illustration from an Endorheic Lake in Africa

NASA Astrophysics Data System (ADS)

Velpuri, N.; Senay, G. B.

2010-12-01

Lake Turkana is one of the lakes in the Great Rift Valley, Africa. This lake has no outlet hence it is considered as closed or endorheic lake. To meet the demand of electricity in the east African region, Ethiopia is currently building Gilgel Gibe-III dam on the Omo River, which supplies up to 80% of the inflows to the Lake Turkana. On completion, this dam would be the tallest dam in Africa with a height of 241 m. As Lake Turkana is highly dependent on the inflows from the Omo River, the construction of this dam could potentially pose a threat to the downstream river valley and to Lake Turkana. This hydroelectric project is arguably one of the most controversial projects in the region. The impact of the dam on the lake is evaluated using Remote Sensing datasets and hydrologic modeling. First, lake water levels (1998-2007) were estimated using the Simplified Lake Water Balance (SLAB) approach which takes in satellite based rainfall estimates, modeled runoff and evapotranspiration data over the Turkana basin. Modeled lake levels were validated against TOPEX/POSIEDON/Jason-1 satellite altimeter data. Validation results showed that the model could capture observed trends and seasonal variations in lake levels. The fact that the lake is endorheic makes it easy to model the lake levels. Using satellite based estimates for the years 1998-2009, future scenarios for rainfall and evapotranspiration were generated using the Monte Carlo simulation approach and the impact of Gilgel Gibe-III dam on the Lake Turkana water levels is evaluated using SLAB approach. Preliminary results indicate that the impact of the dam on the lake would vary with the initial water level in the lake at the time of dam commissioning. It was found that during the initial period of dam/reservoir filling the lake level would drop up to 2-3 m (95% confidence interval). However, on average the lake would stabilize within 10 years from the date of commissioning. The variability within the lake levels due

Fires in Tanzania and Mozambique

NASA Technical Reports Server (NTRS)

2002-01-01

Like many countries, the southeastern African country of Malawi faces the challenge of balancing a growing population's need for food and energy with preservation of natural resources. This MODIS image from November 8, 2001, shows Malawi surrounded by (starting from top and moving clockwise) Tanzania, Mozambique, and northern Zambia. Lake Malawi runs north-south through the eastern part of the country, and is the southern-most of Africa's Great Rift Lakes, a series of deep lakes that run roughly north-south along the Great Rift Valley in eastern Africa, formed when the Earth buckled and then sank after the collision of Africa and Eurasia millions of years ago. Most of the land around the lake and throughout the country has been cleared of its natural vegetation and converted to agricultural land. This causes soil erosion problems and sedimentation in the lake, which affects the sustainability of fishing in the lake. In this image, greenish swirls in the water around the shores could indicate a mixture of sediment and phytoplankton or algae. Deforestation is also a major issue, especially since wood for fuel is the primary source of the country's energy. The difference between the lands protected by parks and preserves stand out dramatically. The largest protected area is halfway down the western border of the country-Kasungu National Park. Several smaller preserves also exist, and where they do, they stand out in green against the paler landscape. Image courtesy Jacques Descloitres, MODIS Land Rapid Response Team at NASA GSFC

Global Cicada Sound Collection I: Recordings from South Africa and Malawi by B. W. Price & M. H. Villet and harvesting of BioAcoustica data by GBIF

PubMed Central

Price, Benjamin Wills; Rycroft, Simon; Villet, Martin H.

2015-01-01

Abstract Background Sound collections for singing insects provide important repositories that underpin existing research (e.g. Price et al. 2007 at http://bio.acousti.ca/node/11801; Price et al. 2010) and make bioacoustic collections available for future work, including insect communication (Ordish 1992), systematics (e.g. David et al. 2003), and automated identification (Bennett et al. 2015). The BioAcoustica platform (Baker et al. 2015) is both a repository and analysis platform for bioacoustic collections: allowing collections to be available in perpetuity, and also facilitating complex analyses using the BioVeL cloud infrastructure (Vicario et al. 2011). The Global Cicada Sound Collection is a project to make recordings of the world's cicadas (Hemiptera: Cicadidae) available using open licences to maximise their potential for study and reuse. This first component of the Global Cicada Sound Collection comprises recordings made between 2006 and 2008 of Cicadidae in South Africa and Malawi. New information This collection of sounds includes 219 recordings of 133 voucher specimens, comprising 42 taxa (25 identified to species, all identified to genus) from South Africa and Malawi. The recordings have been used to underpin work on the species limits of cicadas in southern Africa, including Price et al. (2007) and Price et al. (2010). The specimens are deposited in the Albany Museum, Grahamstown, South Africa (AMGS). The harvesting of acoustic data as occurrence records by GBIF has been implemented by the Scratchpads Team at the Natural History Museum, London. This link increases the value of individual recordings and the BioAcoustica platform within the global infrastructure of biodiversity informatics by making specimen/occurence records from BioAcoustica available to a wider audience, and allowing their integration with other occurence datasets that also contribute to GBIF. PMID:26379465

Building a knowledge translation platform in Malawi to support evidence-informed health policy.

PubMed

Berman, Joshua; Mitambo, Collins; Matanje-Mwagomba, Beatrice; Khan, Shiraz; Kachimanga, Chiyembekezo; Wroe, Emily; Mwape, Lonia; van Oosterhout, Joep J; Chindebvu, Getrude; van Schoor, Vanessa; Puchalski Ritchie, Lisa M; Panisset, Ulysses; Kathyola, Damson

2015-12-08

With the support of the World Health Organization's Evidence-Informed Policy Network, knowledge translation platforms have been developed throughout Africa, the Americas, Eastern Europe, and Asia to further evidence-informed national health policy. In this commentary, we discuss the approaches, activities and early lessons learned from the development of a Knowledge Translation Platform in Malawi (KTPMalawi). Through ongoing leadership, as well as financial and administrative support, the Malawi Ministry of Health has strongly signalled its intention to utilize a knowledge translation platform methodology to support evidence-informed national health policy. A unique partnership between Dignitas International, a medical and research non-governmental organization, and the Malawi Ministry of Health, has established KTPMalawi to engage national-level policymakers, researchers and implementers in a coordinated approach to the generation and utilization of health-sector research. Utilizing a methodology developed and tested by knowledge translation platforms across Africa, a stakeholder mapping exercise and initial capacity building workshops were undertaken and a multidisciplinary Steering Committee was formed. This Steering Committee prioritized the development of two initial Communities of Practice to (1) improve data utilization in the pharmaceutical supply chain and (2) improve the screening and treatment of hypertension within HIV-infected populations. Each Community of Practice's mandate is to gather and synthesize the best available global and local evidence and produce evidence briefs for policy that have been used as the primary input into structured deliberative dialogues. While a lack of sustained initial funding slowed its early development, KTPMalawi has greatly benefited from extensive technical support and mentorship by an existing network of global knowledge translation platforms. With the continued support of the Malawi Ministry of Health and the

Identifying factors that influence pregnancy intentions: evidence from South Africa and Malawi.

PubMed

Evens, Emily; Tolley, Elizabeth; Headley, Jennifer; McCarraher, Donna R; Hartmann, Miriam; Mtimkulu, Vuyelwa T; Manenzhe, Kgahlisho Nozibele; Hamela, Gloria; Zulu, Fatima

2015-01-01

In developing-country settings, pregnancy intentions are often assessed using a series of questions from the Demographic and Health Surveys, yet research conducted in several countries yields conflicting results regarding these questions' ability to predict pregnancy. Conducted in Malawi and South Africa, this study identified individual, partner and societal factors that influence desire for pregnancy, and women's ability to achieve their intentions. Data come from interviews and focus-group discussions conducted prior to the FEM-PrEP HIV-prevention trial with women from communities at high risk of HIV infection. Cultural norms regarding contraceptive use and childbearing influenced both women's desire for pregnancy and ability to achieve those goals. Partner's expectations for pregnancy, financial concerns, family composition and contraceptive experiences were additional influences. Actively planning for pregnancy was not a salient concept to the majority of participants. Results support the call for a multidimensional measure of pregnancy intention that reflects the variety of factors that influence intentions, highlight the fluid nature of many women's reproductive health decision making and challenge the notion that all fertility decisions are the result of conscious action. Additional work on how women's plans for pregnancy are achieved would be programmatically more useful than current measures of intention.

Seroprevalence of HTLV-1 and HTLV-2 amongst mothers and children in Malawi within the context of a systematic review and meta-analysis of HTLV seroprevalence in Africa.

PubMed

Fox, James M; Mutalima, Nora; Molyneux, Elizabeth; Carpenter, Lucy M; Taylor, Graham P; Bland, Martin; Newton, Robert; Martin, Fabiola

2016-03-01

Human T-lymphotropic virus (HTLV)-1 causes T-cell leukaemia and myelopathy. Together with HTLV-2, it is endemic in some African nations. Seroprevalence data from Malawi are scarce, with no reports on associated disease incidence. HTLV seroprevalence and type were tested in 418 healthy mothers from Malawi. In addition, we tested the sera of 534 children to investigate mother-to-child transmission. To provide context, we conducted a systematic review and meta-analysis of HTLV seroprevalence in African women and children. Stored samples from a previous childhood cancer and BBV study were analysed. ELISA was used for HTLV screening followed by immunoblot for confirmation and typing. Standard methods were used for the systematic review. HTLV seroprevalence was 2.6% (11/418) in mothers and 2.2% (12/534) in children. Three mothers carried HTLV-1 alone, seven had HTLV-2 and one was dually infected. Three children carried HTLV-1 alone, seven had HTLV-2 and two were dually infected. Only two corresponding mothers of the 12 HTLV-positive children were HTLV positive. The systematic review included 66 studies of women and 13 of children conducted in 25 African countries. Seroprevalence of HTLV-1 varied from 0 to 17% and of HTLV-2 from 0 to 4%. In contrast to findings from other studies in Africa, the seroprevalence of HTLV-2 was higher than that of HTLV-1 in Malawi and one of the highest for the African region. The lack of mother-child concordance suggests alternative sources of infection among children. Our data and analyses contribute to HTLV prevalence mapping in Africa. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Aha Malawi! Envisioning Field Experiences That Nurture Cultural Competencies for Preservice Teachers

ERIC Educational Resources Information Center

Talbot, Patricia A.

2011-01-01

This theoretical study uses the context of the writer's personal encounters in Malawi, Africa, to propose a conceptual model for creating diverse field experiences based on best practices in critical pedagogy, service learning, and the underpinnings of transformational learning theory, for the purpose of increasing the probability of meaningful…

Molecular characterization of rotavirus strains detected during a clinical trial of a human rotavirus vaccine in Blantyre, Malawi

PubMed Central

Nakagomi, Toyoko; Nakagomi, Osamu; Dove, Winifred; Doan, Yen Hai; Witte, Desiree; Ngwira, Bagrey; Todd, Stacy; Steele, A Duncan; Neuzil, Kathleen M; Cunliffe, Nigel A

2014-01-01

The human, G1P[8] rotavirus vaccine (Rotarix) significantly reduced severe rotavirus gastroenteritis episodes in a clinical trial in South Africa and Malawi, but vaccine efficacy was lower in Malawi (49.5%) than reported in South Africa (76.9%) and elsewhere. The aim of this study was to examine the molecular relationships of circulating wild-type rotaviruses detected during the clinical trial in Malawi to RIX4414 (the strain contained in Rotarix) and to common human rotavirus strains. Of 88 rotavirus-positive, diarrhoeal stool specimens, 43 rotaviruses exhibited identifiable RNA migration patterns when examined by polyacrylamide gel electrophoresis. The genes encoding VP7, VP4, VP6 and NSP4 of 5 representative strains possessing genotypes G12P[6], G1P[8], G9P[8], and G8P[4] were sequenced. While their VP7 (G) and VP4 (P) genotype designations were confirmed, the VP6 (I) and NSP4 (E) genotypes were either I1E1 or I2E2, indicating that they were of human rotavirus origin. RNA-RNA hybridization using 21 culture-adapted strains showed that Malawian rotaviruses had a genomic RNA constellation common to either the Wa-like or DS-1 like human rotaviruses. Overall, the Malawi strains appear similar in their genetic make-up to rotaviruses described in countries where vaccine efficacy is greater, suggesting that the lower efficacy in Malawi is unlikely to be explained by the diversity of circulating strains. PMID:22520123

CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals.

PubMed

Patil, Crystal L; Abrams, Elizabeth T; Klima, Carrie; Kaponda, Chrissie P N; Leshabari, Sebalda C; Vonderheid, Susan C; Kamanga, Martha; Norr, Kathleen F

2013-10-01

severe health worker shortages and resource limitations negatively affect quality of antenatal care (ANC) throughout sub-Saharan Africa. Group ANC, specifically CenteringPregnancy (CP), may offer an innovative approach to enable midwives to offer higher quality ANC. our overarching goal was to prepare to conduct a clinical trial of CenteringPregnancy-Africa (CP-Africa) in Malawi and Tanzania. In Phase 1, our goal was to determine the acceptability of CP as a model for ANC in both countries. In Phase 2, our objective was to develop CP-Africa session content consistent with the Essential Elements of CP model and with national standards in both Malawi and Tanzania. In Phase 3, our objective was to pilot CP-Africa in Malawi to determine whether sessions could be conducted with fidelity to the Centering process. Phases 1 and 2 took place in Malawi and Tanzania. Phase 3, the piloting of two sessions of CP-Africa, occurred at two sites in Malawi: a district hospital and a small clinic. we used an Action Research approach to promote partnerships among university researchers, the Centering Healthcare Institute, health care administrators, health professionals and women attending ANC to develop CP-Africa session content and pilot this model of group ANC. for Phases 1 and 2, members of the Ministries of Health, health professionals and pregnant women in Malawi and Tanzania were introduced to and interviewed about CP. In Phase 2, we finalised CP-Africa content and trained 13 health professionals in the Centering Healthcare model. In Phase 3, we conducted a small pilot with 24 pregnant women (12 at each site). participants enthusiastically embraced CP-Africa as an acceptable model of ANC health care delivery. The CP-Africa content met both CP and national standards. The pilot established that the CP model could be implemented with process fidelity to the 13 Essential Elements. Several implementation challenges and strategies to address these challenges were identified

CENTERING PREGANCY- AFRICA: A PILOT OF GROUP ANTENATAL CARE TO ADDRESS MILLENIUM DEVELOPMENT GOALS

PubMed Central

Patil, Crystal L.; Abrams, Elizabeth T.; Klima, Carrie; Kaponda, Chrissie P.N.; Leshabari, Sebalda C.; Vonderheid, Susan C.; Kamaga, Martha; Norr, Kathleen F.

2013-01-01

Background Severe health worker shortages and resource limitations negatively affect quality of antenatal care (ANC) throughout sub-Saharan Africa. Group ANC, specifically CenteringPregnancy (CP), may offer an innovative approach to enable midwives to offer higher quality ANC. Objective Our overarching goal was to prepare to conduct a clinical trial of CenteringPregnancy – Africa (CP-Africa) in Malawi and Tanzania. In Phase 1, our goal was to determine the acceptability of CP as model for ANC in both countries. In Phase 2, our objective was to develop CP-Africa session content consistent with the Essential Elements of CP model and with national standards in both Malawi and Tanzania. In Phase 3, our objective was to pilot CP-Africa in Malawi to determine whether sessions could be conducted with fidelity to the Centering process. Setting Phase 1 and 2 took place in Malawi and Tanzania. Phase 3, the piloting of two sessions of CP-Africa, occurred at two sites in Malawi: a district hospital and a small clinic. Design We used an Action Research approach to promote partnerships among university researchers, the Centering Healthcare Institute, healthcare administrators, health professionals and women attending ANC to develop CP-Africa session content and pilot this model of group ANC. Participants For Phases 1 and 2, members of the Ministries of Health, health professionals and pregnant women in Malawi and Tanzania were introduced to and interviewed about CP. In Phase 2, we finalized CP-Africa content and trained thirteen health professionals in the Centering Healthcare model. In Phase 3, we conducted a small pilot with 24 pregnant women (12 at each site). Measurements and Findings Participants enthusiastically embraced CP-Africa as an acceptable model of ANC healthcare delivery. The CP-Africa content met both CP and national standards. The pilot established that the CP model could be implemented with process fidelity to the 13 Essential Elements. Several implementation

The seismic-stratigraphic record of lake-level fluctuations in Lake Challa: Hydrological stability and change in equatorial East Africa over the last 140 kyr

NASA Astrophysics Data System (ADS)

Moernaut, J.; Verschuren, D.; Charlet, F.; Kristen, I.; Fagot, M.; De Batist, M.

2010-02-01

Seismic-reflection data from crater lake Challa (Mt. Kilimanjaro, equatorial East Africa) reveal a ˜ 210-m thick sedimentary infill containing distinct seismic-stratigraphic signatures of late-Quaternary lake-level fluctuations. Extrapolation of a well-constrained age model on the cored upper part of the sequence suggests that these lake-level fluctuations represent a detailed and continuous record of moisture-balance variation in equatorial East Africa over the last 140 kyr. This record indicates that the most severe aridity occurred during peak Penultimate glaciation immediately before ˜ 128 kyr BP (coeval with Heinrich event 11) and during a Last Interglacial 'megadrought' period between ˜ 114 and ˜ 97 kyr BP; in comparison, Last Glacial Maximum (LGM) aridity was modest. It was preceded by ˜ 75 000 years of relatively stable and moist climate conditions interrupted by eleven short-lived dry spells, five of which match the timing of Heinrich events 2 to 6. Climate history near the East African equator reflects variation in the precessional forcing of monsoon rainfall modulated by orbital eccentricity, but precession-driven moisture fluctuations were less extreme than those observed in northern and southern tropical Africa. The near-continuous moist climate from ˜ 97 to 20.5 kyr BP recorded in the Lake Challa record contrasts with the trend towards greater aridity after ˜ 70 kyr BP documented in equatorial West Africa. This long period of moist glacial climate and a short, relatively modest LGM drought can be attributed to greater independence of western Indian Ocean monsoon dynamics from northern high-latitude glaciation than those in the tropical Atlantic Ocean. This rather persistent moist glacial climate regime may have helped maintain high biodiversity in the tropical forest ecosystems of the Eastern Arc mountains in Tanzania.

Learning about War and Peace in the Great Lakes Region of Africa

ERIC Educational Resources Information Center

Bird, Lyndsay

2007-01-01

Two-thirds of the world's conflicts are in Africa. In particular, the Great Lakes region (Rwanda, Burundi, Democratic Republic of Congo, Uganda and Tanzania) continues to see conflicts that are complex, extreme and seemingly intractable. By exploring the narrative experiences of those most affected by the conflicts in the region--specifically…

Understanding the Earth Systems of Malawi: Ecological Sustainability, Culture, and Place-Based Education

ERIC Educational Resources Information Center

Glasson, George E.; Frykholm, Jeffrey A.; Mhango, Ndalapa A.; Phiri, Absalom D.

2006-01-01

The purpose of this 2-year study was to investigate Malawian teacher educators' perspectives and dispositions toward teaching about ecological sustainability issues in Malawi, a developing country in sub-Sahara Africa. This study was embedded in a larger theoretical framework of investigating earth systems science through the understanding of…

Schistosomiasis in Malawi: a systematic review.

PubMed

Makaula, Peter; Sadalaki, John R; Muula, Adamson S; Kayuni, Sekeleghe; Jemu, Samuel; Bloch, Paul

2014-12-10

Schistosomiasis remains an important public health problem that undermines social and economic development in tropical regions of the world, mainly Sub-Saharan Africa. We are not aware of any systematic review of the literature of the epidemiology and transmission of schistosomiasis in Malawi since 1985. Therefore, we reviewed the current state of knowledge of schistosomiasis epidemiology and transmission in this country and identified knowledge gaps and relevant areas for future research and research governance. We conducted computer-aided literature searches of Medline, SCOPUS and Google Scholar using the keywords: "schistosomiasis", "Bilharzia", "Bulinus" and "Biomphalaria" in combination with "Malawi". These searches were supplemented by iterative reviews of reference lists for relevant publications in peer reviewed international scientific journals or other media. The recovered documents were reviewed for their year of publication, location of field or laboratory work, authorship characteristics, ethics review, funding sources as well as their findings regarding parasite and intermediate host species, environmental aspects, geographical distribution, seasonality of transmission, and infection prevalence and intensities. A total of 89 documents satisfied the inclusion criteria and were reviewed. Of these, 76 were published in international scientific journals, 68 were peer reviewed and 54 were original research studies. Most of the documents addressed urinary schistosomiasis and about two thirds of them dealt with the definitive host. Few documents addressed the parasites and the intermediate hosts. While urinary schistosomiasis occurs in most parts of Malawi, intestinal schistosomiasis mainly occurs in the central and southern highlands, Likoma Island and Lower Shire. Studies in selected communities estimated prevalence rates of up to 94.9% for Schistosoma haematobium and up to 67.0% for Schistosoma mansoni with considerable geographical variation. The main

Molecular characterization of rotavirus strains detected during a clinical trial of a human rotavirus vaccine in Blantyre, Malawi.

PubMed

Nakagomi, Toyoko; Nakagomi, Osamu; Dove, Winifred; Doan, Yen Hai; Witte, Desiree; Ngwira, Bagrey; Todd, Stacy; Duncan Steele, A; Neuzil, Kathleen M; Cunliffe, Nigel A

2012-04-27

The human, G1P[8] rotavirus vaccine (Rotarix™) significantly reduced severe rotavirus gastroenteritis episodes in a clinical trial in South Africa and Malawi, but vaccine efficacy was lower in Malawi (49.5%) than reported in South Africa (76.9%) and elsewhere. The aim of this study was to examine the molecular relationships of circulating wild-type rotaviruses detected during the clinical trial in Malawi to RIX4414 (the strain contained in Rotarix™) and to common human rotavirus strains. Of 88 rotavirus-positive, diarrhoeal stool specimens, 43 rotaviruses exhibited identifiable RNA migration patterns when examined by polyacrylamide gel electrophoresis. The genes encoding VP7, VP4, VP6 and NSP4 of 5 representative strains possessing genotypes G12P[6], G1P[8], G9P[8], and G8P[4] were sequenced. While their VP7 (G) and VP4 (P) genotype designations were confirmed, the VP6 (I) and NSP4 (E) genotypes were either I1E1 or I2E2, indicating that they were of human rotavirus origin. RNA-RNA hybridization using 21 culture-adapted strains showed that Malawian rotaviruses had a genomic RNA constellation common to either the Wa-like or the DS-1 like human rotaviruses. Overall, the Malawi strains appear similar in their genetic make-up to rotaviruses described in countries where vaccine efficacy is greater, suggesting that the lower efficacy in Malawi is unlikely to be explained by the diversity of circulating strains. Copyright © 2011 Elsevier Ltd. All rights reserved.

Agroecology and healthy food systems in semi-humid tropical Africa: Participatory research with vulnerable farming households in Malawi.

PubMed

Nyantakyi-Frimpong, Hanson; Kangmennaang, Joseph; Bezner Kerr, Rachel; Luginaah, Isaac; Dakishoni, Laifolo; Lupafya, Esther; Shumba, Lizzie; Katundu, Mangani

2017-11-01

This paper assesses the relationship between agroecology, food security, and human health. Specifically, we ask if agroecology can lead to improved food security and human health among vulnerable smallholder farmers in semi-humid tropical Africa. The empirical evidence comes from a cross-sectional household survey (n=1000) in two districts in Malawi, a small country in semi-humid, tropical Africa. The survey consisted of 571 agroecology-adoption and 429 non-agroecology-adoption households. Ordered logistics regression and average treatment effects models were used to determine the effect of agroecology adoption on self-reported health. Our results show that agroecology-adoption households (OR=1.37, p=0.05) were more likely to report optimal health status, and the average treatment effect shows that adopters were 12% more likely to be in optimal health. Furthermore, being moderately food insecure (OR=0.59, p=0.05) and severely food insecure (OR=0.89, p=0.10) were associated with less likelihood of reporting optimal health status. The paper concludes that with the adoption of agroecology in the semi-humid tropics, it is possible for households to diversify their crops and diets, a condition that has strong implications for improved food security, good nutrition and human health. Copyright © 2016 Elsevier B.V. All rights reserved.

Africa and Applied Linguistics.

ERIC Educational Resources Information Center

Makoni, Sinfree, Ed.; Meinhof, Ulrike H., Ed.

2003-01-01

This collection of articles includes: "Introducing Applied Linguistics in Africa" (Sinfree Makoni and Ulrike H. Meinhof); "Language Ideology and Politics: A Critical Appraisal of French as Second Official Language in Nigeria" (Tope Omoniyi); "The Democratisation of Indigenous Languages: The Case of Malawi" (Themba…

Intergenerational transfers in the era of HIV/AIDS: Evidence from rural Malawi.

PubMed

Kohler, Iliana V; Kohler, Hans-Peter; Anglewicz, Philip; Behrman, Jere R

2012-12-13

Intergenerational transfer patterns in sub-Saharan Africa are poorly understood, despite the alleged importance of support networks to ameliorate the complex implications of the HIV/AIDS epidemic for families. There is a considerable need for research on intergenerational support networks and transfers to better understand the mechanisms through which extended families cope with the HIV/AIDS epidemic and potentially alleviate some of its consequences in sub-Saharan Africa, and to comprehend how transfers respond-or not-to perceptions about own and other family members' health. Using the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), we estimate the age patterns and the multiple directions of financial and non-financial transfer flows in rural Malawi-from prime-aged respondents to their elderly parents and adult children age 15 and up. We also estimate the social, demographic and economic correlates of financial and non-financial transfers of financial intergenerational transfers in this context. Our findings are that: (1) intergenerational financial and non-financial transfers are widespread and a key characteristic of family relationships in rural Malawi; (2) downward and upward transfers are importantly constrained and determined by the availability of transfer partners (parents or adult children); (3) financial net transfers are strongly age-patterned and the middle generations are net-providers of transfers; (4) non-financial transfers are based on mutual assistance rather than reallocation of resources; and (5) intergenerational transfers are generally not related to health status, including HIV positive status.

Links between Higher Education and Employers in Malawi: The Need for a Dialogue?

ERIC Educational Resources Information Center

Hall, David; Thomas, Harold

2005-01-01

The development of skills for employment is an important international policy area, but one that has been relatively ignored in sub-Saharan Africa. This paper reports on findings from a research project in Malawi, supported by the Department for International Development (DFID), that explored the links that exist between employers and the higher…

Outcomes of Antiretroviral Treatment in Programmes with and without Routine Viral Load Monitoring in Southern Africa

PubMed Central

Keiser, Olivia; Chi, Benjamin H.; Gsponer, Thomas; Boulle, Andrew; Orrell, Catherine; Phiri, Sam; Maxwell, Nicola; Maskew, Mhairi; Prozesky, Hans; Fox, Matthew P; Westfall, Andrew; Egger, Matthias

2013-01-01

Objectives To compare outcomes of antiretroviral therapy (ART) in South Africa, where viral load monitoring is routine, with Malawi and Zambia, where monitoring is based on CD4 cell counts. Methods We included 18,706 adult patients starting ART in South Africa and 80,937 patients starting in Zambia or Malawi. We examined CD4 responses in models for repeated measures, and the probability of switching to second-line regimens, mortality and loss to follow-up in multi-state models, measuring time from six months. Findings In South Africa 9.8% (9.1–10.5%) had switched at 3 years, 1.3% (95% CI 0.9–1.6%) remained on failing first-line regimens, 9.2% (8.5–9.8%) were lost to follow-up and 4.3% (3.9–4.8%) had died. In Malawi and Zambia more patients were on a failing first-line regimen (3.7%, 3.6–3.9%), fewer patients had switched (2.1%, 2.0–2.3%) and more patients were lost (15.3%, 15.0–15.6%) or had died (6.3%, 6.0–6.5%). Median CD4 cell counts were lower in South Africa at start of ART (93 vs. 132 cells/µL, p<0.001) but higher after 3 years (425 vs. 383 cells/µL, p<0.001). The hazard ratio comparing South Africa with Malawi and Zambia, adjusted for age, sex, first-line regimen and CD4 cell count, was 0.58 (95% CI 0.50–0.66) for death and 0.53 (0.48–0.58) for loss to follow-up. Conclusions Over 3 years of ART mortality was lower in South Africa than in Malawi or Zambia. The more favourable outcome in South Africa might be explained by viral load monitoring leading to earlier detection of treatment failure, adherence counselling and timelier switching to second-line ART. PMID:21681057

Implementing Free Primary Education Policy in Malawi and Ghana: Equity and Efficiency Analysis

ERIC Educational Resources Information Center

Inoue, Kazuma; Oketch, Moses

2008-01-01

Malawi and Ghana are among the numerous Sub-Saharan Africa countries that have in recent years introduced Free Primary Education (FPE) policy as a means to realizing the 2015 Education for All and Millennium Development Goals international targets. The introduction of FPE policy is, however, a huge challenge for any national government that has…

ARE LITERACY SKILLS ASSOCIATED WITH YOUNG ADULTS’ HEALTH IN AFRICA? EVIDENCE FROM MALAWI

PubMed Central

Smith-Greenaway, Emily

2014-01-01

This study investigates whether literacy skills are a distinct dimension of education that influences young adults’ health in the southeast African context of Malawi. It uses new data from Tsogolo la Thanzi, a study of young adults in southern Malawi, to achieve three aims. The first is descriptive: to demonstrate a direct assessment for measuring literacy in a population-based survey, and show that it captures variability in skills among young adults, including those with comparable levels of educational attainment. The second aim is to identify whether literacy influences young adults’ health—net of their educational attainment and other confounding factors. Multivariate analyses reveal that literacy is associated with two measures of physical health: self-rated health and prolonged sickness. Because literacy is a key determinant of health, the third aim is to provide insight into how to measure it: can commonly used indirect approaches to estimating literacy (e.g., based on educational attainment or self-reports), accurately capture its prevalence and relationship with health? In a second set of analyses, bivariate results show whether, and the extent to which, indirect measures of literacy overestimate literacy’s prevalence, and multivariate models assess whether indirect estimates of literacy capture its relationship with health. The findings support future efforts to incorporate literacy assessments into population surveys to accurately estimate literacy’s prevalence and health benefits, particularly in contexts like Malawi where access to high-quality schools remains limited. PMID:25164414

Research Capacity for Local Innovation: The Case of Conservation Agriculture in Ethiopia, Malawi and Mozambique

ERIC Educational Resources Information Center

Brown, Brendan; Nuberg, Ian; Llewellyn, Rick

2018-01-01

Purpose: The limited uptake of improved agricultural practices in Africa raise questions on the functionality of current agricultural research systems. Our purpose is to explore the capacity for local innovation within the research systems of Ethiopia, Malawi and Mozambique. Design/Methodology/Approach: Using Conservation Agriculture (CA) as a…

Lake Chad, Chad, Africa

NASA Technical Reports Server (NTRS)

1992-01-01

Hydrologic and ecologic changes in the Lake Chad Basin are shown in this Oct 1992 photograph. In space photo documentation, Lake Chad was at its greatest area extent (25,000 sq. km.) during Gemini 9 in June 1966 (see S66-38444). Its reduction during the severe droughts from 1968 to 1974 was first noted during Skylab (1973-1974). After the drought began again in 1982, the lake reached its minimum extent (1,450 sq. km.) in Space Shuttle photographs taken in 1984 and 1985. In this STS-52 photograph, Lake Chad has begun to recover. The area of the open water and interdunal impoundments in the southern basin (the Chari River Basin) is estimated to be 1,900 to 2100 sq. km. Note the green vegetation in the valley of the K'Yobe flow has wetted the northern lake basin for the first time in several years. There is evidence of biomass burning south of the K'Yobe Delta and in the vegetated interdunal areas near the dike in the center of the lake. Also note the dark 'Green Line' of the Sahel (the g

Applying a Reading Program Based on Cognitive Science in Rural Areas of Malawi: Preliminary Results

ERIC Educational Resources Information Center

Iyengar, Radhika; Karim, Alia; Chagwira, Florie

2016-01-01

Reading fluency is a skill foundational to academic performance, and acquiring this skill in early grades is crucial. Throughout sub-Saharan Africa, reading levels of students are far below grade level, and Malawi is no exception. Research suggests that students, particularly in consistently spelled languages, acquire automaticity most easily by…

Lake Challa (Mt. Kilimanjaro) sediments as recorder of present and past seasonality in equatorial East Africa

NASA Astrophysics Data System (ADS)

Kristen, I.; Wolff, C.; Schettler, G.; Dulski, P.; Naumann, R.; Haug, G. H.; Blaauw, M.; Verschuren, D.

2008-12-01

In discussions on the impact of global warming on moisture balance and human water resources, natural archives of past hydrological variability in tropical regions are attracting increasing attention. The EuroCLIMATE project CHALLACEA studies the sediment archive of Lake Challa, a 4.5 km² and ~94 m deep crater lake located on the lower eastern slope of Mt. Kilimanjaro with the aim to produce a continuous, high-resolution and multi-proxy reconstruction of past temperature and moisture-balance variability in equatorial East Africa over the past 25,000 years. Lake Challa is a freshwater lake with a water budget controlled mostly by sub-surface in- and outflow and lake-surface evaporation. Accordingly, microscopic thin-section investigation of sediment composition reveals an overall dominance of autochthonous components (diatom frustules, calcite, and organic matter). First results from an ongoing sediment trap study point to distinct seasonality in sediment input: calcite and organic matter accumulate during the warm southern hemisphere summer months (November - March), whereas the principal diatom blooms occur during the cool and windy period between June and October. Here we present the results of physical and chemical investigations of the lake water column between September 1999 and November 2007, which document the concomitant seasonal changes in lake mixing/stratification and related element cycling. High-resolution μXRF profiles of these elements in the laminated sediments of Lake Challa thus also show marked seasonal cycles, as well as longer-term variability. In particular, variability in the Mn/Fe ratio along the top 15 cm of the sediment record is interpreted to reflect changes in lake stratification during the last ~100 years. This proxy record is evaluated in comparison with records of historical weather variability in East Africa, and of potentially influencing parameters such as the El Niño Southern Oscillation and the Indian Ocean Dipole. Eventually

Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

PubMed

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

PubMed Central

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777

Sediment resuspension in a shallow lake with muddy substrates: St Lucia, South Africa

NASA Astrophysics Data System (ADS)

Zikhali, Vulindlela; Tirok, Katrin; Stretch, Derek

2015-10-01

Wind-driven sediment resuspension affects the physical and biological environment of the water column in shallow estuarine lakes. This study investigated the relationship between wind-driven waves and suspended sediment concentration (SSC) using the 33 km2 South Lake basin of Lake St Lucia, South Africa as a case study. Five wave poles measuring significant wave height and turbidity were deployed over an aggregate period of twenty days at distributed locations where sediment substrate compositions varied from muddy to sandy and depths ranged from 0.7 m to 2.1 m. The resulting turbidity dynamics were used to test a simple depth-averaged model of suspended sediment concentrations. The model performed best in the muddy regions of the lake and was able to simulate the resuspension dynamics more accurately than the settling dynamics. Peak suspended sediment concentration levels were best captured for the deeper muddy locations. The model provides a means to make spatially explicit predictions of suspended sediment concentrations that can be used to understand the forcing mechanisms for primary producer growth and distribution or to improve sediment budget calculations.

Three genetic groups of the Eucalyptus stem canker pathogen Teratosphaeria zuluensis introduced into Africa from an unknown source.

PubMed

Jimu, Luke; Chen, ShuaiFei; Wingfield, Michael J; Mwenje, Eddie; Roux, Jolanda

2016-01-01

The Eucalyptus stem canker pathogen Teratosphaeria zuluensis was discovered in South Africa in 1988 and it has subsequently been found in several other African countries as well as globally. In this study, the population structure, genetic diversity and evolutionary history of T. z uluensis were analysed using microsatellite markers to gain an enhanced understanding of its movement in Africa. Isolates were collected from several sites in Malawi, Mozambique, Uganda and Zambia. Data obtained were compared with those previously published for a South African population. The data obtained from 334 isolates, amplified across eight microsatellite loci, were used for assignment, differentiation and genetic diversity tests. STRUCTURE analyses, θ st and genetic distances revealed the existence of two clusters, one dominated by isolates from South Africa and the other by isolates from the Zambezi basin including Malawi, Mozambique and Zambia. High levels of admixture were found within and among populations, dominated by the Mulanje population in Malawi. Moderate to low genetic diversity of the populations supports the previously held view that the pathogen was introduced into Africa. The clonal nature of the Ugandan population suggests a very recent introduction, most likely from southern Africa.

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

PubMed

Wang, Qun; Fu, Alex Z; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Out-of-Pocket Expenditure on Chronic Non-Communicable Diseases in Sub-Saharan Africa: The Case of Rural Malawi

PubMed Central

Wang, Qun; Fu, Alex Z.; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy. PMID:25584960

First Responders and Prehospital Care for Road Traffic Injuries in Malawi.

PubMed

Chokotho, Linda; Mulwafu, Wakisa; Singini, Isaac; Njalale, Yasin; Maliwichi-Senganimalunje, Limbika; Jacobsen, Kathryn H

2017-02-01

Introduction Road traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians. Problem This study examined the challenges associated with current first response practices in Malawi. In April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer. Access to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services. Prehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals. Chokotho L , Mulwafu W , Singini I , Njalale Y , Maliwichi-Senganimalunje L , Jacobsen KH . First responders and prehospital care for road traffic injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14-19.

Assessing and Responding to Palliative Care Needs in Rural Sub-Saharan Africa: Results from a Model Intervention and Situation Analysis in Malawi

PubMed Central

Kalanga, Noel; Keck, James W.; Wroe, Emily B.; Phiri, Atupere; Mayfield, Alishya; Chingoli, Felix; Beste, Jason A.; Tengatenga, Listern; Bazile, Junior

2014-01-01

Introduction Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understand palliative care needs, knowledge, and preferences. Methods Employing rapid evaluation methodology, we collected data from 3 sources: 1) chart review of all adult patients from the NPCP’s first 9 months; 2) structured interviews with patients and caregivers; 3) semi-structured interviews with key stakeholders. Results The NPCP enrolled 63 patients in its first 9 months. Frequent diagnoses were cancer (n = 50, 79%) and HIV/AIDS (n = 37 of 61, 61%). Nearly all (n = 31, 84%) patients with HIV/AIDS were on antiretroviral therapy. Providers registered 112 patient encounters, including 22 (20%) home visits. Most (n = 43, 68%) patients had documented pain at baseline, of whom 23 (53%) were treated with morphine. A majority (n = 35, 56%) had ≥1 follow-up encounter. Mean African Palliative Outcome Scale pain score decreased non-significantly between baseline and follow-up (3.0 vs. 2.7, p = 0.5) for patients with baseline pain and complete pain assessment documentation. Providers referred 48 (76%) patients for psychosocial services, including community health worker support, socioeconomic assistance, or both. We interviewed 36 patients referred to the NPCP after the chart review period. Most had cancer (n = 19, 53%) or HIV/AIDS (n = 10, 28%). Patients frequently reported needing income (n = 24, 67%) or food (n = 22, 61%). Stakeholders cited a need to make integrated palliative care widely available. Conclusions We identified a high prevalence of pain and psychosocial needs among patients with serious chronic illnesses in rural Malawi. Early NPCP results suggest that comprehensive palliative care can be provided in rural

The Score Reliability of Draw-a-Person Intellectual Ability Test (DAP: IQ) for Rural Malawi Students

ERIC Educational Resources Information Center

Khasu, Denis S.; Williams, Thomas O., Jr.

2016-01-01

In this brief article, the reliability of scores for the Draw-A-Person Intellectual Ability Test for Children, Adolescents, and Adults (DAP: IQ; Reynolds & Hickman, 2004) was examined through several analyses with a sample of 147 children from rural Malawi, Africa using a Chichewa translation of instructions. Cronbach alpha coefficients for…

Sunspots, El Niño, and the levels of Lake Victoria, East Africa

NASA Astrophysics Data System (ADS)

Stager, J. Curt; Ruzmaikin, Alexander; Conway, Declan; Verburg, Piet; Mason, Peter J.

2007-08-01

An association of high sunspot numbers with rises in the level of Lake Victoria, East Africa, has been the focus of many investigations and vigorous debate during the last century. In this paper, we show that peaks in the ~11-year sunspot cycle were accompanied by Victoria level maxima throughout the 20th century, due to the occurrence of positive rainfall anomalies ~1 year before solar maxima. Similar patterns also occurred in at least five other East African lakes, which indicates that these sunspot-rainfall relationships were broadly regional in scale. Although irradiance fluctuations associated with the sunspot cycle are weak, their effects on tropical rainfall could be amplified through interactions with sea surface temperatures and atmospheric circulation systems, including ENSO. If this Sun-rainfall relationship persists in the future, then sunspot cycles can be used for long-term prediction of precipitation anomalies and associated outbreaks of insect-borne disease in much of East Africa. In that case, unusually wet rainy seasons and Rift Valley Fever epidemics should occur a year or so before the next solar maximum, which is expected to occur in 2011-2012 AD.

Barriers to pilot mobile teleophthalmology in a rural hospital in Southern Malawi.

PubMed

Pérez, Guillermo Martínez; Swart, Wayne; Munyenyembe, Jimmy Kondwani; Saranchuk, Peter

2014-01-01

Malawi has one of the highest HIV prevalences in Sub-Saharan Africa. The rate of eligible HIV-infected people being initiated on antiretroviral therapy (ART) and retained in HIV-care is currently far from adequate. Consequently, many people continue present with advanced immunosuppression at public health facilities, often with undiagnosed opportunistic infections (OIs). In this context, mHealth was the innovation chosen to assist Eye Clinical Officers in early diagnosis of HIV-related diseases having eye manifestations in a rural hospital in Thyolo, Southern Malawi. The mTeleophthalmology program began in October 2013, but was stopped prematurely due to organizational and technological barriers that compromised its feasibility. Sharing these barriers might be useful to inform the design of similar innovations in other resource-limited settings with a high HIV prevalence and a dearth of eye specialists with capacity to diagnose HIV-related retinopathies.

Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique.

PubMed

Bergmann, Julie N; Legins, Kenneth; Sint, Tin Tin; Snidal, Sarah; Amor, Yanis Ben; McCord, Gordon C

2017-03-01

This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi's program had a cost-effectiveness of $11-29/DALY, while Mozambique's was $16-59/DALY. Some components were more effective than others ($1-4/DALY for Malawi's Male motivators vs. $179/DALY for Mozambique's One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.

A Review of Community Extension Approaches to Innovation for Improved Livelihoods in Ghana, Uganda and Malawi

ERIC Educational Resources Information Center

Wellard, Kate; Rafanomezana, Jenny; Nyirenda, Mahara; Okotel, Misaki; Subbey, Vincent

2013-01-01

Purpose: Farmer-to-farmer extension offers a potentially low-cost and wide-reach alternative in supporting agricultural innovation. Various approaches are being promoted but information on their impact and sustainability is sparse. This study examines experiences of Self Help Africa and partners in Ghana, Uganda and Malawi. It asks: What is good…

Primary production in a tropical large lake: the role of phytoplankton composition.

PubMed

Darchambeau, F; Sarmento, H; Descy, J-P

2014-03-01

Phytoplankton biomass and primary production in tropical large lakes vary at different time scales, from seasons to centuries. We provide a dataset made of 7 consecutive years of phytoplankton biomass and production in Lake Kivu (Eastern Africa). From 2002 to 2008, bi-weekly samplings were performed in a pelagic site in order to quantify phytoplankton composition and biomass, using marker pigments determined by HPLC. Primary production rates were estimated by 96 in situ (14)C incubations. A principal component analysis showed that the main environmental gradient was linked to a seasonal variation of the phytoplankton assemblage, with a clear separation between diatoms during the dry season and cyanobacteria during the rainy season. A rather wide range of the maximum specific photosynthetic rate (PBm) was found, ranging between 1.15 and 7.21 g carbong(-1)chlorophyll ah(-1), and was best predicted by a regression model using phytoplankton composition as an explanatory variable. The irradiance at the onset of light saturation (Ik) ranged between 91 and 752 μE m(-2)s(-1) and was linearly correlated with the mean irradiance in the mixed layer. The inter-annual variability of phytoplankton biomass and production was high, ranging from 53 to 100 mg chlorophyll am(-2) (annual mean) and from 143 to 278 g carbon m(-2)y(-1), respectively. The degree of seasonal mixing determined annual production, demonstrating the sensitivity of tropical lakes to climate variability. A review of primary production of other African great lakes allows situating Lake Kivu productivity in the same range as that of lakes Tanganyika and Malawi, even if mean phytoplankton biomass was higher in Lake Kivu. Copyright © 2013 Elsevier B.V. All rights reserved.

Understanding the earth systems of Malawi: Ecological sustainability, culture, and place-based education

NASA Astrophysics Data System (ADS)

Glasson, George E.; Frykholm, Jeffrey A.; Mhango, Ndalapa A.; Phiri, Absalom D.

2006-07-01

The purpose of this 2-year study was to investigate Malawian teacher educators' perspectives and dispositions toward teaching about ecological sustainability issues in Malawi, a developing country in sub-Sahara Africa. This study was embedded in a larger theoretical framework of investigating earth systems science through the understanding of nature-knowledge-culture systems from local, place-based perspectives. Specifically, we were interested in learning more about eco-justice issues that are related to environmental degradation in Malawi and the potential role of inquiry-oriented pedagogies in addressing these issues. In a science methods course, the African educators' views on deforestation and teaching about ecological sustainability were explored within the context of the local environment and culture. Teachers participated in inquiry pedagogies designed to promote the sharing of perspectives related to the connections between culture and ecological degradation. Strategies encouraging dialogue and reflection included role-playing, class discussions, curriculum development activities, teaching experiences with children, and field trips to a nature preserve. Data were analyzed from postcolonial and critical pedagogy of place theoretical perspectives to better understand the hybridization of viewpoints influenced by both Western and indigenous science and the political hegemonies that impact sustainable living in Malawi. Findings suggested that the colonial legacy of Malawi continues to impact the ecological sustainability issue of deforestation. Inquiry-oriented pedagogies and connections to indigenous science were embraced by the Malawian educators as a means to involve children in investigation, decision making, and ownership of critical environmental issues.

What can health care professionals in the United Kingdom learn from Malawi?

PubMed Central

Neville, Ron; Neville, Jemma

2009-01-01

Debate on how resource-rich countries and their health care professionals should help the plight of sub-Saharan Africa appears locked in a mind-set dominated by gloomy statistics and one-way monetary aid. Having established a project to link primary care clinics based on two-way sharing of education rather than one-way aid, our United Kingdom colleagues often ask us: "But what can we learn from Malawi?" A recent fact-finding visit to Malawi helped us clarify some aspects of health care that may be of relevance to health care professionals in the developed world, including the United Kingdom. This commentary article is focused on encouraging debate and discussion as to how we might wish to re-think our relationship with colleagues in other health care environments and consider how we can work together on a theme of two-way shared learning rather than one-way aid. PMID:19327137

Barriers to pilot mobile teleophthalmology in a rural hospital in Southern Malawi

PubMed Central

Pérez, Guillermo Martínez; Swart, Wayne; Munyenyembe, Jimmy Kondwani; Saranchuk, Peter

2014-01-01

Introduction Malawi has one of the highest HIV prevalences in Sub-Saharan Africa. The rate of eligible HIV-infected people being initiated on antiretroviral therapy (ART) and retained in HIV-care is currently far from adequate. Consequently, many people continue present with advanced immunosuppression at public health facilities, often with undiagnosed opportunistic infections (OIs). Methods In this context, mHealth was the innovation chosen to assist Eye Clinical Officers in early diagnosis of HIV-related diseases having eye manifestations in a rural hospital in Thyolo, Southern Malawi. Results The mTeleophthalmology program began in October 2013, but was stopped prematurely due to organizational and technological barriers that compromised its feasibility. Conclusion Sharing these barriers might be useful to inform the design of similar innovations in other resource-limited settings with a high HIV prevalence and a dearth of eye specialists with capacity to diagnose HIV-related retinopathies. PMID:25767656

From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

PubMed Central

2011-01-01

Background Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure. Methods/Design The international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations. Results An integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230). Discussion The PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of

HIV and mental illness in Malawi and the neuropsychiatric sequelae of efavirenz.

PubMed

Drury, Andrew; Gleadow-Ware, Selena; Gilfillan, Sheila; Ahrens, Jen

2018-03-01

Little is published about mental disorders in Malawi, specifically in relation to Human Immunodeficiency Virus (HIV) and it's treatment. Efavirenz is a medication commonly used as part of triple therapy for HIV treatment. Indeed, in 2013, Malawi introduced 5A with Efavirenz as part of it's 1st line treatment for HIV. There exists some literature documenting known psychiatric side effects of Efavirenz, which include anxiety, mood changes, nightmares, psychosis and suicidal ideation. Little is known about what features are most common in the presentation and what factors in the patient and drug which may make this reaction more likely. The aim of this commentary is to review the association between HIV and psychiatric disorder, and consider the neuropsychiatric side-effects of Efavirenz. An evaluative literature review was completed by means of multiple electronic database search as well as an additional manual search to obtain published works identified through the electronic search. Search terms used were: Efavirenz, Acquired Immunodeficiency Syndrome, Africa, Antiretroviral Therapy, Developing Countries, Malawi, Mental Disorders, Public Health, and Psychiatry. This is an important area of study, as potentially large numbers of individuals with HIV are being placed on Efavirenz as first line treatment, yet 60% may experience some form of neuropsychiatric side effects.

Exposure to violence predicts poor educational outcomes in young children in South Africa and Malawi

PubMed Central

Sherr, L.; Hensels, I. S.; Skeen, S.; Tomlinson, M.; Roberts, K. J.; Macedo, A.

2016-01-01

Background Violence during childhood may affect short and long-term educational factors. There is scant literature on younger children from resource poor settings. Methods This study assessed child violence experiences (harsh punishment and exposure to domestic or community violence) and school enrolment, progress and attendance in children attending community-based organisations in South Africa and Malawi (n=989) at baseline and at 15 months' follow-up, examining differential experience of HIV positive, HIV affected and HIV unaffected children. Results Violence exposure was high: 45.4% experienced some form of psychological violence, 47.8% physical violence, 46.7% domestic violence and 41.8% community violence. Primary school enrolment was 96%. Violence was not associated with school enrolment at baseline but, controlling for baseline, children exposed to psychological violence for discipline were more than ten times less likely to be enrolled at follow-up (OR 0.09; 95% CI 0.01 to 0.57). Harsh discipline was associated with poor school progress. For children HIV positive a detrimental effect of harsh physical discipline was found on school performance (OR 0.10; 95% CI 0.02 to 0.61). Conclusion Violence experiences were associated with a number of educational outcomes, which may have long-term consequences. Community-based organisations may be well placed to address such violence, with a particular emphasis on the challenges faced by children who are HIV positive. PMID:26678567

Earth Observation

NASA Image and Video Library

2011-07-23

ISS028-E-018675 (23 July 2011) --- Biomass burning in southern Africa is featured in this image photographed by an Expedition 28 crew member on the International Space Station. A smoke pall of subcontinental proportions dominates this view of tropical southern Africa. In what has been described as the most fire-prone part of the world, numerous fires give rise to regional smoke palls every dry season. Fires are both natural and set by local people to clear woodland for agricultural fields. This recent, oblique, northwest-looking view taken in July 2011 at the end of the dry season shows the extent of the smoke on the African plateau?from central Zimbabwe (lower left) to northern Malawi more than 1,000 kilometers away (top right)?and in the wide coastal plains of the lower Zambezi River valley of Mozambique (lower right). Here smoke can be seen blowing inland (left to right), channeled up the Zambezi River valley and contributing to the pall on the plateau. The light gray smoke plumes contrast with higher altitude, brighter patchy cloud cover at lower right. The smoke palls obscure much surface detail, so that Lake Malawi, one of Africa?s Great Lakes, is barely visible, as is Lake Cahora Bassa, Africa?s fourth largest reservoir, in the Zambezi valley. The sun?s reflection off its surface (sunglint) makes Lake Kariba most prominent in the view at left. Kariba is the world?s largest artificial reservoir by volume, and is 220 kilometers long, giving a sense of the scale of the view. The steep, shadowed, mid-afternoon faces of the Inyanga Mountains on the Mozambique-Zimbabwe border protrude above the smoke layer at lower left. Solar panels extending from Russian spacecraft docked at the International Space Station are visible in the foreground at left.

OUTLINE OF VOCATIONAL TRAINING IN MALAWI.

ERIC Educational Resources Information Center

Australian Dept. of Labour and National Service, Perth.

THE 1963 POPULATION OF MALAWI WAS 3,753,000. MALAWI'S ECONOMY IS BASED ON AGRICULTURE. PRIMARY EDUCATION COVERS 8 YEARS AND ENROLLS 98 PERCENT OF THE 380,000 PUPILS IN SCHOOL. TECHNICAL SCHOOLS INCLUDE TRADE- AND TECHNICIAN-ORIENTED PROGRAMS UNDER THE MINISTRY OF EDUCATION. A NEW UNIVERSITY OF MALAWI INCLUDES NO COURSES OF A TECHNICAL NATURE, BUT…

Cholera outbreaks in Malawi in 1998-2012: social and cultural challenges in prevention and control.

PubMed

Msyamboza, Kelias Phiri; Kagoli, Mathew; M'bang'ombe, Maurice; Chipeta, Sikhona; Masuku, Humphrey Dzanjo

2014-06-11

Cholera still remains a significant cause of morbidity and mortality in developing countries, although comprehensive surveillance data to inform policy and strategies are scarce. A desk review of the national cholera database and zonal and districts reports was conducted. Interviews were conducted with district health management teams, health workers, and participants in communities in six districts affected by cholera in 2011/2012 to obtain data on water, sanitation, and sociocultural issues. From 1998 to 2012, cholera outbreaks occurred every year in Malawi, with the highest number of cases and deaths reported in 2001/2002 (33,546 cases, 968 deaths; case fatality rate [CFR] 2.3%). In 2011/2012, cholera outbreak was widespread in the southern region, affecting 10 out of 13 districts, where 1,806 cases and 38 deaths (CFR 2.1%) were reported. Unsafe water sources, lack of maintenance of broken boreholes, frequent breakdown of piped water supply, low coverage of pit latrines (range 40%-60%), lack of hand washing facilities (< 5%), salty borehole water, fishermen staying on Lake Chilwa, cross-border Malawi-Mozambique disease spread, and sociocultural issues were some of the causes of the persistent cholera outbreaks in Malawi. Despite improvements in safe drinking water and sanitation, cholera is still a major public health problem. Introduction of a community-led total sanitation approach, use of social and cultural information in community mobilization strategies, and introduction of an oral cholera vaccine could help to eliminate cholera in Malawi.

Explanations for Child Sexual Abuse Given by Convicted Offenders in Malawi: No Evidence for "HIV Cleansing"

ERIC Educational Resources Information Center

Mtibo, Charles; Kennedy, Neil; Umar, Eric

2011-01-01

Objective: A commonly cited, but unproven reason given for the rise in reported cases of child sexual abuse in Sub-Saharan Africa is the "HIV cleansing myth"--the belief that an HIV infected individual can be cured by having sex with a child virgin. The purpose of this study was to explore in Malawi the reasons given by convicted sex…

Inclusion and Human Rights in Health Policies: Comparative and Benchmarking Analysis of 51 Policies from Malawi, Sudan, South Africa and Namibia

PubMed Central

MacLachlan, Malcolm; Amin, Mutamad; Mannan, Hasheem; El Tayeb, Shahla; Bedri, Nafisa; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert; McVeigh, Joanne

2012-01-01

While many health services strive to be equitable, accessible and inclusive, peoples’ right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed – EquiFrame – to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development. PMID:22649488

Vegetation controls on weathering intensity during the last deglacial transition in southeast Africa

USGS Publications Warehouse

Ivory, Sarah J.; McGlue, Michael M.; Ellis, Geoffrey S.; Lézine, Anne-Marie; Cohen, Andrew S.; Vincens, Annie

2015-01-01

Tropical climate is rapidly changing, but the effects of these changes on the geosphere are unknown, despite a likelihood of climatically-induced changes on weathering and erosion. The lack of long, continuous paleo-records prevents an examination of terrestrial responses to climate change with sufficient detail to answer questions about how systems behaved in the past and may alter in the future. We use high-resolution records of pollen, clay mineralogy, and particle size from a drill core from Lake Malawi, southeast Africa, to examine atmosphere-biosphere-geosphere interactions during the last deglaciation (~18–9 ka), a period of dramatic temperature and hydrologic changes. The results demonstrate that climatic controls on Lake Malawi vegetation are critically important to weathering processes and erosion patterns during the deglaciation. At 18 ka, afromontane forests dominated but were progressively replaced by tropical seasonal forest, as summer rainfall increased. Despite indication of decreased rainfall, drought-intolerant forest persisted through the Younger Dryas (YD) resulting from a shorter dry season. Following the YD, an intensified summer monsoon and increased rainfall seasonality were coeval with forest decline and expansion of drought-tolerant miombo woodland. Clay minerals closely track the vegetation record, with high ratios of kaolinite to smectite (K/S) indicating heavy leaching when forest predominates, despite variable rainfall. In the early Holocene, when rainfall and temperature increased (effective moisture remained low), open woodlands expansion resulted in decreased K/S, suggesting a reduction in chemical weathering intensity. Terrigenous sediment mass accumulation rates also increased, suggesting critical linkages among open vegetation and erosion during intervals of enhanced summer rainfall. This study shows a strong, direct influence of vegetation composition on weathering intensity in the tropics. As climate change will likely impact

Vegetation controls on weathering intensity during the last deglacial transition in southeast Africa.

PubMed

Ivory, Sarah J; McGlue, Michael M; Ellis, Geoffrey S; Lézine, Anne-Marie; Cohen, Andrew S; Vincens, Annie

2014-01-01

Tropical climate is rapidly changing, but the effects of these changes on the geosphere are unknown, despite a likelihood of climatically-induced changes on weathering and erosion. The lack of long, continuous paleo-records prevents an examination of terrestrial responses to climate change with sufficient detail to answer questions about how systems behaved in the past and may alter in the future. We use high-resolution records of pollen, clay mineralogy, and particle size from a drill core from Lake Malawi, southeast Africa, to examine atmosphere-biosphere-geosphere interactions during the last deglaciation (∼ 18-9 ka), a period of dramatic temperature and hydrologic changes. The results demonstrate that climatic controls on Lake Malawi vegetation are critically important to weathering processes and erosion patterns during the deglaciation. At 18 ka, afromontane forests dominated but were progressively replaced by tropical seasonal forest, as summer rainfall increased. Despite indication of decreased rainfall, drought-intolerant forest persisted through the Younger Dryas (YD) resulting from a shorter dry season. Following the YD, an intensified summer monsoon and increased rainfall seasonality were coeval with forest decline and expansion of drought-tolerant miombo woodland. Clay minerals closely track the vegetation record, with high ratios of kaolinite to smectite (K/S) indicating heavy leaching when forest predominates, despite variable rainfall. In the early Holocene, when rainfall and temperature increased (effective moisture remained low), open woodlands expansion resulted in decreased K/S, suggesting a reduction in chemical weathering intensity. Terrigenous sediment mass accumulation rates also increased, suggesting critical linkages among open vegetation and erosion during intervals of enhanced summer rainfall. This study shows a strong, direct influence of vegetation composition on weathering intensity in the tropics. As climate change will likely

How are health professionals earning their living in Malawi?

PubMed Central

Muula, Adamson S; Maseko, Fresier C

2006-01-01

Background The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. Methods The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. Results Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. Conclusion Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health

Malaria research in Malawi from 1984 to 2016: a literature review and bibliometric analysis.

PubMed

Mwendera, Chikondi A; de Jager, Christiaan; Longwe, Herbert; Hongoro, Charles; Mutero, Clifford M; Phiri, Kamija S

2017-06-12

Malaria research can play a vital role in addressing the malaria burden in Malawi. An organized approach in addressing malaria in Malawi started in 1984 by the establishment of the first National Malaria Control Programme and research was recognized to be significant. This study aimed to assess the type and amount of malaria research conducted in Malawi from 1984 to 2016 and its related source of funding. A systematic literature search was conducted in the Medline/PubMed database for Malawian publications and approved malaria studies from two Ethical Committees were examined. Bibliometric analysis was utilized to capture the affiliations of first and senior/last authors, funding acknowledgements, while titles, abstracts and accessed full text were examined for research type. A total of 483 publications and 165 approved studies were analysed. Clinical and basic research in the fields of malaria in pregnancy 105 (21.5%), severe malaria 97 (20.1%) and vector and/or agent dynamics 69 (14.3%) dominated in the publications while morbidity 33 (20%), severe malaria 28 (17%) and Health Policy and Systems Research 24 (14.5%) dominated in the approved studies. In the publications, 146 (30%) first authors and 100 (21%) senior authors, and 88 (53.3%) principal investigators in approved studies were affiliated to Malawian-based institutions. Most researchers were affiliated to the Malawi-Liverpool Wellcome Trust, College of Medicine, Blantyre Malaria Project, Ministry of Health, and Malaria Alert Centre. The major malaria research funders were the National Institute for Health/USA, Wellcome Trust and the US Agency for International Development. Only three (2.5%) out of 118 journals publishing research on malaria in Malawi were from Africa and the Malaria Journal, with 76 (15.7%) publications, published most of the research from Malawi, followed by the American Journal of Tropical Medicine and Hygiene with 57 (11.8%) in comparison to only 13 (2.7%) published in the local Malawi

Health Selection, Migration, and HIV Infection in Malawi.

PubMed

Anglewicz, Philip; VanLandingham, Mark; Manda-Taylor, Lucinda; Kohler, Hans-Peter

2018-04-27

Despite its importance in studies of migrant health, selectivity of migrants-also known as migration health selection-has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA-very high levels of HIV, in particular-differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.

Exposure to violence predicts poor educational outcomes in young children in South Africa and Malawi.

PubMed

Sherr, L; Hensels, I S; Skeen, S; Tomlinson, M; Roberts, K J; Macedo, A

2016-01-01

Violence during childhood may affect short and long-term educational factors. There is scant literature on younger children from resource poor settings. This study assessed child violence experiences (harsh punishment and exposure to domestic or community violence) and school enrolment, progress and attendance in children attending community-based organisations in South Africa and Malawi (n=989) at baseline and at 15 months' follow-up, examining differential experience of HIV positive, HIV affected and HIV unaffected children. Violence exposure was high: 45.4% experienced some form of psychological violence, 47.8% physical violence, 46.7% domestic violence and 41.8% community violence. Primary school enrolment was 96%. Violence was not associated with school enrolment at baseline but, controlling for baseline, children exposed to psychological violence for discipline were more than ten times less likely to be enrolled at follow-up (OR 0.09; 95% CI 0.01 to 0.57). Harsh discipline was associated with poor school progress. For children HIV positive a detrimental effect of harsh physical discipline was found on school performance (OR 0.10; 95% CI 0.02 to 0.61). Violence experiences were associated with a number of educational outcomes, which may have long-term consequences. Community-based organisations may be well placed to address such violence, with a particular emphasis on the challenges faced by children who are HIV positive. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Regional nitrogen budget of the Lake Victoria Basin, East Africa: syntheses, uncertainties and perspectives

NASA Astrophysics Data System (ADS)

Zhou, Minghua; Brandt, Patric; Pelster, David; Rufino, Mariana C.; Robinson, Timothy; Butterbach-Bahl, Klaus

2014-10-01

Using the net anthropogenic nitrogen input (NANI) approach we estimated the N budget for the Lake Victoria Basin in East Africa. The NANI of the basin ranged from 887 to 3008 kg N km-2 yr-1 (mean: 1827 kg N km-2 yr-1) for the period 1995-2000. The net nitrogen release at basin level is due primarily to livestock and human consumption of feed and foods, contributing between 69% and 85%. Atmospheric oxidized N deposition contributed approximately 14% to the NANI of the Lake Victoria Basin, while either synthetic N fertilizer imports or biological N fixations only contributed less than 6% to the regional NANI. Due to the low N imports of feed and food products (<20 kg N km-2 yr-1), nitrogen release to the watershed must be derived from the mining of soil N stocks. The fraction of riverine N export to Lake Victoria accounted for 16%, which is much lower than for watersheds located in Europe and USA (25%). A significant reduction of the uncertainty of our N budget estimate for Lake Victoria Basin would be possible if better data on livestock systems and riverine N export were available. Our study indicates that at present soil N mining is the main source of nitrogen in the Lake Victoria Basin. Thus, sustainable N management requires increasing agricultural N inputs to guarantee food security and rehabilitation and protection of soils to minimize environmental costs. Moreover, to reduce N pollution of the lake, improving management of human and animal wastes needs to be carefully considered in future.

Wind-driven circulation patterns in a shallow estuarine lake: St Lucia, South Africa

NASA Astrophysics Data System (ADS)

Schoen, Julia H.; Stretch, Derek D.; Tirok, Katrin

2014-06-01

The spatiotemporal structure of wind-driven circulation patterns and associated water exchanges or residence times can drive important bio-hydrodynamic interactions in shallow lakes and estuaries. The St Lucia estuarine lake in South Africa is an example of such a system. It is a UNESCO World Heritage Site and RAMSAR wetland of international importance but no detailed research on its circulation patterns has previously been undertaken. In this study, a hydrodynamic model was used to investigate the structure of these circulations to provide insights into their role in transport and water exchange processes. A strong diurnal temporal pattern of wind speeds, together with directional switching between two dominant directions, drives intermittent water exchanges and mixing between the lake basins. “High speed flows in shallow nearshore areas with slower upwind counter-flows in deeper areas, linked by circulatory gyres, are key features of the circulation”. These patterns are strongly influenced by the complex geometry of St Lucia and constrictions in the system. Water exchange time scales are non-homogeneous with some basin extremities having relatively long residence times. The influence of the circulation patterns on biological processes is discussed.

Task sharing within a managed clinical network to improve child health in Malawi.

PubMed

O'Hare, Bernadette; Phiri, Ajib; Lang, Hans-Joerg; Friesen, Hanny; Kennedy, Neil; Kawaza, Kondwani; Jana, Collins E; Chirambo, George; Mulwafu, Wakisa; Heikens, Geert T; Mipando, Mwapatsa

2015-07-21

indicators. Data from different districts will be compared at baseline and annually until 2020 as the specialists of both cadres take up posts. If a managed clinical network improves child healthcare in Malawi, it may be a potential model for the other countries in sub-Saharan Africa with similar cadres in their healthcare system and face similar challenges in terms of scarcity of specialists.

ADULT EDUCATION IN AFRICA. CURRENT INFORMATION SOURCES, NUMBER 12.

ERIC Educational Resources Information Center

Syracuse Univ., NY. ERIC Clearinghouse on Adult Education.

TWENTY-THREE ABSTRACTS AND ANNOTATIONS OF RECENT (1962-67) PUBLICATIONS ON ADULT EDUCATION IN AFRICA ARE PROVIDED IN THIS BIBLIOGRAPHY. EDUCATIONAL NEEDS AND POLICIES AND SPECIFIC NATIONAL AND INSTITUTIONAL PROGRAMS IN ETHIOPIA, TANZANIA, KENYA, MALAWI, ZAMBIA, RHODESIA, AND NIGERIA ARE FEATURED, WITH COMMUNITY AND RURAL DEVELOPMENT, MANPOWER…

Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

PubMed Central

Mwesawina, Maurice; Baluku, Yosia; Kanyanda, Setiala S. E.; Orach, Christopher Garimoi

2016-01-01

Introduction Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control. Materials and Methods We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO. Results A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries. Conclusions Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the

Evidence for Strong Controls from Preexisting Structures on Border Fault Development and Basin Evolution in the Malawi Rift from 3D Lacustrine Refraction Data

NASA Astrophysics Data System (ADS)

Accardo, N. J.; Shillington, D. J.; Gaherty, J. B.; Scholz, C. A.; Ebinger, C.; Nyblade, A.; McCartney, T.; Chindandali, P. R. N.; Kamihanda, G.; Ferdinand-Wambura, R.

2017-12-01

A long-standing debate surrounds controls on the development and ultimately abandonment of basin bounding border faults. The Malawi Rift in the the Western Branch of the East African Rift System presents an ideal location to investigate normal fault development. The rift is composed of a series of half graben basins bound by large border faults, which cross several terranes and pre-existing features. To delineate rift basin structure, we undertook 3D first arrival tomography across the North and Central basins of the Malawi Rift based on seismic refraction data acquired in Lake Malawi. The resulting 3D velocity model allows for the first-ever mapping of 3D basin structure in the Western Branch of the EAR. We estimate fault displacement profiles along the two border faults and find that each accommodated 7.2 km of throw. Previous modeling studies suggest that given the significant lengths (>140 km) and throws of these faults, they may be nearing their maximum dimensions or may have already been abandoned. While both faults accommodate similar throws, their lengths differ by 40 km, likely due to the influence of both preexisting basement fabric and large-scale preexisting structures crossing the rift. Over 4 km of sediment exists where the border faults overlap in the accommodation zone indicating that these faults likely established their lengths early. Portions of both basins contain packages of sediment with anomalously fast velocities (> 4 km/s), which we interpret to represent sediment packages from prior rifting episodes. In the Central Basin, this preexisting sediment traces along the inferred offshore continuation of the Karoo-aged Ruhuhu Basin that intersects Lake Malawi at the junction between the North and Central basins. This feature may have influenced the length of the border fault bounding the Central Basin. In the North Basin, the preexisting sediment is thicker ( 4 km) and likely represents the offshore continuation of a series of preexisting rift

Health systems challenges in cervical cancer prevention program in Malawi.

PubMed

Maseko, Fresier C; Chirwa, Maureen L; Muula, Adamson S

2015-01-01

Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi. The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO. Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. RESULTS showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment. Numerous health

IMMUNISATION TRAINING NEEDS IN MALAWI.

PubMed

Tsega, A Y; Hausi, H T; Steinglass, R; Chirwa, G Z

2014-09-01

The Malawi Ministry of Health (MOH) and its immunisation partners conducted a training needs assessment in May 2013 to assess the current status of immunisation training programmemes in health training institutions, to identify unmet training needs, and to recommend possible solutions for training of health workers on a regular basis. A cross-sectional, descriptive study. Health training institutions in Malawi, a developing country that does not regularly update its curricula to include new vaccines and management tools, nor train healthcare workers on a regular basis. Researchers interviewed Malawi's central immunisation manager, three zonal immunisation officers, six district officers, 12 health facility immunisation coordinators, and eight principals of training institutions. All health training institutions in Malawi include immunisation in their preservice training curricula. However, the curriculum is not regularly updated; thus, the graduates are not well equipped to provide quality services. In addition, the duration of the training curriculum is inadequate, and in-service training sessions for managers and service providers are conducted only on an ad hoc basis. All levels of Malawi's health system have not met sufficient training needs for providing immunisations, and the health training institutions teach their students with outdated materials. It is recommended that the training institutions update their training curricula regularly and the service providers are trained on a regular basis.

Global leaf companies control the tobacco market in Malawi.

PubMed

Otañez, Marty G; Mamudu, Hadii; Glantz, Stanton A

2007-08-01

To examine the influence of US-based tobacco leaf-buying companies, Universal Corporation and Alliance One International, on Malawi's economy and trade policy in 2000-6. Analyses of ethnographic data and tobacco industry documents. Universal Corporation and Alliance One International, through their subsidiary companies Limbe Leaf and Alliance One, respectively, in Malawi, control policy-making advisory groups and operate a tobacco cartel to influence Malawi's economic and trade sectors. Limbe Leaf's corporate secretary and lawyer is a member of several policy-making committees that advise the Malawi government on tobacco-related trade policy. The corporate representative's presence prevents other committee members from taking positions against the tobacco industry and ensures government policy that advances industry interests to obtain low-cost tobacco. The World Bank and Malawi's Anti-corruption Bureau report allegations of collusion between Limbe Leaf and Alliance One over prices at tobacco markets. Allegations of collusion between Limbe Leaf and Alliance One prompted Malawi President Bingu Mutharika in 2006 to warn the companies to end non-competitive practices or leave the country, but there was no meaningful follow-up action. Findings from interviews with small-scale tobacco traders in Malawi suggest that Universal and Alliance One International purchase smuggled raw tobacco from the neighbouring countries, Zambia and Mozambique, undermining growers' efforts to benefit from tobacco farming in Malawi. These actions restrict competition, depress tobacco prices for Malawi's farmers and contribute to poverty in Malawi, while keeping the country dependent on tobacco growing.

Attitudes towards mental illness in Malawi: a cross-sectional survey

PubMed Central

2012-01-01

Background Stigma and discrimination associated with mental illness are strongly linked to suffering, disability and poverty. In order to protect the rights of those with mental disorders and to sensitively develop services, it is vital to gain a more accurate understanding of the frequency and nature of stigma against people with mental illness. Little research about this issue has been conducted in Sub- Saharan Africa. Our study aimed to describe levels of stigma in Malawi. Methods A cross-sectional survey of patients and carers attending mental health and non-mental health related clinics in a general hospital in Blantyre, Malawi. Participants were interviewed using an adapted version of the questionnaire developed for the “World Psychiatric Association Program to Reduce Stigma and Discrimination Because of Schizophrenia”. Results 210 participants participated in our study. Most attributed mental disorder to alcohol and illicit drug abuse (95.7%). This was closely followed by brain disease (92.8%), spirit possession (82.8%) and psychological trauma (76.1%). There were some associations found between demographic variables and single question responses, however no consistent trends were observed in stigmatising beliefs. These results should be interpreted with caution and in the context of existing research. Contrary to the international literature, having direct personal experience of mental illness seemed to have no positive effect on stigmatising beliefs in our sample. Conclusions Our study contributes to an emerging picture that individuals in Sub-Saharan Africa most commonly attribute mental illness to alcohol/ illicit drug use and spirit possession. Our work adds weight to the argument that stigma towards mental illness is an important global health and human rights issue. PMID:22823941

DDT residue contamination in sediments from Lake Sibaya in northern KwaZulu-Natal, South Africa: implications for conservation in a World Heritage Site.

PubMed

Humphries, Marc S

2013-11-01

Maputaland in northern KwaZulu-Natal is a biodiversity hotspot and host to a number of ecologically important systems, including Lake Sibaya, southern Africa's largest natural freshwater lake. The region is malaria endemic and this study reports the presence of DDT and its metabolites in the sediments of Lake Sibaya that have resulted from the widespread and continued use of DDT in the region. DDT residues (p,p'-DDT, p,p'-DDD, and p,p'-DDE) were detected at all 11 sites sampled, with total concentrations ranging from 0.8 to 123 ng g(-1). Total DDT concentrations at Lake Sibaya represent some of the highest levels reported in South Africa, with most samples exceeding sediment quality guideline values. The findings from this study raise concerns and indicate that urgent further work is needed to investigate the potential for bioaccumulation, which could adversely affect breeding fish, bird, and crocodile populations in the region. While this study represents the first report on DDT contamination in Lake Sibaya, results have important implications for a number of other aquatic ecosystems within the Maputaland ecoregion, as well as the many local people who depend on them. Copyright © 2013 Elsevier Ltd. All rights reserved.

Global leaf companies control the tobacco market in Malawi

PubMed Central

Otañez, Marty G; Mamudu, Hadii; Glantz, Stanton A

2007-01-01

Objective To examine the influence of US‐based tobacco leaf‐buying companies, Universal Corporation and Alliance One International, on Malawi's economy and trade policy in 2000–6. Design Analyses of ethnographic data and tobacco industry documents. Results Universal Corporation and Alliance One International, through their subsidiary companies Limbe Leaf and Alliance One, respectively, in Malawi, control policy‐making advisory groups and operate a tobacco cartel to influence Malawi's economic and trade sectors. Limbe Leaf's corporate secretary and lawyer is a member of several policy‐making committees that advise the Malawi government on tobacco‐related trade policy. The corporate representative's presence prevents other committee members from taking positions against the tobacco industry and ensures government policy that advances industry interests to obtain low‐cost tobacco. The World Bank and Malawi's Anti‐corruption Bureau report allegations of collusion between Limbe Leaf and Alliance One over prices at tobacco markets. Allegations of collusion between Limbe Leaf and Alliance One prompted Malawi President Bingu Mutharika in 2006 to warn the companies to end non‐competitive practices or leave the country, but there was no meaningful follow‐up action. Findings from interviews with small‐scale tobacco traders in Malawi suggest that Universal and Alliance One International purchase smuggled raw tobacco from the neighbouring countries, Zambia and Mozambique, undermining growers' efforts to benefit from tobacco farming in Malawi. Conclusion These actions restrict competition, depress tobacco prices for Malawi's farmers and contribute to poverty in Malawi, while keeping the country dependent on tobacco growing. PMID:17652242

Parental Bereavement in Young Children Living in South Africa and Malawi: Understanding Mental Health Resilience.

PubMed

Macedo, A; Sherr, L; Tomlinson, M; Skeen, S; Roberts, K J

2018-04-17

Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time. This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi, and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and non-orphaned children. Consecutive attenders of community based organisations (children;4-13 years, and their caregivers) were interviewed at baseline and 15-18 month follow up (n=833). Interviews comprised of inventories on demographic information, family data, child mental health, bereavement experience and community characteristics. Mental health screens were used to operationalise resilience as the absence of symptoms of depression, suicidality, trauma, emotional and behavioural problems. Almost 60% of children experienced parental loss. One quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) vs. non-orphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, gender, country of residence or between orphaned and non-orphaned children. This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.

Diversity and distribution of polyphagan water beetles (Coleoptera) in the Lake St Lucia system, South Africa

PubMed Central

Bird, Matthew S.; Bilton, David T.; Perissinotto, Renzo

2017-01-01

Abstract Water beetles belonging to the suborder Polyphaga vary greatly in larval and adult ecologies, and fulfil important functional roles in shallow-water ecosystems by processing plant material, scavenging and through predation. This study investigates the species richness and composition of aquatic polyphagan assemblages in and around the St Lucia estuarine lake (South Africa), within the iSimangaliso Wetland Park, a UNESCO World Heritage Site. A total of 32 sites were sampled over three consecutive collection trips between 2013 and 2015. The sites encompassed a broad range of aquatic habitats, being representative of the variety of freshwater and estuarine environments present on the St Lucia coastal plain. Thirty-seven polyphagan taxa were recorded during the dedicated surveys of this study, in addition to seven species-level records from historical collections. Most beetles recorded are relatively widespread Afrotropical species and only three are endemic to South Africa. Samples were dominated by members of the Hydrophilidae (27 taxa), one of which was new to science (Hydrobiomorpha perissinottoi Bilton, 2016). Despite the fauna being dominated by relatively widespread taxa, five represent new records for South Africa, highlighting the poor state of knowledge on water beetle distribution patterns in the region. Wetlands within the dense woodland characterising the False Bay region of St Lucia supported a distinct assemblage of polyphagan beetles, whilst sites occurring on the Eastern and Western Shores of Lake St Lucia were very similar in their beetle composition. In line with the Afrotropical region as a whole, the aquatic Polyphaga of St Lucia appear to be less diverse than the Hydradephaga, for which 68 species were recorded during the same period. However, the results of the present study, in conjunction with those for Hydradephaga, show that the iSimangaliso Wetland Park contains a high beetle diversity. The ongoing and future ecological protection

Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe

PubMed Central

Mwenge, Lawrence; Sande, Linda; Mangenah, Collin; Ahmed, Nurilign; Kanema, Sarah; d’Elbée, Marc; Sibanda, Euphemia; Kalua, Thokozani; Ncube, Gertrude; Johnson, Cheryl C.; Hatzold, Karin; Cowan, Frances M.; Corbett, Elizabeth L.; Ayles, Helen; Maheswaran, Hendramoorthy

2017-01-01

Background Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. Methods Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. Results Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. Conclusions Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services. PMID:29036171

Patterns of intimate partner violence: a study of female victims in Malawi.

PubMed

Bazargan-Hejazi, Shahrzad; Medeiros, Sarah; Mohammadi, Reza; Lin, Johnny; Dalal, Koustuv

2013-01-01

countries in sub-Saharan Africa. Further studies are needed to assess the attitudes and behaviors of Malawi women towards acceptability and justification of IPV as well as their willingness to disclose it.

Patterns of Intimate Partner Violence: a study of female victims in Malawi

PubMed Central

Bazargan-Hejazi, Shahrzad; Medeiros, Sarah; Mohammadi, Reza; Lin, Johnny; Dalal, Koustuv

2013-01-01

Malawi appears slightly lower than that reported for other countries in sub-Saharan Africa. Further studies are needed to assess the attitudes and behaviors of Malawi women towards acceptability and justification of IPV as well as their willingness to disclose it. PMID:22289886

Remote Sensing Analysis of Malawi's Agricultural Inputs Subsidy and Climate Variability Impacts on Productivity

NASA Astrophysics Data System (ADS)

Galford, G. L.; Fiske, G. J.; Sedano, F.; Michelson, H.

2016-12-01

Agriculture in sub-Saharan Africa is characterized by smallholder production and low yields ( 1 ton ha-1 year-1 since records began in 1961) for staple food crops such as maize (Zea mays). Many years of low-input farming have depleted much of the region's agricultural land of critical soil carbon and nitrogen, further reducing yield potentials. Malawi is a 98,000 km2 subtropical nation with a short rainy season from November to May, with most rainfall occurring between December and mid-April. This short growing season supports the cultivation of one primary crop, maize. In Malawi, many smallholder farmers face annual nutrient deficits as nutrients removed as grain harvest and residues are beyond replenishment levels. As a result, Malawi has had stagnant maize yields averaging 1.2 ton ha-1 year-1 for decades. After multiple years of drought and widespread hunger in the early 2000s, Malawi introduced an agricultural input support program (fertilizer and seed subsidy) in time for the 2006 harvest that was designed to restore soil nutrients, improve maize production, and decrease dependence on food aid. Malawi's subsidy program targets 50-67% of smallholder farmers who cultivate half a hectare or less, yet collectively supply 80% of the country's maize. The country has achieved significant increases in crop yields (now 2 tons/ha/year) and, as our analysis shows, benefited from a new resilience against drought. We utilized Landsat time series to determine cropland extent from 2000-present and identify areas of marginal and/or intermittent production. We found a strong latitudinal gradient of precipitation variability from north to south in CHIRPS data. We used the precipitation variability to normalize trends in a productivity proxy derived from MODIS EVI. After normalization of productivity to precipitation variability, we found significant productivity trends correlated to subsidy distribution. This work was conducted with Google's Earth Engine, a cloud-based platform

Intergenerational transfers in the era of HIV/AIDS: Evidence from rural Malawi

PubMed Central

Kohler, Iliana V.; Kohler, Hans-Peter; Anglewicz, Philip; Behrman, Jere R.

2013-01-01

BACKGROUND Intergenerational transfer patterns in sub-Saharan Africa are poorly understood, despite the alleged importance of support networks to ameliorate the complex implications of the HIV/AIDS epidemic for families. OBJECTIVE There is a considerable need for research on intergenerational support networks and transfers to better understand the mechanisms through which extended families cope with the HIV/AIDS epidemic and potentially alleviate some of its consequences in sub-Saharan Africa, and to comprehend how transfers respond—or not—to perceptions about own and other family members' health. METHODS Using the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), we estimate the age patterns and the multiple directions of financial and non-financial transfer flows in rural Malawi—from prime-aged respondents to their elderly parents and adult children age 15 and up. We also estimate the social, demographic and economic correlates of financial and non-financial transfers of financial intergenerational transfers in this context. RESULTS AND CONCLUSIONS Our findings are that: (1) intergenerational financial and non-financial transfers are widespread and a key characteristic of family relationships in rural Malawi; (2) downward and upward transfers are importantly constrained and determined by the availability of transfer partners (parents or adult children); (3) financial net transfers are strongly age-patterned and the middle generations are net-providers of transfers; (4) non-financial transfers are based on mutual assistance rather than reallocation of resources; and (5) intergenerational transfers are generally not related to health status, including HIV positive status. PMID:23606809

Penetration of Atlantic Walker Circulation Into East Africa During Early to mid-Holocene: Hydrogen Isotope Evidence From Sacred Lake, Mt. Kenya

NASA Astrophysics Data System (ADS)

Hou, J.; Russell, J. M.; Huang, Y.

2007-12-01

The tropics play a very important role in global climate variability, yet the mechanisms behind the tropical climate variation remain poorly understood. Here, we present a high-resolution, well-dated record from Sacred Lake, Kenya, East Africa. We measured D/H ratios of botryococcenes, a class of highly specific biomarkers produced by freshwater algae ( Botrycoccus braunii) in a sediment core obtained from this open lake. Our main goal is to examine changes in East African rainfall amount and moisture source during the past 18kyr BP. During the late Pleistocene and late Holocene, the hydrogen isotope records track local hydrological variations inferred from numerous lake level and pollen records from the region. However, during the early to mid-Holocene (10-5ka cal yr BP), the D/H values from Sacred Lake were as much as 90 per mil heavier than during the late Pleistocene and late Holocene. If the "amount effect" is the main control on the isotopic compositions of rainfall during the early to mid Holocene, Our data would suggest drier conditions, which is inconsistent with the "African Humid Period" inferred by numerous records of the mid-Holocene. We propose that the high isotopic ratios in precipitation in East Africa during the early to mid-Holocene is due to an eastward shift in the large-scale atmospheric circulation of the tropics. In East Africa, this shift involves a major increase in moisture source from the Atlantic Ocean relative to Indian Ocean. Heavier isotope ratios of precipitation originated from Atlantic Ocean result from the intensive convection and recycling of water vapor over the Congo Basin, as opposed to Indian moisture that traverses dry land masses and losses moisture rapidly. In comparison to the late Holocene, the early to mid-Holocene is characterized by relatively northerly positioning of the ITCZ and intense monsoon systems as well as weak ENSO. These factors combine to shift the walker circulation eastward, allowing the Atlantic

Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient–Level Costing Data

PubMed Central

Bar-Zeev, Naor; Tate, Jacqueline E.; Pecenka, Clint; Chikafa, Jean; Mvula, Hazzie; Wachepa, Richard; Mwansambo, Charles; Mhango, Themba; Chirwa, Geoffrey; Crampin, Amelia C.; Parashar, Umesh D.; Costello, Anthony; Heyderman, Robert S.; French, Neil; Atherly, Deborah; Cunliffe, Nigel A.

2016-01-01

Background. Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012. Methods. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral–level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness. Results. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged <5 years with gastroenteritis. Costs did not differ by rotavirus test result, but were significantly higher for admitted children and those with increased severity on Vesikari scale. Adding rotavirus vaccine to the national schedule costs Malawi $0.42 per dose in system costs. Vaccine copayment is an additional $0.20. Over 20 years, the vaccine program will avert 1 026 000 cases of rotavirus gastroenteritis, 78 000 inpatient admissions, 4300 deaths, and 136 000 disability-adjusted-life-years (DALYs). For this year's birth cohort, it will avert 54 000 cases of rotavirus and 281 deaths in children aged <5 years. The program will cost $10.5 million and save $8.0 million in averted healthcare costs. Societal cost per DALY averted was $10, and the cost per rotavirus case averted was $1. Conclusions. Gastroenteritis causes substantial economic burden to Malawi. The rotavirus vaccine program is highly cost-effective. Together with the demonstrated impact of rotavirus vaccine in reducing population hospitalization burden, its cost-effectiveness makes a strong argument

Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient-Level Costing Data.

PubMed

Bar-Zeev, Naor; Tate, Jacqueline E; Pecenka, Clint; Chikafa, Jean; Mvula, Hazzie; Wachepa, Richard; Mwansambo, Charles; Mhango, Themba; Chirwa, Geoffrey; Crampin, Amelia C; Parashar, Umesh D; Costello, Anthony; Heyderman, Robert S; French, Neil; Atherly, Deborah; Cunliffe, Nigel A

2016-05-01

Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral-level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged <5 years with gastroenteritis. Costs did not differ by rotavirus test result, but were significantly higher for admitted children and those with increased severity on Vesikari scale. Adding rotavirus vaccine to the national schedule costs Malawi $0.42 per dose in system costs. Vaccine copayment is an additional $0.20. Over 20 years, the vaccine program will avert 1 026 000 cases of rotavirus gastroenteritis, 78 000 inpatient admissions, 4300 deaths, and 136 000 disability-adjusted-life-years (DALYs). For this year's birth cohort, it will avert 54 000 cases of rotavirus and 281 deaths in children aged <5 years. The program will cost $10.5 million and save $8.0 million in averted healthcare costs. Societal cost per DALY averted was $10, and the cost per rotavirus case averted was $1. Gastroenteritis causes substantial economic burden to Malawi. The rotavirus vaccine program is highly cost-effective. Together with the demonstrated impact of rotavirus vaccine in reducing population hospitalization burden, its cost-effectiveness makes a strong argument for widespread utilization in other low-income, high

Barriers to Uptake of Conservation Agriculture in southern Africa: Multi-level Analyses from Malawi

NASA Astrophysics Data System (ADS)

Dougill, Andrew; Stringer, Lindsay; Whitfield, Stephen; Wood, Ben; Chinseu, Edna

2015-04-01

Conservation agriculture is a key set of actions within the growing body of climate-smart agriculture activities being advocated and rolled out across much of the developing world. Conservation agriculture has purported benefits for environmental quality, food security and the sustained delivery of ecosystem services. In this paper, new multi-level analyses are presented, assessing the current barriers to adoption of conservation agriculture practices in Malawi. Despite significant donor initiatives that have targeted conservation agriculture projects, uptake rates remain low. This paper synthesises studies from across 3 levels in Malawi: i.) national level- drawing on policy analysis, interviews and a multi-stakeholder workshop; ii.) district level - via assessments of development plans and District Office and extension service support, and; iii) local level - through data gained during community / household level studies in Dedza District that have gained significant donor support for conservation agriculture as a component of climate smart agriculture initiatives. The national level multi-stakeholder Conservation Agriculture workshop identified three areas requiring collaborative research and outlined routes for the empowerment of the National Conservation Agriculture Task Force to advance uptake of conservation agriculture and deliver associated benefits in terms of agricultural development, climate adaptation and mitigation. District level analyses highlight that whilst District Development Plans are now checked against climate change adaptation and mitigation criteria, capacity and knowledge limitations exist at the District level, preventing project interventions from being successfully up-scaled. Community level assessments highlight the need for increased community participation at the project-design phase and identify a pressing requirement for conservation agriculture planning processes (in particular those driven by investments in climate

Modeling rain-fed maize vulnerability to droughts using the standardized precipitation index from satellite estimated rainfall—Southern Malawi case study

USGS Publications Warehouse

Funk, Christopher C.; Verdin, James; Adams Chavula,; Gregory J. Husak,; Harikishan Jayanthi,; Tamuka Magadzire,

2013-01-01

During 1990s, disaster risk reduction emerged as a novel, proactive approach to managing risks from natural hazards. The World Bank, USAID, and other international donor agencies began making efforts to mainstream disaster risk reduction in countries whose population and economies were heavily dependent on rain-fed agriculture. This approach has more significance in light of the increasing climatic hazard patterns and the climate scenarios projected for different hazard prone countries in the world. The Famine Early Warning System Network (FEWS NET) has been monitoring the food security issues in the sub-Saharan Africa, Asia and in Haiti. FEWS NET monitors the rainfall and moisture availability conditions with the help of NOAA RFE2 data for deriving food security status in Africa. This paper highlights the efforts in using satellite estimated rainfall inputs to develop drought vulnerability models in the drought prone areas in Malawi. The satellite RFE2 based SPI corresponding to the critical tasseling and silking phases (in the months of January, February, and March) were statistically regressed with drought-induced yield losses at the district level. The analysis has shown that the drought conditions in February and early March lead to most damage to maize yields in this region. The district-wise vulnerabilities to drought were upscaled to obtain a regional maize vulnerability model for southern Malawi. The results would help in establishing an early monitoring mechanism for drought impact assessment, give the decision makers additional time to assess seasonal outcomes, and identify potential food-related hazards in Malawi.

An economic perspective on Malawi's medical "brain drain".

PubMed

Record, Richard; Mohiddin, Abdu

2006-12-18

The medical "brain drain" has been described as rich countries "looting" doctors and nurses from developing countries undermining their health systems and public health. However this "brain-drain" might also be seen as a success in the training and "export" of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. Many see this "brain drain" of medical staff as wrong with developed countries exploiting poorer ones. The effects are considerable with Malawi facing high vacancy rates in its public health system, and with migration threatening to outstrip training despite efforts to improve pay and conditions. This shortage of staff has made it more challenging for Malawi to deliver on its Essential Health Package and to absorb new international health funding.Yet, without any policy effort Malawi has been able to demonstrate its global competitiveness in the training ("production") of skilled health professionals. Remittances from migration are a large and growing source of foreign exchange for poor countries and tend to go directly to households. Whilst the data for Malawi is limited, studies from other poor countries demonstrate the power of remittances in significantly reducing poverty. Malawi can benefit from the export of health professionals provided there is a resolution of the situation whereby the state pays for training and the benefits are gained by the individual professional working abroad. Solutions include migrating staff paying back training costs, or rich host governments remitting part of a tax (e.g. income or national insurance) to the Malawi government. These schemes would allow Malawi to scale up training of health professionals for local needs and to work abroad. There is concern about the negative impacts of the medical "brain-drain". However a closer look at the evidence for and against the medical

Mosaic maternal ancestry in the Great Lakes region of East Africa.

PubMed

Gomes, Verónica; Pala, Maria; Salas, Antonio; Álvarez-Iglesias, Vanesa; Amorim, António; Gómez-Carballa, Alberto; Carracedo, Ángel; Clarke, Douglas J; Hill, Catherine; Mormina, Maru; Shaw, Marie-Anne; Dunne, David W; Pereira, Rui; Pereira, Vânia; Prata, Maria João; Sánchez-Diz, Paula; Rito, Teresa; Soares, Pedro; Gusmão, Leonor; Richards, Martin B

2015-09-01

The Great Lakes lie within a region of East Africa with very high human genetic diversity, home of many ethno-linguistic groups usually assumed to be the product of a small number of major dispersals. However, our knowledge of these dispersals relies primarily on the inferences of historical, linguistics and oral traditions, with attempts to match up the archaeological evidence where possible. This is an obvious area to which archaeogenetics can contribute, yet Uganda, at the heart of these developments, has not been studied for mitochondrial DNA (mtDNA) variation. Here, we compare mtDNA lineages at this putative genetic crossroads across 409 representatives of the major language groups: Bantu speakers and Eastern and Western Nilotic speakers. We show that Uganda harbours one of the highest mtDNA diversities within and between linguistic groups, with the various groups significantly differentiated from each other. Despite an inferred linguistic origin in South Sudan, the data from the two Nilotic-speaking groups point to a much more complex history, involving not only possible dispersals from Sudan and the Horn but also large-scale assimilation of autochthonous lineages within East Africa and even Uganda itself. The Eastern Nilotic group also carries signals characteristic of West-Central Africa, primarily due to Bantu influence, whereas a much stronger signal in the Western Nilotic group suggests direct West-Central African ancestry. Bantu speakers share lineages with both Nilotic groups, and also harbour East African lineages not found in Western Nilotic speakers, likely due to assimilating indigenous populations since arriving in the region ~3000 years ago.

Vegetation Controls on Weathering Intensity during the Last Deglacial Transition in Southeast Africa

PubMed Central

Ivory, Sarah J.; McGlue, Michael M.; Ellis, Geoffrey S.; Lézine, Anne-Marie; Cohen, Andrew S.; Vincens, Annie

2014-01-01

Tropical climate is rapidly changing, but the effects of these changes on the geosphere are unknown, despite a likelihood of climatically-induced changes on weathering and erosion. The lack of long, continuous paleo-records prevents an examination of terrestrial responses to climate change with sufficient detail to answer questions about how systems behaved in the past and may alter in the future. We use high-resolution records of pollen, clay mineralogy, and particle size from a drill core from Lake Malawi, southeast Africa, to examine atmosphere-biosphere-geosphere interactions during the last deglaciation (∼18–9 ka), a period of dramatic temperature and hydrologic changes. The results demonstrate that climatic controls on Lake Malawi vegetation are critically important to weathering processes and erosion patterns during the deglaciation. At 18 ka, afromontane forests dominated but were progressively replaced by tropical seasonal forest, as summer rainfall increased. Despite indication of decreased rainfall, drought-intolerant forest persisted through the Younger Dryas (YD) resulting from a shorter dry season. Following the YD, an intensified summer monsoon and increased rainfall seasonality were coeval with forest decline and expansion of drought-tolerant miombo woodland. Clay minerals closely track the vegetation record, with high ratios of kaolinite to smectite (K/S) indicating heavy leaching when forest predominates, despite variable rainfall. In the early Holocene, when rainfall and temperature increased (effective moisture remained low), open woodlands expansion resulted in decreased K/S, suggesting a reduction in chemical weathering intensity. Terrigenous sediment mass accumulation rates also increased, suggesting critical linkages among open vegetation and erosion during intervals of enhanced summer rainfall. This study shows a strong, direct influence of vegetation composition on weathering intensity in the tropics. As climate change will likely

Monitoring Lakes in Africa with Altimetry and GRACE

NASA Astrophysics Data System (ADS)

Carabajal, C. C.; Boy, J. P.

2017-12-01

Thanks to more than two decades of radar altimetry measurements from TOPEX/POSEIDON, Jason 1, 2 and 3, ENVISAT and others, 18 Ice, Cloud and Land Elevation Satellite (ICESat) laser altimeter measurement campaigns over 6 years, and 15 years of Gravity Recovery And Climate Experiment (GRACE) observations, water levels changes of major lakes and reservoirs can be remotely measured regularly with unprecedented precision, facilitating monitoring of continental water storage variations. Smaller footprint laser altimeters like ICESat are more suitable for the retrieval of water level variations of small inland water bodies, better discriminating water returns when water height measurements have the potential to be contaminated by land or vegetation. Using imagery from the Moderate Resolution Imaging Spectroradiometer (MODIS) contemporaneous with the altimetry data collections, in combination with careful examination of the laser waveforms, one can better isolate returns form the water surface. Combining these altimetry observations, we derive and compare water height estimates for several lakes and reservoirs in Africa from radar and laser altimetry measurements, we estimate the surface extent of each individual water body from available MODIS imagery, and derive corresponding estimates of volume variations for each water body. Mass variations from time-variable gravity measurements from the GRACE mission, using the latest one-degree global iterated mascons solution from GSFC are then transformed into volume changes, assuming a constant density, and compared to altimetry plus imagery estimates. These methods demonstrate the power of combined observations to monitor water resources and facilitate their management. Upcoming laser altimetry missions like ICESat-2, with vastly improved coverage and temporal sampling, continuous observations, better measurements techniques, including inland water products specifically formulated for these applications, when combined with SWOT

Is it ethical to prevent secondary use of stored biological samples and data derived from consenting research participants? The case of Malawi.

PubMed

Mungwira, Randy G; Nyangulu, Wongani; Misiri, James; Iphani, Steven; Ng'ong'ola, Ruby; Chirambo, Chawanangwa M; Masiye, Francis; Mfutso-Bengo, Joseph

2015-12-02

This paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi. The current research ethics regulations and guidelines in Malawi do not allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes. In conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public

Integration of altimetric lake levels and GRACE gravimetry over Africa: Inferences for terrestrial water storage change 2003-2011

NASA Astrophysics Data System (ADS)

Moore, P.; Williams, S. D. P.

2014-12-01

Terrestrial water storage (TWS) change for 2003-2011 is estimated over Africa from GRACE gravimetric data. The signatures from change in water of the major lakes are removed by utilizing kernel functions with lake heights recovered from retracked ENVISAT satellite altimetry. In addition, the contribution of gravimetric change due to soil moisture and biomass is removed from the total GRACE signal by utilizing the GLDAS land surface model. The residual TWS time series, namely groundwater and the surface waters in rivers, wetlands, and small lakes, are investigated for trends and the seasonal cycle using linear regression. Typically, such analyses assume that the data are temporally uncorrelated but this has been shown to lead to erroneous inferences in related studies concerning the linear rate and acceleration. In this study, we utilize autocorrelation and investigate the appropriate stochastic model. The results show the proper distribution of TWS change and identify the spatial distribution of significant rates and accelerations. The effect of surface water in the major lakes is shown to contribute significantly to the trend and seasonal variation in TWS in the lake basin. Lake Volta, a managed reservoir in Ghana, is seen to have a contribution to the linear trend that is a factor of three greater than that of Lake Victoria despite having a surface area one-eighth of that of Lake Victoria. Analysis also shows the confidence levels of the deterministic trend and acceleration identifying areas where the signatures are most likely due to a physical deterministic cause and not simply stochastic variations.

Does Water Hyacinth on East African Lakes Promote Cholera Outbreaks?

PubMed Central

Feikin, Daniel R.; Tabu, Collins W.; Gichuki, John

2010-01-01

Cholera outbreaks continue to occur regularly in Africa. Cholera has been associated with proximity to lakes in East Africa, and Vibrio cholerae has been found experimentally to concentrate on the floating aquatic plant, water hyacinth, which is periodically widespread in East African lakes since the late 1980s. From 1994 to 2008, Nyanza Province, which is the Kenyan province bordering Lake Victoria, accounted for a larger proportion of cholera cases than expected by its population size (38.7% of cholera cases versus 15.3% of national population). Yearly water-hyacinth coverage on the Kenyan section of Lake Victoria was positively associated with the number of cholera cases reported in Nyanza Province (r = 0.83; P = 0.0010). Water hyacinth on freshwater lakes might play a role in initiating cholera outbreaks and causing sporadic disease in East Africa. PMID:20682884

An economic perspective on Malawi's medical "brain drain"

PubMed Central

Record, Richard; Mohiddin, Abdu

2006-01-01

Background The medical "brain drain" has been described as rich countries "looting" doctors and nurses from developing countries undermining their health systems and public health. However this "brain-drain" might also be seen as a success in the training and "export" of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. Discussion Many see this "brain drain" of medical staff as wrong with developed countries exploiting poorer ones. The effects are considerable with Malawi facing high vacancy rates in its public health system, and with migration threatening to outstrip training despite efforts to improve pay and conditions. This shortage of staff has made it more challenging for Malawi to deliver on its Essential Health Package and to absorb new international health funding. Yet, without any policy effort Malawi has been able to demonstrate its global competitiveness in the training ("production") of skilled health professionals. Remittances from migration are a large and growing source of foreign exchange for poor countries and tend to go directly to households. Whilst the data for Malawi is limited, studies from other poor countries demonstrate the power of remittances in significantly reducing poverty. Malawi can benefit from the export of health professionals provided there is a resolution of the situation whereby the state pays for training and the benefits are gained by the individual professional working abroad. Solutions include migrating staff paying back training costs, or rich host governments remitting part of a tax (e.g. income or national insurance) to the Malawi government. These schemes would allow Malawi to scale up training of health professionals for local needs and to work abroad. Summary There is concern about the negative impacts of the medical "brain-drain". However a closer look at the evidence

Paleolimnology of Lake Tanganyika, East Africa, over the past 100 k yr

USGS Publications Warehouse

Scholz, C.A.; King, J.W.; Ellis, G.S.; Swart, Peter K.; Stager, J.C.; Colman, Steven M.

2003-01-01

New sediment core data from a unique slow-sedimentation rate site in Lake Tanganyika contain a much longer and continuous record of limnological response to climate change than have been previously observed in equatorial regions of central Africa. The new core site was first located through an extensive seismic reflection survey over the Kavala Island Ridge (KIR), a sedimented basement high that separates the Kigoma and Kalemie Basins in Lake Tanganyika. Proxy analyses of paleoclimate response carried out on core T97-52V include paleomagnetic and index properties, TOC and isotopic analyses of organic carbon, and diatom and biogenic silica analyses. A robust age model based on 11 radiocarbon (AMS) dates indicates a linear, continuous sedimentation rate nearly an order of magnitude slower here compared to other core sites around the lake. This age model indicates continuous sedimentation over the past 79 k yr, and a basal age in excess of 100 k yr. The results of the proxy analyses for the past ??? 20 k yr are comparable to previous studies focused on that interval in Lake Tanganyika, and show that the lake was about 350 m lower than present at the Last Glacial Maximum (LGM). Repetitive peaks in TOC and corresponding drops in ??13C over the past 79 k yr indicate periods of high productivity and mixing above the T97-52V core site, probably due to cooler and perhaps windier conditions. From ??? 80 through ??? 58 k yr the ??13C values are relatively negative (-26 to -28???) suggesting predominance of algal contributions to bottom sediments at this site during this time. Following this interval there is a shift to higher values of ??13C, indicating a possible shift to C-4 pathway-dominated grassland-type vegetation in the catchment, and indicating cooler, dryer conditions from ??? 55 k yr through the LGM. Two seismic sequence boundaries are observed at shallow stratigraphic levels in the seismic reflection data, and the upper boundary correlates to a major discontinuity

Prevention and management of malaria during pregnancy: findings from a comparative qualitative study in Ghana, Kenya and Malawi

PubMed Central

2013-01-01

Background In endemic regions of sub-Saharan Africa, malaria during pregnancy (MiP) is a major preventable cause of maternal and infant morbidity and mortality. Current recommended MiP prevention and control includes intermittent preventive treatment (IPTp), distribution of insecticide-treated bed nets (ITNs) and appropriate case management. This article explores the social and cultural context to the uptake of these interventions at four sites across Africa. Methods A comparative qualitative study was conducted at four sites in three countries: Ghana, Malawi and Kenya. Individual and group interviews were conducted with pregnant women, their relatives, opinion leaders, other community members and health providers. Observations, which focused on behaviours linked to MiP prevention and treatment, were also undertaken at health facilities and in local communities. Results ITNs were generally recognized as important for malaria prevention. However, their availability and use differed across the sites. In Malawi and Kenya, ITNs were sought-after items, but there were complaints about availability. In central Ghana, women saved ITNs until the birth of the child and they were used seasonally in northern Ghana. In Kenya and central Ghana, pregnant women did not associate IPTp with malaria, whereas, in Malawi and northern Ghana, IPTp was linked to malaria, but not always with prevention. Although IPTp adherence was common at all sites, whether delivered with directly observed treatment or not, a few women did not comply with IPTp often citing previous side effects. Although generally viewed as positive, experiences of malaria testing varied across the four sites: treatment was sometimes administered in spite of a negative diagnosis in Ghana (observed) and Malawi (reported). Despite generally following the advice of healthcare staff, particularly in Kenya, personal experience, and the availability and accessibility of medication – including anti-malarials – influenced

Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey

PubMed Central

Abouyannis, Michael; Dacombe, Russell; Dambe, Isaias; Mpunga, James; Faragher, Brian; Gausi, Francis; Ndhlovu, Henry; Kachiza, Chifundo; Suarez, Pedro; Mundy, Catherine; Banda, Hastings T; Nyasulu, Ishmael

2014-01-01

Abstract Objective To document the prevalence of multidrug resistance among people newly diagnosed with – and those retreated for – tuberculosis in Malawi. Methods We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs – and tested for resistance to second-line drugs – at a Supranational Tuberculosis Reference Laboratory in South Africa. Findings Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive. Conclusion The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa – probably reflecting the strength of Malawi’s tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis. PMID:25378741

Beyond Denomination: The Relationship between Religion and Family Planning in Rural Malawi

PubMed Central

Yeatman, Sara E.; Trinitapoli, Jenny

2010-01-01

Despite the centrality of religion and fertility to life in rural Africa, the relationship between the two remains poorly understood. The study presented here uses unique integrated individual and congregational level data from rural Malawi to examine religious influences on contraceptive use. In this religiously diverse population, we find evidence that the particular characteristics of a congregation—leader’s positive attitudes toward family planning and discussion of sexual morality, which do not fall along broad denominational lines—are more relevant than denominational categories for predicting women’s contraceptive use. We further find evidence for a relationship between religious socialization and contraceptive behavior. PMID:20463916

Migration dynamics, entrepreneurship, and African development: Lessons from Malawi.

PubMed

Thomas, Kevin J A; Inkpen, Christopher

2013-12-01

Using data from Malawi, this study situates the discourse on migration, entrepreneurship, and development within the context of Africa's social realities. It examines self-employment differences among three groups of migrants and corresponding group differences in agricultural and non-agricultural self-employment. International migrants are found to be more engaged in self-employment than internal-migrants. However, our results suggest that previous findings on the development-related contributions of returning migrants from the West need to be appropriately contextualized. When returnees from the West invest in self-employment, they typically shy away from Africa's largest economic sector - agriculture. In contrast, levels of self-employment, especially in agricultural self-employment, are highest among returning migrants and immigrants from other African countries, especially from those nearby. We also underscore the gendered dimensions of migrants' contribution to African development by demonstrating that female migrants are more likely to be self-employed in agriculture than male migrants. Furthermore, as human-capital increases, migrants are more likely to concentrate their self-employment activities in non-agricultural activities and not in the agricultural sector. The study concludes by using these findings to discuss key implications for policy and future research.

Mainstreaming conservation agriculture in Malawi: Knowledge gaps and institutional barriers.

PubMed

Dougill, Andrew J; Whitfield, Stephen; Stringer, Lindsay C; Vincent, Katharine; Wood, Benjamin T; Chinseu, Edna L; Steward, Peter; Mkwambisi, David D

2017-06-15

Conservation agriculture (CA) practices of reduced soil tillage, permanent organic soil coverage and intercropping/crop rotation, are being advocated globally, based on perceived benefits for crop yields, soil carbon storage, weed suppression, reduced soil erosion and improved soil water retention. However, some have questioned their efficacy due to uncertainty around the performance and trade-offs associated with CA practices, and their compatibility with the diverse livelihood strategies and varied agro-ecological conditions across African smallholder systems. This paper assesses the role of key institutions in Malawi in shaping pathways towards more sustainable land management based on CA by outlining their impact on national policy-making and the design and implementation of agricultural development projects. It draws on interviews at national, district and project levels and a multi-stakeholder workshop that mapped the institutional landscape of decision-making for agricultural land management practices. Findings identify knowledge gaps and institutional barriers that influence land management decision-making and constrain CA uptake. We use our findings to set out an integrated roadmap of research needs and policy options aimed at supporting CA as a route to enhanced sustainable land management in Malawi. Findings offer lessons that can inform design, planning and implementation of CA projects, and identify the multi-level institutional support structures required for mainstreaming sustainable land management in sub-Saharan Africa. Copyright © 2016 Elsevier Ltd. All rights reserved.

Rabies Encephalitis in Malaria-Endemic Area, Malawi, Africa

PubMed Central

Mallewa, Macpherson; Fooks, Anthony R.; Banda, Daniel; Chikungwa, Patrick; Mankhambo, Limangeni; Molyneux, Elizabeth; Molyneux, Malcolm E.

2007-01-01

In a malaria-endemic area of Africa, rabies was an important cause of fatal central nervous system infection, responsible for 14 (10.5%) of 133 cases. Four patients had unusual clinical manifestations, and rabies was only diagnosed postmortem. Three (11.5%) of 26 fatal cases were originally attributed to cerebral malaria. PMID:17370529

Exploratory studies into seasonal flow forecasting potential for large lakes

NASA Astrophysics Data System (ADS)

Sene, Kevin; Tych, Wlodek; Beven, Keith

2018-01-01

In seasonal flow forecasting applications, one factor which can help predictability is a significant hydrological response time between rainfall and flows. On account of storage influences, large lakes therefore provide a useful test case although, due to the spatial scales involved, there are a number of modelling challenges related to data availability and understanding the individual components in the water balance. Here some possible model structures are investigated using a range of stochastic regression and transfer function techniques with additional insights gained from simple analytical approximations. The methods were evaluated using records for two of the largest lakes in the world - Lake Malawi and Lake Victoria - with forecast skill demonstrated several months ahead using water balance models formulated in terms of net inflows. In both cases slight improvements were obtained for lead times up to 4-5 months from including climate indices in the data assimilation component. The paper concludes with a discussion of the relevance of the results to operational flow forecasting systems for other large lakes.

Physical attractiveness and women's HIV risk in rural Malawi.

PubMed

Frye, Margaret; Chae, Sophia

2017-01-01

Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15-35. Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings.

The Intraplate Earthquakes of SE Africa

NASA Astrophysics Data System (ADS)

Fonseca, J. F. B. D.; Domingues, A.

2014-12-01

Southeast Africa is a region of complex tectonic inheritance, combining early Archean cratonic blocks - the Zimbabwe and Kaapvaal cratons - and several collision belts ranging in age from ~2.6Ga (Limpopo Belt) to the Pan-African Orogeny, 800-500 Ma ago (Zambezi Belt, Mozambique Belt). Mesozoic rifting was the last tectonic event to leave an imprint in the lithosphere of the region. Tertiary deformation is mild and related to the extensional regime of the East African Rift System (EARS) further north. Instrumental seismology started in Johannesburg in 1910 (Saunders et al., 2008). Ambraseys and Adams (1991) conducted a reappraisal of the seismicity of Sub-Saharan Africa from 1900 to 1930, and the compilations by Krige and Maree (1948) and Gutenberg and F. Richter (1949) are main sources for the two subsequent decades. The available data can be considered complete since 1900 for magnitudes above M6 (Ambraseys and Adams, 1991), although major epicentral errors are likely to affect the early decades. Earthquakes above this threshold in the region to the south of Lake Malawi and to the east of the Okavango Rift are reported in 1919 (MS6.5, NE South Africa), 1932 (MS6.8, Natal Bay), 1940 (MS6.2, SE Mozambique), 1951 (MS6.0, Central Mozambique), 1957 (M6.0, Central Mozambique), again in 1957 (M6.2, Central Mozambique), 1958 (M6.0, Southern Zimbabwe), 1959 (M6.1, Southern Zambia) and 2006 (M7.0, Central Mozambique). The four M>6 earthquakes from 1957 to 1959 configure a cluster in time, followed by a shutdown (at M>6) that was to last nearly five decades. While a coincidence is unlikely, a causal link is challenged by the large spatial scatter of about 500 km. However, the fact that the four earthquakes occurred on the border of the Zimbabwe craton may provide a clue to the mechanism promoting the clustering. We combine these data with recent seismicity results (Fonseca et al., 2014) to discuss possible factors controlling the seismotectonics of the region.

Interannual lake level fluctuations (1993 1999) in Africa from Topex/Poseidon: connections with ocean atmosphere interactions over the Indian Ocean

NASA Astrophysics Data System (ADS)

Mercier, Franck; Cazenave, Anny; Maheu, Caroline

2002-04-01

Water level fluctuations of continental lakes are related to regional to global scale climate changes. Water level fluctuations reflect variations in evaporation and precipitation over the lake area and its catchment area. Over such inland water bodies, the satellite altimetry technique offers both a world-wide coverage and a satisfying accuracy. We present here results of lake level variations of 12 African lakes based on 7 years of Topex/Poseidon (T/P) altimetry data acquired between 1993 and 1999. Among the 12 African lakes presented in this study, three are reservoirs whose level fluctuations are mainly driven by anthropogenic usage of the water. Either closed or open, the nine remaining lakes are sensitive indicators of the climate evolution over Africa during the 1990s. Seasonal signals of each lake are clearly identified and filtered out to focus on the interannual fluctuations. Clear correlated regional variations are reported among the east African lakes: several lakes exhibit a regular level decrease between 1993 and 1997, probably due to intense droughts. However, the most spectacular feature is an abrupt water level rise occurring in late 1997-early 1998 and affecting most of the lakes located within the Rift Valley. This major anomalous pattern, explained by a large excess rainfall anomaly occurring in late 1997, is quantified in both space and time domains through an EOF analysis of the lake level height time series. The spatial distribution of the leading mode of lake level height correlates with the dominant mode of precipitation computed over the same time span. Nevertheless, similar rainfall anomaly, but with lesser intensity, occurred in late 1994 without any noticeable consequence on lake level. The precipitation anomaly appears related to the equatorial Indian Ocean warming reported during the 1997-1998 ENSO event.

High-elevation amplification of warming since the Last Glacial Maximum in East Africa: New perspectives from biomarker paleotemperature reconstructions

NASA Astrophysics Data System (ADS)

Loomis, S. E.; Russell, J. M.; Kelly, M. A.; Eggermont, H.; Verschuren, D.

2013-12-01

elevations in East Africa (Sacred Lake, Lake Tanganyika, and Lake Malawi), we are able to reconstruct a continuous record of lapse rates and freezing level heights (FLHs) back to the LGM. We find that tropical lapse rates have varied widely over the last 22 ky, with the largest (lowest) lapse rate (FLH) around the LGM, while the smallest (highest) lapse rate (FLH) occurs during the mid-Holocene, confirming the amplification of warming at high altitudes between the LGM and present. These lapse rate and FLH reconstructions match records of regional hydrological variability, confirming the importance of glacial/interglacial humidity variations on altitudinal temperature gradients in the tropics. Furthermore, the FLH record largely matches records of tropical glacier ELA changes, indicating that warming from LGM-present was likely amplified at high altitudes throughout the tropics.

The association between school bullying victimization and substance use among adolescents in Malawi: the mediating effect of loneliness.

PubMed

Kim, Youn Kyoung; Okumu, Moses; Small, Eusebius; Nikolova, Silviya Pavlova; Mengo, Cecilia

2018-06-12

Background and objectives Research has shown an increased prevalence of substance use among adolescents in countries in Sub-Saharan Africa. Peer affiliation, bullying, and psychological stress are significantly associated with substance use. This study empirically tested theoretical frameworks linking peer affiliation, bullying victimization, loneliness and substance use (specifically tobacco or alcohol use) among adolescents. Materials and methods Data were obtained from the 2009 Malawi Global School-based Health Survey (GSHS) with a representative sample of 2359 students aged 13-17 years in Malawi, Sub-Saharan Africa. Missing data were handled using multiple imputation. The study conducted path analyses using Mplus to test the conceptual models of tobacco use and alcohol use. Results The results showed that loneliness partially mediated the association between bullying victimization and tobacco use in the first model, as well as the relationship between bullying victimization and alcohol use in the second model. Results indicated statistically significant indirect paths from bullying victimization to tobacco use and alcohol use through the mediation of loneliness. However, peer affiliation did not directly predict bullying victimization in the two path models; it directly predicted tobacco use only. Conclusions These findings have important implications in early intervention for health practitioners in school and mental health settings to prevent feelings of loneliness and substance use among adolescents who have experience with bullying victimization but no experience with depression, alcohol use or tobacco use.

Comparative study of the silica and cation geothermometry of the Malawi hot springs: Potential alternative energy source

NASA Astrophysics Data System (ADS)

Dulanya, Zuze; Morales-Simfors, Nury; Sivertun, Åke

2010-06-01

Malawi is one of the poorest countries in the world and one of the most densely populated in south-eastern Africa. Its major power source is hydro-electricity. During the past few years, the power generation capacity has been reduced, which has impacted negatively on the socio-economic development of the country. The country holds an enormous potential to generate geothermal energy due to the country's position within the Great African Rift valley. This could contribute to economic growth, poverty reduction and technological development in Malawi. The paper presents findings of research on comparisons between silica (quartz and chalcedony) and cation geothermometers (Na-K, Na-K-Ca and K-Mg) of hot springs in the Malawi Rift, in order to deduce the temperature at depth of selected hot springs. The saturation indices of most springs have a bearing on the geology of the areas where these hot springs are found. The Na-K geothermometers are, in general, higher than the Na-K-Ca geothermometer and the K-Mg geothermometer shows temperatures that are too low to be considered. The difference in the results between the different geothermometers may indicate shallow conditions of mixing with groundwater. Results also indicate that some hot springs have sufficient heat-generating capabilities and warrant further exploration work to assess their suitability for energy generation.

Evaluating COSMO's lake module (FLake) for an East-African lake using a comprehensive set of lake temperature profiles

NASA Astrophysics Data System (ADS)

Thiery, W.; Martynov, A.; Darchambeau, F.; Demuzere, M.; van Lipzig, N.

2012-04-01

The African great lakes are of utmost importance for the local economy (fishing), as well as being essential to the survival of the local people. During last decades, these lakes have been changing rapidly and their evolution is a major concern. Hence, it is important to correctly represent them in regional climate models for simulations over tropical Africa. However, so far lake models have been developed and tested primarily for boreal conditions. In this study, for the first time the freshwater lake model FLake is evaluated over East-Africa, more specifically over lake Kivu. Meteorological observations from January 2003 to December 2008 from an automatic weather station in Bukavu, DRC, are used to drive the standalone version of FLake. For the evaluation, a unique dataset is used which contains over 200 temperature profiles recorded since 2002. Results show that FLake in its default configuration is very successful at reproducing both the timing and magnitude of the seasonal cycle at 5 m depth. Flake captures that this seasonality is regulated by the water vapour pressure, which constrains evaporation except during summer (JJA). A positive bias of ~1 K is attributed to the driving data, which are collected in the city and are therefore expected to mirror higher temperatures and lower wind speeds compared to the lake surface. The evaluation also showed that driving FLake with Era-Interim from the nearest pixel does only slightly deteriorate the model performance. Using forcing fields from the Canadian Regional Climate Model, version 5 (CRCM5) simulation output gives similar performance as Era-Interim. Furthermore, a drawback of FLake is that it does not account for salinity and its effect upon lake stratification, and therefore requires artificial initial conditions for both lake depth and bottom temperature in order to reproduce the correct mixing regime in lake Kivu. Further research will therefore aim at improving FLake's representation of tropical lakes.

Strides in Preservation of Malawi's Natural Stone

NASA Astrophysics Data System (ADS)

Kamanga, Tamara; Chisenga, Chikondi; Katonda, Vincent

2017-04-01

The geology of Malawi is broadly grouped into four main lithological units that is the Basement Complex, the Karoo Super group, Tertiary to Quaternary sedimentary deposits and the Chilwa Alkaline province. The basement complex rocks cover much of the country and range in age from late Precambrian to early Paleozoic. They have been affected by three major phases of deformation and metamorphism that is the Irumide, Ubendian and The Pan-African. These rocks comprise gneisses, granulites and schists with associated mafic, ultramafic, syenites and granite rocks. The Karoo System sedimentary rocks range in age from Permian to lower Jurassic and are mainly restricted to two areas in the extreme North and extreme Alkaline Province - late Jurassic to Cretaceous in age, preceded by upper Karoo Dolerite dyke swarms and basaltic lavas, have been intruded into the Basement Complex gneisses of southern Malawi. Malawi is endowed with different types of natural stone deposits most of which remain unexploited and explored. Over twenty quarry operators supply quarry stone for road and building construction in Malawi. Hundreds of artisanal workers continue to supply aggregate stones within and on the outskirts of urban areas. Ornamental stones and granitic dimension stones are also quarried, but in insignificant volumes. In Northern Malawi, there are several granite deposits including the Nyika, which is the largest single outcrop occupying approximately 260.5 km2 , Mtwalo Amazonite an opaque to translucent bluish -green variety of microcline feldspar that occurs in alkali granites and pegmatite, the Ilomba granite (sodalite) occurring in small areas within biotite; apatite, plagioclase and calcite. In the Center, there are the Dzalanyama granites, and the Sani granites. In the South, there are the Mangochi granites. Dolerite and gabbroic rocks spread across the country, treading as black granites. Malawi is also endowed with many deposits of marble. A variety of other igneous

Educating Handicapped Young People in Eastern and Southern Africa in 1981-83.

ERIC Educational Resources Information Center

Ross, D. H.

This publication compiles the findings and conclusions of the 3-year first phase (1980-83) of the Unesco Sub-regional Project for Special Education in Eastern and Southern Africa. It presents the state of the art of special education and prospects for future development in Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mauritius, Seychelles, Somalia,…

A strategic assessment of unsafe abortion in Malawi.

PubMed

Jackson, Emily; Johnson, Brooke Ronald; Gebreselassie, Hailemichael; Kangaude, Godfrey D; Mhango, Chisale

2011-05-01

As part of efforts to achieve Millennium Development Goal 5--to reduce maternal mortality by 75% and achieve universal access to reproductive health by 2015--the Malawi Ministry of Health conducted a strategic assessment of unsafe abortion in Malawi. This paper describes the findings of the assessment, including a human rights-based review of Malawi's laws, policies and international agreements relating to sexual and reproductive health and data from 485 in-depth interviews about sexual and reproductive health, maternal mortality and unsafe abortion, conducted with Malawians from all parts of the country and social strata. Consensus recommendations to address the issue of unsafe abortion were developed by a broad base of local and international stakeholders during a national dissemination meeting. Malawi's restrictive abortion law, inaccessibility of safe abortion services, particularly for poor and young women, and lack of adequate family planning, youth-friendly and post-abortion care services were the most important barriers. The consensus reached was that to make abortion safe in Malawi, there were four areas for urgent action--abortion law reform; sexuality education and family planning; adolescent sexual and reproductive health services; and post-abortion care services. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

FIFA 11 for Health Programme: Implementation in Five Countries in Sub-Saharan Africa

ERIC Educational Resources Information Center

Fuller, Colin W.; Junge, Astrid; Amaning, Jacob; Kaijage, Rogasian R.; Kaputa, John; Magwende, George; Pambo, Prince; Dvorak, Jiri

2015-01-01

Objective: To assess the effectiveness of the FIFA 11 for Health programme in increasing children's knowledge about communicable and non-communicable diseases in five countries of Sub-Saharan Africa. Method: A prospective five-cohort study was implemented in schools in Ghana (17), Malawi (12), Namibia (11), Tanzania (18) and Zambia (11). The…

Mental Health Facilitator (MHF) Service Implementation in Schools in Malawi, Africa: A Strategy for Increasing Community Human Resources

ERIC Educational Resources Information Center

Luke, Melissa; Hinkle, J. Scott; Schweiger, Wendi; Henderson, Donna

2016-01-01

The Mental Health Facilitator (MHF) program utilizes a population-based curriculum and has been implemented in Malawi for the past seven years. This article reports findings from an ethnographic study that explored how 40 MHF stakeholders have experienced the MHF program. This transdisciplinary program is a 30-hour training in community mental…

Developmental Idealism and Cultural Models of the Family in Malawi

PubMed Central

Pierotti, Rachael S.; Young-DeMarco, Linda; Watkins, Susan

2014-01-01

This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between

Universal Basic Education and the Provision of Quality Mathematics in Southern Africa

ERIC Educational Resources Information Center

Kazima, Mercy

2014-01-01

In this paper, I discuss Universal Basic Education (UBE) in relation to the teaching and learning of mathematics in Southern Africa. I present the status of UBE for all countries in the region and then use 3 selected examples: Botswana, Malawi, and Zambia, to illustrate the provision of mathematics in the general framework of UBE in the countries.…

How many species of cichlid fishes are there in African lakes?

PubMed

Turner, G F; Seehausen, O; Knight, M E; Allender, C J; Robinson, R L

2001-03-01

The endemic cichlid fishes of Lakes Malawi, Tanganyika and Victoria are textbook examples of explosive speciation and adaptive radiation, and their study promises to yield important insights into these processes. Accurate estimates of species richness of lineages in these lakes, and elsewhere, will be a necessary prerequisite for a thorough comparative analysis of the intrinsic and extrinsic factors influencing rates of diversification. This review presents recent findings on the discoveries of new species and species flocks and critically appraises the relevant evidence on species richness from recent studies of polymorphism and assortative mating, generally using behavioural and molecular methods. Within the haplochromines, the most species-rich lineage, there are few reported cases of postzygotic isolation, and these are generally among allopatric taxa that are likely to have diverged a relatively long time in the past. However, many taxa, including many which occur sympatrically and do not interbreed in nature, produce viable, fertile hybrids. Prezygotic barriers are more important, and persist in laboratory conditions in which environmental factors have been controlled, indicating the primary importance of direct mate preferences. Studies to date indicate that estimates of alpha (within-site) diversity appear to be robust. Although within-species colour polymorphisms are common, these have been taken into account in previous estimates of species richness. However, overall estimates of species richness in Lakes Malawi and Victoria are heavily dependent on the assignation of species status to allopatric populations differing in male colour. Appropriate methods for testing the specific status of allopatric cichlid taxa are reviewed and preliminary results presented.

Comparison of simulated and reconstructed variations in East African hydroclimate over the last millennium

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klein, Francois; Goosse, Hugues; Graham, Nicholas E.

The multi-decadal to centennial hydroclimate changes in East Africa over the last millennium are studied by comparing the results of forced transient simulations by six general circulation models (GCMs) with published hydroclimate reconstructions from four lakes: Challa and Naivasha in equatorial East Africa, and Masoko and Malawi in southeastern inter-tropical Africa. All GCMs simulate fairly well the unimodal seasonal cycle of precipitation in the Masoko–Malawi region, while the bimodal seasonal cycle characterizing the Challa–Naivasha region is generally less well captured by most models. Model results and lake-based hydroclimate reconstructions display very different temporal patterns over the last millennium. Additionally, theremore » is no common signal among the model time series, at least until 1850. This suggests that simulated hydroclimate fluctuations are mostly driven by internal variability rather than by common external forcing. After 1850, half of the models simulate a relatively clear response to forcing, but this response is different between the models. Overall, the link between precipitation and tropical sea surface temperatures (SSTs) over the pre-industrial portion of the last millennium is stronger and more robust for the Challa–Naivasha region than for the Masoko–Malawi region. At the inter-annual timescale, last-millennium Challa–Naivasha precipitation is positively (negatively) correlated with western (eastern) Indian Ocean SST, while the influence of the Pacific Ocean appears weak and unclear. Although most often not significant, the same pattern of correlations between East African rainfall and the Indian Ocean SST is still visible when using the last-millennium time series smoothed to highlight centennial variability, but only in fixed-forcing simulations. Furthermore, this means that, at the centennial timescale, the effect of (natural) climate forcing can mask the imprint of internal climate variability in large

Comparison of simulated and reconstructed variations in East African hydroclimate over the last millennium

DOE PAGES

Klein, Francois; Goosse, Hugues; Graham, Nicholas E.; ...

2016-07-13

The multi-decadal to centennial hydroclimate changes in East Africa over the last millennium are studied by comparing the results of forced transient simulations by six general circulation models (GCMs) with published hydroclimate reconstructions from four lakes: Challa and Naivasha in equatorial East Africa, and Masoko and Malawi in southeastern inter-tropical Africa. All GCMs simulate fairly well the unimodal seasonal cycle of precipitation in the Masoko–Malawi region, while the bimodal seasonal cycle characterizing the Challa–Naivasha region is generally less well captured by most models. Model results and lake-based hydroclimate reconstructions display very different temporal patterns over the last millennium. Additionally, theremore » is no common signal among the model time series, at least until 1850. This suggests that simulated hydroclimate fluctuations are mostly driven by internal variability rather than by common external forcing. After 1850, half of the models simulate a relatively clear response to forcing, but this response is different between the models. Overall, the link between precipitation and tropical sea surface temperatures (SSTs) over the pre-industrial portion of the last millennium is stronger and more robust for the Challa–Naivasha region than for the Masoko–Malawi region. At the inter-annual timescale, last-millennium Challa–Naivasha precipitation is positively (negatively) correlated with western (eastern) Indian Ocean SST, while the influence of the Pacific Ocean appears weak and unclear. Although most often not significant, the same pattern of correlations between East African rainfall and the Indian Ocean SST is still visible when using the last-millennium time series smoothed to highlight centennial variability, but only in fixed-forcing simulations. Furthermore, this means that, at the centennial timescale, the effect of (natural) climate forcing can mask the imprint of internal climate variability in large

Distribution of Glycerol Diakyl Glycerol Tetraethers in Surface Soil and Crater Lake Sediments from Mount Kenya, East Africa

NASA Astrophysics Data System (ADS)

Omuombo, C.; Huguet, A.; Olago, D.; Williamson, D.

2013-12-01

Glycerol diakyl glycerol tetraethers (GDGTs), a palaeoclimate proxy based on the relative abundance of lipids produced by archaea and bacteria, is gaining wide acceptance for the determination of past temperature and pH conditions. This study looks at the spatial distribution and abundance of GDGTs in soil and sediment samples along an altitudinal transect from 3 crater lakes of Mt. Kenya (Lake Nkunga, Sacred Lake and Lake Rutundu) ranging in elevation from 1700m - 3080m above sea level. GDGTs were extracted with solvents and then analysed using high performance liquid chromatography/atmospheric pressure chemical ionization-mass spectrometry (HPLC/APCI-MS). Mean annual air temperature and pH were estimated based on the relative abundance of the different branched GDGTs, i.e. on the MBT (Methylation index of Branched Tetraethers) and CBT (Cyclization ratio of Branched Tetraethers) indices. Substantial amount of GDGTs were detected in both soil and sediment samples. In addition, branched GDGT distribution was observed to vary with altitude. These results highlight the importance of quantifying the branched GDGTs to understand the environmental parameters controlling the distribution of these lipids. The MBT/CBT proxy is a promising tool to infer palaeotemperatures and characterize the climate events of the past millennia in equatorial east Africa.

Geochemical and Sedimentological Records of Late Quaternary Climate Change, Lake Tanganyika, Tropical East Africa

NASA Astrophysics Data System (ADS)

Felton, A. A.; Russell, J. M.; Cohen, A. S.; Baker, M. E.; McGlue, M. M.; Lezzar, K. E.

2005-12-01

We have analyzed piston core records from Lake Tanganyika (western Tanzania, East African Rift Valley) to investigate possible signals of tropical paleoclimate change during the Late Quaternary. Long paleoclimate records from East Africa are of importance for understanding climatic processes such as the role of solar variability in regulating tropical climates at Milankovitch time scales, and the relationship between abrupt climate changes, migration of Intertropical Convergence Zone, and regional climate variability (Nicholson, 2000). However, records of pre-Holocene climate variability from tropical African lakes (>25ka) are still quite rare. Long records from Lake Tanganyika are of particular interest given the lake's antiquity and its demonstrated potential for producing high resolution (frequently annually laminated) sedimentary records (Cohen et al., 1993). We analyzed physical properties, grain size, total organic carbon, major, minor and trace element variability, and biogenic silica data for a 7.75 m core from the Kalya slope and horst region of central Lake Tanganyika at 640m water depth. Nine 14C dates provide an age model for the core, which spans ~62 cal kyr. Elemental concentrations preserved in Lake Tanganyika sediments record variability in deposition and runoff into the lake basin. Under conditions of rapid erosion, exposure and rapid weathering of bedrock has been shown to generate high concentrations of original silicate minerals enriched in soluble cations such as sodium and potassium, elements that are also biologically conservative. Prior to 40ka cal yr. core sediments are characterized by high magnetic susceptibility, intermediate levels of organic carbon, low to intermediate levels of biogenic silica, and fine grain size, indicative of relatively high precipitation. There is a profound decrease in magnetic susceptibility, a decrease in organic carbon and an increase in grain size at 40ka cal yr, which persists until ~16ka cal yr. Seismic

Color reflectance spectroscopy of profundal lake sediments: a novel moisture-balance proxy for tropical East Africa

NASA Astrophysics Data System (ADS)

Meyer, Inka; Van Daele, Maarten; Fiers, Geraldine; Verleyen, Eli; De Batist, Marc; Verschuren, Dirk

2016-04-01

Investigations of the continuous sediment record from Lake Challa, a deep freshwater crater lake on the eastern slope of Mt. Kilimanjaro, are expanding our knowledge about past climate and environmental changes in equatorial East Africa. During a field campaign in 2005 a 20.65-m long composite sediment sequence was retrieved from the center of the lake, covering the past 25,000 years. Unlike many other East African lakes, Lake Challa never dried out during this period and therefore provides one of the few continuous and high-resolution regional climate-proxy records since before the LGM. Continuously taken digital line-scan images (GeoTek MSCL core logger) revealed systematic colour variation from greenish to yellow-brownish sediments throughout the core sequence. To characterize the origin of these colour variations, high-resolution colour reflectance spectrometry was carried out. The relative absorption band depth (RABD) at different wavelengths was calculated to distinguish between sediment components with distinct absorption/ reflection characteristics. RABD660/670 can be used as a proxy for chlorophyll and its derivates, and RABD610 as a proxy for carotenoids and their derivates. Comparison of RABD660/670 with independent reconstructions of rainfall (the Branched and Isoprenoid Tetraether (BIT) index of bacterial lipids) and seismic lake level reconstructions showed a positive correlation between these proxies. During times of wetter climate and higher lake level, e.g. the early Holocene, the RABD660/670 value is higher than during times of inferred dry conditions and low lake level, e.g. the early late-Glacial period (during which no chlorophyll or its derivates were detected). We attribute this positive correlation to reduced preservation of chlorophyll contained in the settling remains of dead phytoplankton during lowstands, when bottom waters may have been better oxygenated. This data is supported by the variation in fossil pigment concentration and

Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience.

PubMed

Mulwafu, Wakisa; Nyirenda, Thomas Elliot; Fagan, Johannes J; Bem, Chris; Mlumbe, Kumvana; Chitule, Jean

2014-07-01

Sub-Saharan Africa countries like Malawi have a paucity of ear, nose and throat (ENT) data, services and training opportunities. To reflect on new Malawian ENT experience and to propose guidelines to poorly resourced countries. Analysis of data predating and following establishment of ENT services in Malawi. In 2008 the first and only Malawian ENT specialist established ENT services with external funding. Fifteen clinical officers have been trained and a nurse placed at each outreach hospital. In 2012, 15,284 consultations were recorded: 543 (3.6%) from outreach clinics. Forty-nine percent needed medical treatment, while 45% needed medical advice. Surgery was performed on 2.7% of patients; 21% for foreign bodies in the nose and throat and 18% for foreign bodies and biopsies of ears. To establish accessible and sustainable specialist ENT services in a poor country requires building on an established local health delivery system, careful planning and investment in personnel, infrastructure, training and data collection. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Exposure to violence and psychological well-being over time in children affected by HIV/AIDS in South Africa and Malawi

PubMed Central

Skeen, S.; Macedo, A.; Tomlinson, M.; Hensels, I. S.; Sherr, L.

2016-01-01

ABSTRACT Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12–15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). Interpersonal violence in the home predicted child depression (β = 0.17, p < .001), trauma symptoms (β = 0.17, p < .001), lower self-esteem (β = −0.17, p < .001), and internalising and externalising behavioural problems (β = 0.07, p < .05), while exposure to community violence predicted trauma symptoms (β = 0.16, p < .001) and behavioural problems (β = 0.07, p < .05). Harsh physical discipline predicted lower self-esteem (β = −0.18, p < .001) and behavioural problems for children (β = 0.24, p < .001). Exposure to home (OR: 1.89, 95% CI: 1.23–2.85) and community violence predicted risk behaviour (OR: 2.39, 95% CI: 1.57–3.62). Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children. PMID:27002770

Social Networks, Social Participation, and Health among Youth Living in Extreme Poverty in Rural Malawi

PubMed Central

Rock, Amelia; Barrington, Clare; Abdoulayi, Sara; Tsoka, Maxton; Mvula, Peter; Handa, Sudhanshu

2017-01-01

Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth’s peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly through lack of required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth’s social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence. PMID:27760393

Social networks, social participation, and health among youth living in extreme poverty in rural Malawi.

PubMed

Rock, Amelia; Barrington, Clare; Abdoulayi, Sara; Tsoka, Maxton; Mvula, Peter; Handa, Sudhanshu

2016-12-01

Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth's social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence. Copyright © 2016 Elsevier Ltd. All rights reserved.

High-Stakes Testing in the Warm Heart of Africa: The Challenges and Successes of the Malawi National Examinations Board

ERIC Educational Resources Information Center

Chakwera, Elias; Khembo, Dafter; Sireci, Stephen G.

2004-01-01

In the United States, tests are held to high standards of quality. In developing countries such as Malawi, psychometricians must deal with these same high standards as well as several additional pressures such as widespread cheating, test administration difficulties due to challenging landscapes and poor resources, difficulties in reliably scoring…

Experiences of self-disclosure among tuberculosis patients in rural Southern Malawi.

PubMed

Zolowere, Davie; Manda, Kumbukani; Panulo, Ben; Muula, Adamson S

2008-01-01

Tuberculosis (Tb) is a significant public health problem in Southern Africa, largely as a consequence of the HIV/AIDS pandemic. Self-disclosure of diagnosis to others within the patients' social environment may be problematic because the diagnosis of Tb may attract stigma, largely derived from the association of this disease with HIV infection. In Malawi, there are limited reports of the diagnosis disclosure experiences of Tb patients. A qualitative study using in-depth interviews was conducted in Thyolo, a rural southern Malawi district to: (1) explore the relationship of persons to whom Tb patients disclose their diagnoses; and (2) identify the motivations for such disclosures. Thirty-two adult Tb patients participated in the study. Their ages ranged from 22 to 49 years (median 31 years), and 19 were male. The majority of patients reported having disclosed their disease status to close family members, such as spouses, siblings and parents; only a few had disclosed their status to their children. The most common way of disclosure was through personal discussion between the patient and their significant others. Study participants perceived that disclosure brought returns in terms of encouragement and empowerment. Some patients felt stigmatized or feared stigmatization following disclosure of their disease status, and some patients on antiretroviral therapy for HIV felt stigmatized by fellow patients. Patient-to-patient interaction was perceived as a valuable resource in trying to cope with a Tb diagnosis. The findings of this study suggest that Tb patients in southern Malawi were interested in disclosing their Tb diagnosis if they felt they would not be stigmatized or stood to gain as a result of self-disclosure. Disclosure of diagnosis was facilitated by trust, a feeling of safety, and a sense of obligation to others. The perceived stigmatization of patients by other patients is cause for concern. This study calls for the health education of patients, with the

The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa.

PubMed

Norseth, Hanne M; Ndhlovu, Patricia D; Kleppa, Elisabeth; Randrianasolo, Bodo S; Jourdan, Peter M; Roald, Borghild; Holmen, Sigve D; Gundersen, Svein G; Bagratee, Jayanthilall; Onsrud, Mathias; Kjetland, Eyrun F

2014-01-01

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

A review of mercury in Lake Victoria, East Africa: implications for human and ecosystem health.

PubMed

Campbell, Linda; Dixon, D G; Hecky, R E

2003-01-01

Lake Victoria, East Africa, has been the site of many recent studies measuring mercury (Hg) concentrations in water, fish, sediment, soil, and humans. Most of these studies were motivated by concerns about Hg contamination from processing of gold ore on the southern shores. Total Hg (THg) concentrations in fish were usually below permissible World Health Organization (WHO) concentrations and international marketing limits and do not threaten the lucrative export industry. Nile perch 3-10 kg and most >10 kg had THg concentrations above the WHO threshold concentrations for at-risk groups (200 ng/g). Elevated THg concentrations in large Nile perch are not of major concern because Nile perch are rarely consumed by the people living on Lake Victoria and very large Nile perch are becoming increasingly rare in catches. Water THg concentrations were below Canadian drinking water guidelines but were elevated relative to those in the northern Great Lakes. Sediment and soil THg concentrations were within inter-national guidelines and are comparable to those in northern latitudes but are lower than those in the Amazon basin. Biomass burning and soil erosion are estimated to be the major sources of THg for the lake and probably constitute a larger source of THg than gold mining in Tanzania.THg concentrations in urine and hair from human volunteers indicate that while gold miners and frequent skin-bleaching cream users are at risk of inorganic mercury poisoning, the rest of the population, including fishermen, is not. Human exposure assessments demonstrated that fish consumption and soil geophagy constitute major sources of THg for humans, but the total estimated daily intake of THg was below the Health Canada tolerable daily intake (TDI) limits. The use of beauty creams containing high inorganic Hg concentrations, however, caused the estimated THg exposure to exceed the TDI. The high THg content in the hair of regular cream users supports this assessment. The nutritional

Continuous 1.3-million-year record of East African hydroclimate, and implications for patterns of evolution and biodiversity

NASA Astrophysics Data System (ADS)

Lyons, Robert P.; Scholz, Christopher A.; Cohen, Andrew S.; King, John W.; Brown, Erik T.; Ivory, Sarah J.; Johnson, Thomas C.; Deino, Alan L.; Reinthal, Peter N.; McGlue, Michael M.; Blome, Margaret W.

2015-12-01

The transport of moisture in the tropics is a critical process for the global energy budget and on geologic timescales, has markedly influenced continental landscapes, migratory pathways, and biological evolution. Here we present a continuous, first-of-its-kind 1.3-My record of continental hydroclimate and lake-level variability derived from drill core data from Lake Malawi, East Africa (9-15° S). Over the Quaternary, we observe dramatic shifts in effective moisture, resulting in large-scale changes in one of the world's largest lakes and most diverse freshwater ecosystems. Results show evidence for 24 lake level drops of more than 200 m during the Late Quaternary, including 15 lowstands when water levels were more than 400 m lower than modern. A dramatic shift is observed at the Mid-Pleistocene Transition (MPT), consistent with far-field climate forcing, which separates vastly different hydroclimate regimes before and after ∼800,000 years ago. Before 800 ka, lake levels were lower, indicating a climate drier than today, and water levels changed frequently. Following the MPT high-amplitude lake level variations dominate the record. From 800 to 100 ka, a deep, often overfilled lake occupied the basin, indicating a wetter climate, but these highstands were interrupted by prolonged intervals of extreme drought. Periods of high lake level are observed during times of high eccentricity. The extreme hydroclimate variability exerted a profound influence on the Lake Malawi endemic cichlid fish species flock; the geographically extensive habitat reconfiguration provided novel ecological opportunities, enabling new populations to differentiate rapidly to distinct species.

Continuous 1.3-million-year record of East African hydroclimate, and implications for patterns of evolution and biodiversity

PubMed Central

Lyons, Robert P.; Scholz, Christopher A.; Cohen, Andrew S.; King, John W.; Brown, Erik T.; Ivory, Sarah J.; Johnson, Thomas C.; Deino, Alan L.; Reinthal, Peter N.; McGlue, Michael M.; Blome, Margaret W.

2015-01-01

The transport of moisture in the tropics is a critical process for the global energy budget and on geologic timescales, has markedly influenced continental landscapes, migratory pathways, and biological evolution. Here we present a continuous, first-of-its-kind 1.3-My record of continental hydroclimate and lake-level variability derived from drill core data from Lake Malawi, East Africa (9–15° S). Over the Quaternary, we observe dramatic shifts in effective moisture, resulting in large-scale changes in one of the world’s largest lakes and most diverse freshwater ecosystems. Results show evidence for 24 lake level drops of more than 200 m during the Late Quaternary, including 15 lowstands when water levels were more than 400 m lower than modern. A dramatic shift is observed at the Mid-Pleistocene Transition (MPT), consistent with far-field climate forcing, which separates vastly different hydroclimate regimes before and after ∼800,000 years ago. Before 800 ka, lake levels were lower, indicating a climate drier than today, and water levels changed frequently. Following the MPT high-amplitude lake level variations dominate the record. From 800 to 100 ka, a deep, often overfilled lake occupied the basin, indicating a wetter climate, but these highstands were interrupted by prolonged intervals of extreme drought. Periods of high lake level are observed during times of high eccentricity. The extreme hydroclimate variability exerted a profound influence on the Lake Malawi endemic cichlid fish species flock; the geographically extensive habitat reconfiguration provided novel ecological opportunities, enabling new populations to differentiate rapidly to distinct species. PMID:26644580

Continuous 1.3-million-year record of East African hydroclimate, and implications for patterns of evolution and biodiversity.

PubMed

Lyons, Robert P; Scholz, Christopher A; Cohen, Andrew S; King, John W; Brown, Erik T; Ivory, Sarah J; Johnson, Thomas C; Deino, Alan L; Reinthal, Peter N; McGlue, Michael M; Blome, Margaret W

2015-12-22

The transport of moisture in the tropics is a critical process for the global energy budget and on geologic timescales, has markedly influenced continental landscapes, migratory pathways, and biological evolution. Here we present a continuous, first-of-its-kind 1.3-My record of continental hydroclimate and lake-level variability derived from drill core data from Lake Malawi, East Africa (9-15° S). Over the Quaternary, we observe dramatic shifts in effective moisture, resulting in large-scale changes in one of the world's largest lakes and most diverse freshwater ecosystems. Results show evidence for 24 lake level drops of more than 200 m during the Late Quaternary, including 15 lowstands when water levels were more than 400 m lower than modern. A dramatic shift is observed at the Mid-Pleistocene Transition (MPT), consistent with far-field climate forcing, which separates vastly different hydroclimate regimes before and after ∼800,000 years ago. Before 800 ka, lake levels were lower, indicating a climate drier than today, and water levels changed frequently. Following the MPT high-amplitude lake level variations dominate the record. From 800 to 100 ka, a deep, often overfilled lake occupied the basin, indicating a wetter climate, but these highstands were interrupted by prolonged intervals of extreme drought. Periods of high lake level are observed during times of high eccentricity. The extreme hydroclimate variability exerted a profound influence on the Lake Malawi endemic cichlid fish species flock; the geographically extensive habitat reconfiguration provided novel ecological opportunities, enabling new populations to differentiate rapidly to distinct species.

Integrating interannual climate variability forecasts into weather-indexed crop insurance. The case of Malawi, Kenya and Tanzania

NASA Astrophysics Data System (ADS)

Vicarelli, M.; Giannini, A.; Osgood, D.

2009-12-01

In this study we explore the potential for re-insurance schemes built on regional climatic forecasts. We focus on micro-insurance contracts indexed on precipitation in 9 villages in Kenya, Tanzania (Eastern Africa) and Malawi (Southern Africa), and analyze the precipitation patterns and payouts resulting from El Niño Southern Oscillation (ENSO). The inability to manage future climate risk represents a “poverty trap” for several African regions. Weather shocks can potentially destabilize not only household, but also entire countries. Governments in drought-prone countries, donors and relief agencies are becoming aware of the importance to develop an ex-ante risk management framework for weather risk. Joint efforts to develop innovative mechanisms to spread and pool risk such as microinsurance and microcredit are currently being designed in several developing countries. While ENSO is an important component in modulating the rainfall regime in tropical Africa, the micro-insurance experiments currently under development to address drought risk among smallholder farmers in this region do not take into account ENSO monitoring or forecasting yet. ENSO forecasts could be integrated in the contracts and reinsurance schemes could be designed at the continental scale taking advantage of the different impact of ENSO on different regions. ENSO is associated to a bipolar precipitation pattern in Southern and Eastern Africa. La Niña years (i.e. Cold ENSO Episodes) are characterized by dry climate in Eastern Africa and wet climate in Southern Africa. During El Niño (or Warm Episode) the precipitation dipole is inverted, and Eastern Africa experiences increased probability for above normal rainfall (Halpert and Ropelewski, 1992, Journal of Climate). Our study represents the first exercise in trying to include ENSO forecasts in micro weather index insurance contract design. We analyzed the contracts payouts with respect to climate variability. In particular (i) we simulated

THE TEACHING OF GEO SCIENCE IN MALAWI SECONDARY SCHOOLS: The case of the Solar System and beyond

NASA Astrophysics Data System (ADS)

Chasukwa Mwalwenje, Yvonne; Chasukwa, Fidel

2016-04-01

orange year in and year out. Using such single improvisation strategy has resulted into boring and monotonous lessons hence high failure in the subject. Furthermore, the study reveals that other factors contributing to poor pass rate include use of single teaching and learning skills hence making the topic less popular among the learners. The paper concludes that education stakeholders need to take extra steps on purchasing of teaching and learning instructions to improve teaching and learning of the solar system to produce successful Malawian astronomers. The responsibility of purchasing teaching instructions should not be left to government alone. Lastly, teaching and learning of the solar system should be innovative and meaningful to the environment outside the classroom where learners can see pieces of empirical evidence. Key Words: Malawi, Geography, Malawi National Examinations Board, Solar System References All Africa (1999) Poor School examination results blamed on education system Malawi National Examinations Board (2015)

Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi

PubMed Central

Rennie, Stuart; Perry, Brian; Corneli, Amy; Chilungo, Abdullah; Umar, Eric

2015-01-01

Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man’s risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with men, women, and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context. PMID:25630610

Fish faunal resurgence in Lake Nabugabo, East Africa

USGS Publications Warehouse

Chapman, L.J.; Chapman, Colin A.; Schofield, P.J.; Olowo, J.P.; Kaufman, L.S.; Seehausen, O.; Ogutu-Ohwayo., R.

2003-01-01

 In Lake Nabugabo, Uganda, a small satellite of the equatorial Lake Victoria, approximately 50% of the indigenous fish species disappeared from the open waters subsequent to establishment of the introduced predatory Nile perch (   Lates niloticus ). However, several of these species persisted in wetland refugia. Over the past decade, Nile perch in Lake Nabugabo have been intensively fished. Herein we report a resurgence of some indigenous species in open waters. In a multiyear study, we used annual transects in inshore and offshore waters of exposed ( no wetland ) and wetland habitats to document the pattern of resurgence. In 1995, haplochromine cichlids were largely confined to inshore areas, particularly wetland ecotones, and were rare in Nile perch stomachs, as were most other indigenous species. By 2000 haplochromine cichlids were abundant in inshore and offshore areas of both exposed and wetland transects. Several indigenous noncichlids also reappeared in the main lake, including three of the four original mormyrid species. Between 1995 and 1999, there was a dramatic increase in the proportion of haplochromines in the diet of Nile perch. When haplochromines were rare ( 1995 ), Nile perch switched from an invertebrate-dominated diet to piscivory at a large size ( 30 cm total length ). In 2000, however, Nile perch were strongly piscivorous by 5–10 cm total length. The pattern of faunal loss and recovery in Lake Nabugabo demonstrates the importance of refugia in providing the seeds of resurgence and provides a model with which to understand some changes in Lake Victoria.

Physical attractiveness and women’s HIV risk in rural Malawi

PubMed Central

Frye, Margaret; Chae, Sophia

2017-01-01

BACKGROUND Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. OBJECTIVE We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country’s severe AIDS epidemic. METHODS We use interviewers’ ratings of respondents’ attractiveness, along with HIV test results and women’s assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15–35. RESULTS Results show that women who are rated by interviewers as ‘much less’ or ‘less’ attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women’s own assessments of their HIV risk: Among women who tested negative, those perceived as ‘much less’ or ‘less’ attractive than average report themselves to be at greater risk of HIV infection. CONCLUSIONS These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. CONTRIBUTION This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings. PMID:29242708

Cardio-thoracic ratio in Negroes in Southern Africa

PubMed Central

Walker, Alexander R. P.; Richardson, B. D.; Wadvalla, M.; Walker, B. F.

1972-01-01

Negro groups in West, Central and Southern Africa, also in Jamaica, have mean cardio-thoracic ratios significantly greater than those in corresponding age-sex groups of Caucasians. To throw more light on the situation, studies on young and elderly Negroes have been made in certain groups in Southern Africa, also on local Caucasian groups. Only slight differences in ratio were found between local Negro groups, and Caucasian groups in South Africa, also in Wales and Tecumseh (U.S.A.). Yet ratios in Negro males from Malawi and Mozambique, resident in South Africa, were significantly greater than values in local Negroes. High ratios are not therefore invariable for Negroes. The difference observed relates to heart, not thoracic diameter. Since the phenomenon, which concerns heart position, is apparent in the young, almost certainly it is of ethnic origin. Investigations on cardiomegaly in African populations must take this factor into reckoning. Its presence or absence locally may readily be assessed by determining ratios in relatively small numbers of young people of both sexes. PMID:4263410

Characterizing Pediatric Non-Malarial Fever and Identifying the At-Risk Child in Rural Malawi.

PubMed

Kortz, Teresa Bleakly; Blair, Alden; Scarr, Ellen; Mguntha, Andrew Masozi; Bandawe, Gama; Schell, Ellen; Rankin, Sally; Baltzell, Kimberly

2018-01-01

Objective . To characterize children with non-malarial fever at risk of nonrecovery or worsening in rural Malawi. Methods . This is a subgroup analysis of patients ≤14 years of age from a prospective cohort study in non-malarial fever subjects (temperature ≥37.5°C, or fever within 48 hours, and malaria negative) in southern Malawi cared for at a mobile clinic during the 2016 dry (August to September) or wet (November to December) season. Data collection included chart review and questionnaires; 14-day follow-up was conducted. We conducted univariate descriptive statistics on cohort characteristics, bivariate analyses to examine associations between characteristics and outcomes, and multivariate logistic regressions to explore factors associated with nonrecovery. Results . A total of 2893 patients were screened, 401 were enrolled, 286 of these were children, and 280 children completed follow-up. Eighty-seven percent reported symptom resolution, 12.9% reported no improvement, and there were no deaths or hospitalizations. No improvement was associated with dry season presentation (42.6% vs 75.0%, P < .0003), >2 days of symptoms (51.6% vs 72.2%, P = .03), and food insecurity (62.3% vs 86.1%, P = .007). Dry season subjects had a 4.35 times greater likelihood of nonimprovement (95% confidence interval [CI] = 1.96-11.11). Household food insecurity and being >2 hours from a permanent clinic were associated with no improvement (adjusted odds ratio [AOR] = 4.61, 95% CI = 1.81-14.29; and AOR = 2.38, 95% CI = 1.11-5.36, respectively). Conclusion . Outcomes were generally excellent in this rural, outpatient pediatric cohort, though risk factors for nonrecovery included food insecurity, access to a standing clinic, and seasonality. Ideally, this study will inform clinic- and policy-level changes aimed at ameliorating the modifiable risk factors in Malawi and throughout rural Africa.

The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi.

PubMed

Lancaster, Kathryn Elizabeth; Powers, Kimberly A; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C; Chadwick, Katy; Go, Vivian F; Pence, Brian W; Hoffman, Irving F; Miller, William C

2016-01-01

The HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi. From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome. HIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22-28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3-17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes. FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.

The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi

PubMed Central

Lancaster, Kathryn Elizabeth; Powers, Kimberly A.; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C.; Chadwick, Katy; Go, Vivian F.; Pence, Brian W.; Hoffman, Irving F.; Miller, William C.

2016-01-01

Objective The HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi. Methods From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome. Results HIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22–28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3–17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes. Conclusions FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered. PMID:26808043

Mathematical Modeling to Assess the Drivers of the Recent Emergence of Typhoid Fever in Blantyre, Malawi.

PubMed

Pitzer, Virginia E; Feasey, Nicholas A; Msefula, Chisomo; Mallewa, Jane; Kennedy, Neil; Dube, Queen; Denis, Brigitte; Gordon, Melita A; Heyderman, Robert S

2015-11-01

Multiyear epidemics of Salmonella enterica serovar Typhi have been reported from countries across eastern and southern Africa in recent years. In Blantyre, Malawi, a dramatic increase in typhoid fever cases has recently occurred, and may be linked to the emergence of the H58 haplotype. Strains belonging to the H58 haplotype often exhibit multidrug resistance and may have a fitness advantage relative to other Salmonella Typhi strains. To explore hypotheses for the increased number of typhoid fever cases in Blantyre, we fit a mathematical model to culture-confirmed cases of Salmonella enterica infections at Queen Elizabeth Central Hospital, Blantyre. We explored 4 hypotheses: (1) an increase in the basic reproductive number (R0) in response to increasing population density; (2) a decrease in the incidence of cross-immunizing infection with Salmonella Enteritidis; (3) an increase in the duration of infectiousness due to failure to respond to first-line antibiotics; and (4) an increase in the transmission rate following the emergence of the H58 haplotype. Increasing population density or decreasing cross-immunity could not fully explain the observed pattern of typhoid emergence in Blantyre, whereas models allowing for an increase in the duration of infectiousness and/or the transmission rate of typhoid following the emergence of the H58 haplotype provided a good fit to the data. Our results suggest that an increase in the transmissibility of typhoid due to the emergence of drug resistance associated with the H58 haplotype may help to explain recent outbreaks of typhoid in Malawi and similar settings in Africa. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Malawi three district evaluation: Community-based maternal and newborn care economic analysis.

PubMed

Greco, Giulia; Daviaud, Emmanuelle; Owen, Helen; Ligowe, Reuben; Chimbalanga, Emmanuel; Guenther, Tanya; Gamache, Nathalie; Zimba, Evelyn; Lawn, Joy E

2017-10-01

Malawi is one of few low-income countries in sub-Saharan Africa to have met the fourth Millennium Development Goal for child survival (MDG 4). To accelerate progress towards MDGs, the Malawi Ministry of Health's Reproductive Health Unit - in partnership with Save the Children, UNICEF and others - implemented a Community Based Maternal and Newborn Care (CBMNC) package, integrated within the existing community-based system. Multi-purpose Health Surveillance Assistants (HSAs) already employed by the local government were trained to conduct five core home visits. The additional financial costs, including donated items, incurred by the CBMNC package were analysed from the perspective of the provider. The coverage level of HSA home visits (35%) was lower than expected: mothers received an average of 2.8 visits rather than the programme target of five, or the more reasonable target of four given the number of women who would go away from the programme area to deliver. Two were home pregnancy and less than one, postnatal, reflecting greater challenges for the tight time window to achieve postnatal home visits. As a proportion of a 40 hour working week, CBMNC related activities represented an average of 13% of the HSA work week. Modelling for 95% coverage in a population of 100,000, the same number of HSAs could achieve this high coverage and financial programme cost could remain the same. The cost per mother visited would be US$6.6, or US$1.6 per home visit. The financial cost of universal coverage in Malawi would stand at 1.3% of public health expenditure if the programme is rolled out across the country. Higher coverage would increase efficiency of financial investment as well as achieve greater effectiveness. The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Diatom-inferred hydrological changes and Holocene geomorphic transitioning of Africa's largest estuarine system, Lake St Lucia

NASA Astrophysics Data System (ADS)

Gomes, M.; Humphries, M. S.; Kirsten, K. L.; Green, A. N.; Finch, J. M.; de Lecea, A. M.

2017-06-01

The diverse lagoons and coastal lakes along the east coast of South Africa occupy incised valleys that were flooded during the rise and subsequent stabilisation of relative sea-level during the Holocene. Sedimentary deposits contained within these waterbodies provide an opportunity to investigate complex hydrological and sedimentological processes, and examine sea-level controls governing system geomorphic evolution. In this paper, we combine diatom and sulfur isotope analyses from two sediment cores extracted from the northern sub-basins of Lake St Lucia, a large shallow estuarine lake that is today largely isolated from direct ocean influence behind a Holocene-Pleistocene barrier complex. Analyses allow the reconstruction of hydrological changes associated with the geomorphic development of the system over the mid-to late Holocene. The sedimentary sequences indicate that St Lucia was a shallow, partially enclosed estuary/embayment dominated by strong tidal flows prior to ∼6200 cal. BP. Infilling was initiated when sea-level rise slowed and stabilised around present day levels, resulting in the accumulation of fine-grained sediment behind an emergent proto-barrier. Diatom assemblages, dominated by marine benthic and epiphytic species, reveal a system structured by marine water influx and characterised by marsh and tidal flat habitats until ∼4550 cal. BP. A shift in the biological community at ∼4550 cal. BP is linked to the development of a back-barrier water body that supported a brackish community. Marine planktonics and enrichments in δ34S suggest recurrent, large-scale barrier inundation events during this time, coincident with a mid-Holocene sea-level highstand. Periodic marine incursions associated with episodes of enhanced storminess and overwash remained prevalent until ∼1200 cal. BP, when further barrier construction ultimately isolated the northern basins from the ocean. This study provides the first reconstruction of the palaeohydrological

Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi.

PubMed

Vetrini, Damir; Kiire, Christine A; Burgess, Philip I; Harding, Simon P; Kayange, Petros C; Kalua, Khumbo; Msukwa, Gerald; Beare, Nicholas A V; Madan, Jason

2018-01-01

To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa. A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed. In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%. Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients.

Positively essential: traditional birth attendants in Malawi.

PubMed

Stronge, Shirley

2011-06-01

One of the biggest challenges for healthcare professionals working in developing countries is the lack of trained personnel to carry out much needed health care provision. Shirley Stronge worked as a nurse/midwife tutor in a rural area in the north of Malawi. Millennium Development Goals four and five have focused our attention on the care required by mothers and newborns. Shirley has chosen to reflect on the role of Traditional Birth Attendants in the north of Malawi and their positive impact on maternity services in this area.

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

PubMed Central

Norseth, Hanne M.; Ndhlovu, Patricia D.; Kleppa, Elisabeth; Randrianasolo, Bodo S.; Jourdan, Peter M.; Roald, Borghild; Holmen, Sigve D.; Gundersen, Svein G.; Bagratee, Jayanthilall; Onsrud, Mathias; Kjetland, Eyrun F.

2014-01-01

Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Methodology/Principal findings Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. Significance This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice. PMID:25412334

Dermatophytes and dermatophytosis in the eastern and southern parts of Africa.

PubMed

Nweze, E I; Eke, I E

2018-01-01

Dermatophytosis is currently a disease of global importance and a public health burden. It is caused by dermatophytes, which attack and grow on dead animal keratin. Dermatophytes belong to three genera, namely, Epidermophyton, Microsporum, and Trichophyton. The predominant clinical forms and causative agents vary from one region of the world to another. Poor socioeconomic status, high population densities, and poor sanitary conditions are some of the factors responsible for the high prevalence of dermatophytosis in many developing countries, which include countries in southern and eastern Africa, the focus of this review. To the best of our knowledge, there is currently no review article on published findings on dermatophytosis in the eastern and southern parts of Africa. This information will be of interest to the medical and research community since the world has become a global village. This review covers published research findings in eastern and southern regions of Africa until this date. The countries covered in the current review include Kenya, Ethiopia, Tanzania, South Africa, Mozambique, Madagascar, Malawi, Rwanda, Burundi, Uganda, Zambia, Zimbabwe, and Botswana. T. violaceum is the most common human etiological agent in all the countries under review with prevalence ranging from 56.7% to 95%, except for Madagascar (M. langeronii, reclassified as M. audouinii), Uganda (M. gypseum) and Malawi (M. audouinii). Tinea capitis was the most clinical type, followed by tinea corporis. Etiological agents of animal dermatophytoses were variable in the countries where they were reported. Major risk factors for dermatophytoses are age, climatic, and socioeconomic factors. © The Author 2017. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Physiotherapy in Malawi - a step in the right direction.

PubMed

Fielder, S; Mpezeni, S; Benjamin, L; Cary, I

2013-09-01

Physiotherapists in Malawi are in short supply and the demand for this service is increasing. This profession is instrumental in the rehabilitation of patients following accident and disease. Early input from a physiotherapist can be life changing; for example, timely physiotherapy could prevent a patient from becoming wheelchair-bound for life. This article explores the role of physiotherapists, in the context of what they do, the medical conditions that benefit from physiotherapy and the services available in Malawi. The clinical focus will be on orthopaedic, musculoskeletal and neurological conditions, since those are the specialties of the authors. With the start of the physiotherapy degree programme at the College of Medicine, University of Malawi, huge steps have been taken to address this neglected profession.

Nile River, Lake Nasser, Aswan High Dam, Egypt, Africa

NASA Technical Reports Server (NTRS)

1992-01-01

Lake Nasser, (24.0N, 33.0E) at the Aswan High Dam on the Nile River, in Egypt is the world's second largest artificial lake, extending 500 km, in length and about 5000 sq. km. in area. The lake has a storage capacity sufficient to irrigate farms in Egypt and Sudan year round allowing up to three harvests per year. Other benefits include year round river navagation, hydroelectric power, more fish harvests, reduced flooding and more industrial employment. opportunites.

Geographic variation in sexual behavior can explain geospatial heterogeneity in the severity of the HIV epidemic in Malawi.

PubMed

Palk, Laurence; Blower, Sally

2018-02-09

In sub-Saharan Africa, where ~ 25 million individuals are infected with HIV and transmission is predominantly heterosexual, there is substantial geographic variation in the severity of epidemics. This variation has yet to be explained. Here, we propose that it is due to geographic variation in the size of the high-risk group (HRG): the group with a high number of sex partners. We test our hypothesis by conducting a geospatial analysis of data from Malawi, where ~ 13% of women and ~ 8% of men are infected with HIV. We used georeferenced HIV testing and behavioral data from ~ 14,000 participants of a nationally representative population-level survey: the 2010 Malawi Demographic and Health Survey (MDHS). We constructed gender-stratified epidemic surface prevalence (ESP) maps by spatially smoothing and interpolating the HIV testing data. We used the behavioral data to construct gender-stratified risk maps that reveal geographic variation in the size of the HRG. We tested our hypothesis by fitting gender-stratified spatial error regression (SER) models to the MDHS data. The ESP maps show considerable geographic variation in prevalence: 1-29% (women), 1-20% (men). Risk maps reveal substantial geographic variation in the size of the HRG: 0-40% (women), 16-58% (men). Prevalence and the size of the HRG are highest in urban centers. However, the majority of HIV-infected individuals (~75% of women, ~ 80% of men) live in rural areas, as does most of the HRG (~ 80% of women, ~ 85% of men). We identify a significant (P < 0.001) geospatial relationship linking the size of the HRG with prevalence: the greater the size, the higher the prevalence. SER models show HIV prevalence in women is expected to exceed the national average in districts where > 20% of women are in the HRG. Most importantly, the SER models show that geographic variation in the size of the HRG can explain a substantial proportion (73% for women, 67% for men) of the geographic

Malaria research and its influence on anti-malarial drug policy in Malawi: a case study.

PubMed

Mwendera, Chikondi; de Jager, Christiaan; Longwe, Herbert; Phiri, Kamija; Hongoro, Charles; Mutero, Clifford M

2016-06-01

In 1993, Malawi changed its first-line anti-malarial treatment for uncomplicated malaria from chloroquine to sulfadoxine-pyrimethamine (SP), and in 2007, it changed from SP to lumefantrine-artemether. The change in 1993 raised concerns about whether it had occurred timely and whether it had potentially led to early development of Plasmodium falciparum resistance to SP. This case study examined evidence from Malawi in order to assess if the policy changes were justifiable and supported by evidence. A systematic review of documents and published evidence between 1984 and 1993, when chloroquine was the first-line drug, and 1994 and 2007, when SP was the first-line drug, was conducted herein. The review was accompanied with key informant interviews. A total of 1287 publications related to malaria drug policy changes in sub-Saharan Africa were identified. Using the inclusion criteria, four articles from 1984 to 1993 and eight articles from 1994 to 2007 were reviewed. Between 1984 and 1993, three studies reported on chloroquine poor efficacy prompting policy change according to WHO's recommendation. From 1994 to 2007, four studies conducted in the early years of policy change reported a high SP efficacy of above 80%, retaining it as a first-line drug. Unpublished sentinel site studies between 2005 and 2007 showed a reduced efficacy of SP, influencing policy change to lumefantrine-artemether. The views of key informants indicate that the switch from chloroquine to SP was justified based on local evidence despite unavailability of WHO's policy recommendations, while the switch to lumefantrine-artemether was uncomplicated as the country was following the recommendations from WHO. Ample evidence from Malawi influenced and justified the policy changes. Therefore, locally generated evidence is vital for decision making during policy change.

The impact of long term institutional collaboration in surgical training on trauma care in Malawi.

PubMed

Young, Sven; Banza, Leonard; Mkandawire, Nyengo

2016-01-01

Attempts to address the huge, and unmet, need for surgical services in Africa by training surgical specialists in well established training programmes in high-income countries have resulted in brain drain, as most trainees do not return home on completion of training for various reasons. Local postgraduate training is key to retaining specialists in their home countries. International institutional collaborations have enabled Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, to start training their own surgical specialists from 2009. The direct impact of this has been an increase in Malawian staff from none at all to 12 medical doctors in 2014 in addition to increased foreign faculty. We have also seen improved quality of care as illustrated by a clear reduction in the amputation rate after trauma at KCH, from nearly every fourth orthopaedic operation being an amputation in 2008 to only 4 % in 2014. Over the years the training program at KCH has, with the help from its international partners, merged with the College of Medicine in Blantyre, Malawi, into a national training programme for surgery. Our experiences from this on-going international institutional collaboration to increase the capacity for training surgeons in Malawi show that long-term institutional collaboration in the training of surgeons in low-income countries can be done as a sustainable and up-scalable model with great potential to reduce mortality and prevent disability in young people. Despite the obvious and necessary focus on the rural poor in low-income countries, stakeholders must start to see the value of strengthening teaching hospitals to sustainably meet the growing burden of trauma and surgical disease. Annual operating data from Kamuzu Central Hospital's Main Operating Theatre log book for the years 2008-2014 was collected. Observed annual numbers were presented as graphs for easy visualization. Linear regression curve estimations were calculated and plotted as trend lines on the

Refractive errors, visual impairment, and the use of low-vision devices in albinism in Malawi.

PubMed

Schulze Schwering, M; Kumar, N; Bohrmann, D; Msukwa, G; Kalua, K; Kayange, P; Spitzer, M S

2015-04-01

This study focuses on the refractive implications of albinism in Malawi, which is mostly associated with the burden of visual impairment. The main goal was to describe the refractive errors and to analyze whether patients with albinism in Malawi, Sub-Saharan Africa, benefit from refraction. Age, sex, refractive data, uncorrected and best-corrected visual acuity (UCVA, BCVA), colour vision, contrast sensitivity, and the prescription of sunglasses and low vision devices were collected for a group of 120 albino individuals with oculocutaneous albinism (OCA). Refractive errors were evaluated objectively and subjectively by retinoscopy, and followed by cycloplegic refraction to reconfirm the results. Best-corrected visual acuity (BCVA) was also assessed binocularly. One hundred and twenty albino subjects were examined, ranging in age from 4 to 25 years (median 12 years), 71 (59 %) boys and 49 (41 %) girls. All exhibited horizontal pendular nystagmus. Mean visual acuity improved from 0.98 (0.33) logMAR to 0.77 (0.15) logMAR after refraction (p < 0.001). The best improvement of VA was achieved in patients with mild to moderate myopia. Patients with albinism who were hyperopic more than +1.5 D hardly improved from refraction. With the rule (WTR) astigmatism was more present (37.5 %) than against the rule (ATR) astigmatism (3.8 %). Patients with astigmatism less than 1.5 D improved in 15/32 of cases (47 %) by 2 lines or more. Patients with astigmatism equal to or more than 1.5 D in any axis improved in 26/54 of cases (48 %) by 2 lines or more. Refraction improves visual acuity of children with oculocutaneous albinism in a Sub-Saharan African population in Malawi. The mean improvement was 2 logMAR units.

Surgical pathology in sub-Saharan Africa--volunteering in Malawi.

PubMed

Berezowska, Sabina; Tomoka, Tamiwe; Kamiza, Steve; Milner, Danny A; Langer, Rupert

2012-04-01

The breadth of material found in surgical pathology services in African countries differs from the common spectrum of "the West". We report our experience of a voluntary work in the pathology departments of Blantyre and Lilongwe, Malawi. During a 6-week period, 405 cases (378 histology and 27 cytology cases) were processed. The vast majority showed significant pathological findings (n = 369; 91.1 %): 175 cases (47.4 %) were non-tumoral conditions with predominance of inflammatory lesions, e.g., schistosomiasis (n = 11) and tuberculosis (n = 11). There were 39 (10.6 %) benign tumors or tumor-like lesions. Intraepithelial neoplasia of the cervix uteri dominated among premalignant conditions (n = 15; 4.1 %). The large group of malignancies (n = 140; 37.9 %) comprised 11 pediatric tumors (e.g., rhabdomyosarcoma, small blue round cell tumors) and 129 adult tumors. Among women (n = 76), squamous cell carcinomas (SCCs) of the cervix uteri predominated (n = 25; 32.9 %), followed by breast carcinomas (n = 12; 15.8 %) and esophageal SCC (n = 9; 11.8 %). Males (n = 53) most often showed SCC of the esophagus (n = 9; 17.0 %) and of the urinary bladder (n = 7; 13.2 %). Lymphomas (n = 7) and Kaposi's sarcomas (n = 6) were less frequent. Differences compared to the western world include the character of the conditions in general, the spectrum of inflammatory lesions, and the young age of adult tumor patients (median 45 years; range 18-87 years). Providing pathology service in a low-resource country may be handicapped by lack of personnel, inadequate material resources, or insufficient infrastructure. Rotating volunteers offer a bridge for capacity building of both personnel and the local medical service; in addition, the volunteer's horizons are broadened professionally and personally.

Early- to Mid-Holocene hydroclimate shifts in tropical East Africa: the multi-proxy sediment record from Lake Rutundu, Kenya

NASA Astrophysics Data System (ADS)

De Cort, Gijs; Creutz, Mike; Barao, Lucia; Conley, Daniel; Haug, Gerald; Bodé, Samuel; Blaauw, Maarten; Engstrom, Dan; Verschuren, Dirk

2015-04-01

Following the generally arid conditions of the Last Glacial Maximum (LGM), a large part of the African continent experienced the Early to Mid-Holocene as a much more humid period than today. This so-called African Humid Period (AHP) coincided with high summertime insolation over the Northern Hemisphere subtropics, causing invigorated monsoons to create moist conditions over the northern parts of the continent. Similarly, equatorial and even low-latitude southeastern Africa experienced a wetter climate due to the post-glacial increase in atmospheric greenhouse gasses ultimately leading to altered Atlantic and Indian Ocean monsoon dynamics. The timing and abruptness of the onset and ending of the AHP in the different regions of the continent have been the subject of major discussion. On the other hand, shorter-lived climate fluctuations within the AHP have received much less attention, due to a scarcity of well-dated, high-resolution African paleoclimate records spanning the entire Holocene. In this study we used the sediment record of Lake Rutundu, a high-altitude crater lake on Mount Kenya, to document multidecadal to millennial-scale hydroclimate variability on the East African equator from the LGM to the present. A multiproxy approach combining core-surface scanning techniques (magnetic susceptibility, X-ray fluorescence) and close-interval bulk-sediment analyses (organic matter and biogenic Si content, grain size, organic δ15N and δ13C) resulted in a high-resolution record firmly anchored in time by an age model based on 210Pb dating and sixteen calibrated radiocarbon ages. This new Lake Rutundu hydroclimate record confirms that moister conditions following the LGM returned to East Africa ca.16 kyr BP, and it contains a perfectly timed Younger Dryas episode (12.8-11.5 kyr BP) of intermittent drought. We find that the Early- to Mid-Holocene period, which in African records is often described as uniformly wet, was in fact punctuated by three distinct, century

A Neonatal Resuscitation Curriculum in Malawi, Africa: Did It Change In-Hospital Mortality?

PubMed Central

Hole, Michael K.; Olmsted, Keely; Kiromera, Athanase; Chamberlain, Lisa

2012-01-01

Objective. The WHO estimates that 99% of the 3.8 million neonatal deaths occur in developing countries. Neonatal resuscitation training was implemented in Namitete, Malawi. The study's objective was to evaluate the training's impact on hospital staff and neonatal mortality rates. Study Design. Pre-/postcurricular surveys of trainee attitude, knowledge, and skills were analyzed. An observational, longitudinal study of secondary data assessed neonatal mortality. Result. All trainees' (n = 18) outcomes improved, (P = 0.02). Neonatal mortality did not change. There were 3449 births preintervention, 3515 postintervention. Neonatal mortality was 20.9 deaths per 1000 live births preintervention and 21.9/1000 postintervention, (P = 0.86). Conclusion. Short-term pre-/postintervention evaluations frequently reveal positive results, as ours did. Short-term pre- and postintervention evaluations should be interpreted cautiously. Whenever possible, clinical outcomes such as in-hospital mortality should be additionally assessed. More rigorous evaluation strategies should be applied to training programs requiring longitudinal relationships with international community partners. PMID:22164184

Influences on Children's Human Capital in Rural Malawi: Three Essays

ERIC Educational Resources Information Center

Appiah-Yeboah, Shirley Afua

2013-01-01

The circumstances that characterize poor, rural communities in Malawi suggest that children's health-wealth gradient can vary from other settings. This dissertation begins with a description of the methods used to create a household wealth variable using assets data in the Malawi Longitudinal Study of Families and Health project. By using a fixed…

Women’s perspectives on quality of maternal health care services in Malawi

PubMed Central

Machira, Kennedy; Palamuleni, Martin

2018-01-01

Despite promotion by many stakeholders to improve maternal health outcome in many developing countries including Malawi, many analysts agree that the utmost success in maternal health will arise if maternal health care services are an unparallel led source for women’s health care solutions for any problem related to childbirth. Health advocates worldwide claim that even though maternal services are provided, women’s utilization of such services has not been ascertained. The objective of this study was to explore women’s perspectives on the quality of health care service delivery in Malawi. This article therefore investigates women’s perspectives on the quality of maternal health care services in Malawi. We used six focus group discussions in six health facilities that were selected across Malawi. We found that erratic availability of medical resources and unethical practices among health workers adversely affected quality of maternal health care service delivery. We concluded that the expensive routine operational audits of medical resources and service delivery across health facilities are imperative if women’s health outcomes are to be enhanced in Malawi. PMID:29386917

Childhood Malaria Admission Rates to Four Hospitals in Malawi between 2000 and 2010

PubMed Central

Okiro, Emelda A.; Kazembe, Lawrence N.; Kabaria, Caroline W.; Ligomeka, Jeffrey; Noor, Abdisalan M.; Ali, Doreen; Snow, Robert W.

2013-01-01

Introduction The last few years have witnessed rapid scaling-up of key malaria interventions in several African countries following increases in development assistance. However, there is only limited country-specific information on the health impact of expanded coverage of these interventions. Methods Paediatric admission data were assembled from 4 hospitals in Malawi reflecting different malaria ecologies. Trends in monthly clinical malaria admissions between January 2000 and December 2010 were analysed using time-series models controlling for covariates related to climate and service use to establish whether changes in admissions can be related to expanded coverage of interventions aimed at reducing malaria infection. Results In 3 of 4 sites there was an increase in clinical malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean clinical malaria admission rates at two hospitals (trend P<0.05). At these hospitals clinical malaria admissions had increased from 2000 by 41% to 100%. Comparison of changes in malaria risk and ITN coverage appear to correspond to a lack of disease declines over the period. Changes in intervention coverage within hospital catchments showed minimal increases in ITN coverage from <6% across all sites in 2000 to maximum of 33% at one hospital site by 2010. Additionally, malaria transmission intensity remained unchanged between 2000–2010 across all sites. Discussion Despite modest increases in coverage of measures to reduce infection there has been minimal changes in paediatric clinical malaria cases in four hospitals in Malawi. Studies across Africa are increasingly showing a mixed set of impact results and it is important to assemble more data from more sites to understand the wider implications of malaria funding investment. We also caution that impact surveillance should continue in areas where intervention coverage is increasing with time, for example Malawi, as decline may

A comparative analysis of the distribution, composition and geochemistry of surface sediments in the Linthipe and Songwe River Deltas of Lake Malawi

NASA Astrophysics Data System (ADS)

Dolozi, Michael B.; Kalindekafe, Leonard S. N.; Ngongondo, Cosmo; Dulanya, Zuze

2011-05-01

The Linthipe and Songwe River Deltas are found to the extreme southern and northern parts of Lake Malawi respectively within the East African Rift System. They occur in contrasting tectonic and climatic settings of the rift-valley half-graben structure. The sub-aqueous part of the Songwe Delta consists of relatively finer grained sediments than the Linthipe but is relatively poorly sorted. The composition of sediments within the Songwe Delta shows significant amounts of sedimentary and volcanic lithic fragments which are lacking in the Linthipe. On the other hand, ferromanganese nodules were recovered in the Linthipe Delta at water depths of 80-100 m but were not recovered in Songwe Delta at similar water depths. The finer grained facies of the Songwe Delta suggests a more prograded delta than the Linthipe. However, its poorly sorted sediments are most likely due to the heterogeneous geology of the source area; higher and faster depositional rates due to climatic influences. The lack of Ferromangenese nodules in the Songwe Delta is probably due to the sand-mud facies boundary which occurs at shallower depth. The higher proportion of Total Organic Carbon (TOC) in higher the Linthipe Delta is probably related to high rates of environmental degradation such as deforestation and agricultural activities in the riparian catchment basin. This is in contrast to the Songwe catchment basin where the levels of anthropogenic disturbance are less and climate, geomorphology and the heterogenous character of the source rocks seems to play a major role in the sedimentation processes.

Evidence of El Niño driven desiccation cycles in a shallow estuarine lake: The evolution and fate of Africa's largest estuarine system, Lake St Lucia

NASA Astrophysics Data System (ADS)

Humphries, M. S.; Green, A. N.; Finch, J. M.

2016-12-01

Projections of an increase in drought frequency and intensity over the next century are expected to have severe implications for a number of globally important coastal ecosystems. In this paper, we present geochemical data from three sediment cores extracted from the main depositional basins of Lake St Lucia, Africa's largest estuarine system. Lake St Lucia is subject to extreme natural variations in salinity. The sedimentary record documents the evolution of the system from a relatively deep-water, open lagoon to a confined, shallow estuarine lake that today is highly sensitive to changes in freshwater supply. This is particularly evident in the northern portions of the system, where the presence of distinct halite-enriched horizons document episodes of prolonged drought. The lateral persistence of these halite layers, as revealed by seismic profiling, point to a system-wide onset of desiccation associated with a major shift in the regional hydroclimate. The most severe drought events identified, which may have lasted several years, occur at 1100 and 1750 cal year BP, and are associated with known peaks in El Niño frequency and intensity. Our analyses suggest that past cycles of desiccation and hyper-salinity have been controlled by climatic changes related to ENSO intensification. This study provides a valuable new record from a key ENSO-sensitive region of the Southern Hemisphere. Our findings have important relevance for understanding ENSO variability across the Indo-Pacific region and the influence exerted on systems sensitive to changes in moisture balance.

Evolution of body shape in differently coloured sympatric congeners and allopatric populations of Lake Malawi's rock-dwelling cichlids.

PubMed

Husemann, M; Tobler, M; McCauley, C; Ding, B; Danley, P D

2014-05-01

The cichlid fishes of Lake Malawi represent one of the most diverse adaptive radiations of vertebrates known. Among the rock-dwelling cichlids (mbuna), closely related sympatric congeners possess similar trophic morphologies (i.e. cranial and jaw structures), defend overlapping or adjacent territories, but can be easily distinguished based on male nuptial coloration. The apparent morphological similarity of congeners, however, leads to an ecological conundrum: theory predicts that ecological competition should lead to competitive exclusion. Hence, we hypothesized that slight, yet significant, ecological differences accompanied the divergence in sexual signals and that the divergence of ecological and sexual traits is correlated. To evaluate this hypothesis, we quantified body shape, a trait of known ecological importance, in populations of Maylandia zebra, a barred, widespread mbuna, and several sympatric nonbarred congeners. We found that the barred populations differ in body shape from their nonbarred sympatric congeners and that the direction of shape differences was consistent across all barred vs. nonbarred comparisons. Barred populations are generally deeper bodied which may be an adaptation to the structurally complex habitat they prefer, whereas the nonbarred species have a more fusiform body shape, which may be adaptive in their more open microhabitat. Furthermore, M. zebra populations sympatric with nonbarred congeners differ from populations where the nonbarred phenotype is absent and occupy less morphospace, indicating potential ecological character displacement. Mitochondrial DNA as well as published AFLP data indicated that the nonbarred populations are not monophyletic and therefore may have evolved multiple times independently. Overall our data suggest that the evolution of coloration and body shape may be coupled as a result of correlational selection. We hypothesize that correlated evolution of sexually selected and ecological traits may have

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study

PubMed Central

McCollum, Eric D.; Nambiar, Bejoy; Deula, Rashid; Zadutsa, Beatiwel; Bondo, Austin; King, Carina; Beard, James; Liyaya, Harry; Mankhambo, Limangeni; Lazzerini, Marzia; Makwenda, Charles; Masache, Gibson; Bar-Zeev, Naor; Kazembe, Peter N.; Mwansambo, Charles; Lufesi, Norman; Costello, Anthony; Armstrong, Ben

2017-01-01

Background The pneumococcal conjugate vaccine’s (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction in Malawi in November 2011, we evaluated the case burden and rates of childhood pneumonia. Methods and Findings Between January 1, 2012-June 30, 2014 we conducted active pneumonia surveillance in children <5 years at seven hospitals, 18 health centres, and with 38 community health workers in two districts, central Malawi. Eligible children had clinical pneumonia per Malawi guidelines, defined as fast breathing only, chest indrawing +/- fast breathing, or, ≥1 clinical danger sign. Since pulse oximetry was not in the Malawi guidelines, oxygenation <90% defined hypoxemic pneumonia, a distinct category from clinical pneumonia. We quantified the pneumonia case burden and rates in two ways. We compared the period immediately following vaccine introduction (early) to the period with >75% three-dose PCV13 coverage (post). We also used multivariable time-series regression, adjusting for autocorrelation and exploring seasonal variation and alternative model specifications in sensitivity analyses. The early versus post analysis showed an increase in cases and rates of total, fast breathing, and indrawing pneumonia and a decrease in danger sign and hypoxemic pneumonia, and pneumonia mortality. At 76% three-dose PCV13 coverage, versus 0%, the time-series model showed a non-significant increase in total cases (+47%, 95% CI: -13%, +149%, p = 0.154); fast breathing cases increased 135% (+39%, +297%, p = 0.001), however, hypoxemia fell 47% (-5%, -70%, p = 0.031) and hospital deaths decreased 36% (-1%, -58%, p = 0.047) in children <5 years. We observed a shift towards disease without danger signs, as the proportion of cases with danger signs decreased by 65% (-46%, -77%, p<0.0001). These results were generally robust to plausible alternative model specifications. Conclusions Thirty months after PCV13

Explosive eruption records from Eastern Africa: filling in the gaps with tephra records from stratified lake sequences

NASA Astrophysics Data System (ADS)

Lane, Christine; Asrat, Asfawossen; Cohen, Andy; Cullen, Victoria; Johnson, Thomas; Lamb, Henry; Martin-Jones, Catherine; Poppe, Sam; Schaebitz, Frank; Scholz, Christopher

2017-04-01

On-going research into the preservation of volcanic ash fall in stratified Holocene lake sediments in Eastern Africa reveals the level of incompleteness of our explosive eruption record. Only nine eruptions with VEI >4 are recorded in the LaMEVE database (Crosweller et al., 2012) and of the 188 Holocene eruptions listed for East African volcanoes in the Global Volcanism Programme database, only 24 are dated to > 2000 years ago (GVP, 2013). Tephrostratigraphic investigation of Holocene sediments from a number of lakes, including Lake Kivu (south of the Virunga volcanic field), Lake Victoria (west of the Kenyan Rift volcanism) and palaeolake Chew Bahir (southern Ethiopia), all reveal multiple tephra layers, which indicate vastly underestimated eruption histories. Whereas the tephra layers in Lake Kivu were all located macroscopically, no visible tephra layers were observed in the sediments from Lake Victoria and Chew Bahir. Instead, tephra are preserved as non-visible horizons (cryptotephra), revealed only after laboratory processing. These results indicate that even where we do have stratified visible tephra records, the number of past eruptions may still be a minimum. Cryptotephra studies therefore play a fundamental role in building comprehensive records of past volcanism. Challenges remain, in this understudied region, to identify the volcanic source of each of the tephra layers, which requires geochemical correlation to proximal volcanic deposits. Where correlations to source can be achieved, explosive eruption frequencies and recurrence rates may be assessed for individual volcanoes. Furthermore, if a tephra layer can be traced into multiple sedimentary sequences, the potential exists to evaluate eruption magnitude, providing a more useful criterion for risk assessment. Filling in the gaps in our understanding of East African Rift volcanism and the associated hazards is therefore critically dependent upon bringing together this important data from distal

Development of a framework to improve the utilisation of malaria research for policy development in Malawi.

PubMed

Mwendera, Chikondi; de Jager, Christiaan; Longwe, Herbert; Hongoro, Charles; Phiri, Kamija; Mutero, Clifford M

2017-11-21

The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhance knowledge translation. These efforts aim at maximising health research utilisation in policy and practice to address the world's disease burdens, including malaria. This study aimed at developing a contextual framework to improve the utilisation of malaria research for policy development in Malawi. The study used two approaches including: two case studies of policy analysis exploring the policy-making process in Malawi, utilisation of local malaria research, and the role of key stakeholders in policy formulation process; and the assessment of facilitating factors and barriers to malaria research utilisation for policy-making in Malawi. From the case studies' lessons and elements identified during the assessment of facilitating factors and barriers, a framework is developed to promote an integrated approach to knowledge translation. In this framework the Ministry of Health is considered as the main user of knowledge from research through the demand created by the research directorate and the National Malaria Control Programme. Key documents identified as being particularly relevant to the Ministry of Health for purposes of knowledge translation include the National Health Research Agenda, Guidelines for Policy Development and Analysis, and Guidelines for Evidence Use in Policy-making. Institutions conducting academic and policy-relevant malaria research in Malawi are identified and a consolidation of their linkages with the users of research is established through the Knowledge Translation Unit, the Evidence Informed decision-making Centre, and the African Institute for Development Policy. Equally, key players in this framework are the funding partners for both research and programmes that need to see accountability and impact of their support. Independent

GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

PubMed

Emmett, Susan D; Tucci, Debara L; Smith, Magteld; Macharia, Isaac M; Ndegwa, Serah N; Nakku, Doreen; Mukara, Kaitesi B; Kaitesi, Mukara B; Ibekwe, Titus S; Mulwafu, Wakisa; Gong, Wenfeng; Francis, Howard W; Saunders, James E

2015-09-01

Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

Rapid radiation, ancient incomplete lineage sorting and ancient hybridization in the endemic Lake Tanganyika cichlid tribe Tropheini.

PubMed

Koblmüller, Stephan; Egger, Bernd; Sturmbauer, Christian; Sefc, Kristina M

2010-04-01

The evolutionary history of the endemic Lake Tanganyika cichlid tribe Tropheini, the sister group of the species flocks of Lake Malawi and the Lake Victoria region, was reconstructed from 2009 bp DNA sequence of two mitochondrial genes (ND2 and control region) and from 1293 AFLP markers. A period of rapid cladogenesis at the onset of the diversification of the Tropheini produced a multitude of specialized, predominantly rock-dwelling aufwuchs-feeders that now dominate in Lake Tanganyika's shallow habitat. Nested within the stenotopic rock-dwellers is a monophyletic group of species, which also utilize more sediment-rich habitat. Most of the extant species date back to at least 0.7 million years ago. Several instances of disagreement between AFLP and mtDNA tree topology are attributed to ancient incomplete lineage sorting, introgression and hybridization. A large degree of correspondence between AFLP clustering and trophic types indicated fewer cases of parallel evolution of trophic ecomorphology than previously inferred from mitochondrial data. (c) 2009 Elsevier Inc. All rights reserved.

AIDS epidemic in Malawi: shaking cultural foundations.

PubMed

Chirwa, I

1993-05-01

Many young men and women in Malawi are infected with HIV and dying from AIDS. The head of the Malawi AIDS Control Program estimates that as many as 10% of all adults in the country may be infected with HIV, with the rate being higher in urban areas. While more than 90% of the population is now aware of the existence of AIDS and its dangers, changes in behavior have not taken place and HIV continues to spread. Early campaigns attempted to generate condom use through peer educators among bar girls, truck drivers, and STD patients. Many men state, however, that they prefer to have sex without condoms because it is more exciting. Others cite alcohol consumption, ignorance of the dangers of HIV infection, and/or a fear of suggesting mistrust in a partner as reasons for not using condoms. Many women also find it difficult to negotiate condom use among reluctant men. Making condoms readily accessible and giving them a positive image may help increase their rate of use; the opposition of some religious groups must be thwarted and the distribution system needs to be improved to realize these ends. Condoms are provided to Malawi free of charge by the US Agency of International Development. Supplies are then either distributed free through health centers and bars or sold in shops. The failure of free condoms to be readily available in rural areas where 90% of the population resides, however, poses concern. Finally, training programs, counseling, anonymous HIV testing centers, and peer educators are among some of the interventions being made against AIDS in Malawi.

The AIDS-related activities of religious leaders in Malawi

PubMed Central

TRINTAPOLI, J.

2010-01-01

The AIDS-related activities of religious leaders in Africa extend far beyond preaching about sexual mortality. This study aims to quantify the involvement of religious leaders in the fight against AIDS and to identify key predictors of the types of prevention strategies they promote. Using data from a random sample of Christian and Muslim leaders in Malawi, I use logistic regression to predict six types of AIDS activities, which correspond to three distinct types: formal messages (i.e., preaching), pragmatic interventions (monitoring the sexual behaviour of members and advising divorce to avoid infection), and the promotion of biomedical prevention strategies (promoting condom use and testing for HIV). Preaching about AIDS is the most common prevention activity, and promoting condom use is the least; sizable proportions of clergy promote testing and engage in pragmatic interventions. Denominational patterns in the type of engagement are weak and inconsistent. However, inquiries into the motivation for leaders' activities show that discussions with members about AIDS is the most consistent predictor, suggesting that religious leaders' engagement with HIV prevention is primarily a demand-driven phenomenon. PMID:20552476

"When I Grow up I Would Like to Be …": Factors Affecting Career Choice of Community Disability Workers in Southern Africa

ERIC Educational Resources Information Center

Rule, Sarah; Kahonde, Callista; Lorenzo, Theresa

2015-01-01

The effectiveness of community based rehabilitation (CBR) programmes depends on the calibre of staff recruited and employed. Therefore, this study aimed to understand how the life experiences of community disability workers (CDWs) in Malawi, Botswana and South Africa influenced their choice of career. A life history approach was used to gather…

Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border.

PubMed

Lutterloh, Emily; Likaka, Andrew; Sejvar, James; Manda, Robert; Naiene, Jeremias; Monroe, Stephan S; Khaila, Tadala; Chilima, Benson; Mallewa, Macpherson; Kampondeni, Sam D; Lowther, Sara A; Capewell, Linda; Date, Kashmira; Townes, David; Redwood, Yanique; Schier, Joshua G; Nygren, Benjamin; Tippett Barr, Beth; Demby, Austin; Phiri, Abel; Lungu, Rudia; Kaphiyo, James; Humphrys, Michael; Talkington, Deborah; Joyce, Kevin; Stockman, Lauren J; Armstrong, Gregory L; Mintz, Eric

2012-04-01

Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216 000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border. The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n = 19), ataxia (n = 22), and parkinsonism (n = 8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE. The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment.

The impact of the increasing burden of trauma in Malawi on orthopedic trauma service priorities at Kamuzu Central Hospital.

PubMed

Young, Sven; Banza, Leonard; Munthali, Boston S; Manda, Kumbukani G; Gallaher, Jared; Charles, Anthony

2016-12-01

Background and purpose - The burden of road traffic injuries globally is rising rapidly, and has a huge effect on health systems and development in low- and middle-income countries. Malawi is a small low-income country in southeastern Africa with a population of 16.7 million and a gross national income per capita of only 250 USD. The impact of the rising burden of trauma is very apparent to healthcare workers on the ground, but there are very few data showing this development. Patients and methods - The annual number of femoral fracture patients admitted to Kamuzu Central Hospital (KCH) in the Capital of Malawi, Lilongwe, from 2009 to 2014 was retrieved from the KCH trauma database. Linear regression curve estimation was used to project the growth in the burden of femoral fractures and the number of operations performed for femoral fractures over the same time period. Results - 992 patients with femoral fractures (26% of all admissions for fractures) presented at KCH from 2009 through 2014. In this period, there was a 132% increase in the annual number of femoral fractures admitted to KCH. In the same time period, the total number of operations more than doubled, but there was no increase in the number of operations performed for femoral fractures. Overall, there was a 7% mortality rate for patients with femoral fractures. Interpretation - The burden of femoral fractures in Malawi is rising rapidly, and the surgical resources available cannot keep up with this development. Limited funds for orthopedic trauma care in Malawi should be invested in central training hospitals, to develop a sustainable number of orthopedic surgeons and improve current infrastructure and equipment. The centralization of orthopedic surgical care delivery at the central training hospitals will lead to better access to surgical care and early return of patients to local district hospitals for rehabilitation, thus increasing surgical throughput and efficiency in a more cost-effective manner

A framework to explore micronutrient deficiency in maternal and child health in Malawi, Southern Africa.

PubMed

Dickinson, Natalie; Gulliver, John; MacPherson, Gordon; Atkinson, John; Rankin, Jean; Cummings, Maria; Nisbet, Zoe; Hursthouse, Andrew; Taylor, Avril; Robertson, Chris; Burghardt, Wolfgang

2009-12-21

Global food insecurity is associated with micronutrient deficiencies and it has been suggested that 4.5 billion people world-wide are affected by deficiencies in iron, vitamin A and iodine. Zinc has also been identified to be of increasing concern. The most vulnerable are young children and women of childbearing age. A pilot study has been carried out in Southern Malawi, to attempt to link the geochemical and agricultural basis of micronutrient supply through spatial variability to maternal health and associated cultural and social aspects of nutrition. The aim is to establish the opportunity for concerted action to deliver step change improvements in the nutrition of developing countries. Field work undertaken in August 2007 and July/August 2008 involved the collection of blood, soil and crop samples, and questionnaires from ~100 pregnant women. Complex permissions and authorisation protocols were identified and found to be as much part of the cultural and social context of the work as the complexity of the interdisciplinary project. These issues are catalogued and discussed. A preliminary spatial evaluation is presented linking soil quality and food production to nutritional health. It also considers behavioural and cultural attitudes of women and children in two regions of southern Malawi, (the Shire Valley and Shire Highlands plateau). Differences in agricultural practice and widely varying soil quality (e.g. pH organic matter, C/N and metal content) were observed for both regions and full chemical analysis of soil and food is underway. Early assessment of blood data suggests major differences in health and nutritional status between the two regions. Differences in food availability and type and observations of life style are being evaluated through questionnaire analysis. The particular emphasis of the study is on the interdisciplinary opportunities and the barriers to progress in development support in subsistence communities. Engaging at the community level

IWRM and poverty reduction in Malawi: A socio-economic analysis

NASA Astrophysics Data System (ADS)

Mulwafu, Wapulumuka O.; Msosa, Hendrina K.

Like most other countries in the SADC region, Malawi has swiftly endorsed the United Nations Millennium Development Goals. In the water sector, these principles are reflected in the National Water Policy (2004) and in the Malawi Poverty Reduction Strategy Paper (PRSP) (2002) which emphasize three key aspects. First, the articulation of a vision and policy objectives that address development and management of water for productive purposes, conservation and poverty reduction. Second, the recognition of international and regional conventions and agreements on water resources to which Malawi is a signatory, thereby promoting global partnership for development. Third, the provision of mechanisms for monitoring, assessment and development related to watershed management, conservation and the mitigation of floods and droughts. Both the Malawi Poverty Reduction Strategy Paper and the National Water Policy seek to reduce poverty by increasing access to water for domestic and productive purposes. In particular, the MPRSP will focus on constructing and rehabilitating water facilities, extend water supply capacity, promote community-based management and improve water resources conservation and management. In this paper, we examine the challenges of implementing these goals against the background of various institutional reforms in the water sector. We argue that although Malawi has come up with very clear strategies and guidelines for promoting MDGs, a combination of human and financial resources, bedevil the successful implementation of these ideas. In addition, the strategies do not articulate water as a medium for poverty alleviation in a holistic manner. The paper further demonstrates ways in which the promotion of IWRM can facilitate in reducing poverty.

Parental Divorce and Children's Schooling in Rural Malawi.

PubMed

Chae, Sophia

2016-12-01

A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.

Tobacco growing and the sustainable development goals, Malawi

PubMed Central

Bialous, Stella Aguinaga; Munthali, Spy; Max, Wendy

2017-01-01

Abstract Negative impacts of tobacco result from human consumption and from tobacco-growing activities, most of which now occur in low- and middle-income countries. Malawi is the world’s largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In countries like Malawi, tobacco control refers to control of the tobacco supply chain, rather than control of consumption. We review the impact of tobacco cultivation, using Malawi as an example, to illustrate the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. We place these issues in the context of the sustainable development goals (SDGs), particularly 3a which calls on all governments to strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The SDGs offer an opportunity for low- and middle-income countries that are dependent on tobacco production and that are not yet parties to the Convention, to reconsider joining the FCTC. PMID:28479637

A platform to integrate climate information and rural telemedicine in Malawi

NASA Astrophysics Data System (ADS)

Lowe, R.; Chadza, T.; Chirombo, J.; Fonda, C.; Muyepa, A.; Nkoloma, M.; Pietrosemoli, E.; Radicella, S. M.; Tompkins, A. M.; Zennaro, M.

2012-04-01

It is commonly accepted that climate plays a role in the transmission of many infectious diseases, particularly those transmitted by mosquitoes such as malaria, which is one of the most important causes of mortality and morbidity in developing countries. Due to time lags involved in the climate-disease transmission system, lagged observed climate variables could provide some predictive lead for forecasting disease epidemics. This lead time could be extended by using forecasts of the climate in disease prediction models. This project aims to implement a platform for the dissemination of climate-driven disease risk forecasts, using a telemedicine approach. A pilot project has been established in Malawi, where a 162 km wireless link has been installed, spanning from Blantyre City to remote health facilities in the district of Mangochi in the Southern region, bordering Lake Malawi. This long Wi-Fi technology allows rural health facilities to upload real-time disease cases as they occur to an online health information system (DHIS2); a national medical database repository administered by the Ministry of Health. This technology provides a real-time data logging system for disease incidence monitoring and facilitates the flow of information between local and national levels. This platform allows statistical and dynamical disease prediction models to be rapidly updated with real-time climate and epidemiological information. This permits health authorities to target timely interventions ahead of an imminent increase in malaria incidence. By integrating meteorological and health information systems in a statistical-dynamical prediction model, we show that a long-distance Wi-Fi link is a practical and inexpensive means to enable the rapid analysis of real-time information in order to target disease prevention and control measures and mobilise resources at the local level.

Do not forget the boys - gender differences in children living in high HIV-affected communities in South Africa and Malawi in a longitudinal, community-based study.

PubMed

Hensels, I S; Sherr, L; Skeen, S; Macedo, A; Roberts, K J; Tomlinson, M

2016-03-01

Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12-15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys' worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are not

Linking isoprenoidal GDGT membrane lipid distributions with gene abundances of ammonia-oxidizing Thaumarchaeota and uncultured crenarchaeotal groups in the water column of a tropical lake (Lake Challa, East Africa).

PubMed

Buckles, Laura K; Villanueva, Laura; Weijers, Johan W H; Verschuren, Dirk; Damsté, Jaap S Sinninghe

2013-09-01

Stratified lakes are important reservoirs of microbial diversity and provide habitats for niche differentiation of Archaea. In this study, we used a lipid biomarker/DNA-based approach to reveal the diversity and abundance of Archaea in the water column of Lake Challa (East Africa). Concentrations of intact polar lipid (IPL) crenarchaeol, a specific biomarker of Thaumarchaeota, were enhanced (1 ng l(-1) ) at the oxycline/nitrocline. The predominance of the more labile IPL hexose-phosphohexose crenarchaeol indicated the presence of an actively living community of Thaumarchaeota. Archaeal 16S rRNA clone libraries revealed the presence of thaumarchaeotal groups 1.1a and 1.1b at and above the oxycline. In the anoxic deep water, amoA gene abundance was an order of magnitude lower than at the oxycline and high abundance (∼90 ng l(-1) ) of an IPL with the acyclic glycerol dialkyl glycerol tetraether (GDGT-0) was evident. The predominance of archaeal 16S rRNA sequences affiliated to the uncultured crenarchaeota groups 1.2 and miscellaneous crenarchaeotic group (MCG) points to an origin of GDGT-0 from uncultured crenarchaeota. This study demonstrates the importance of thermal stratification and nutrient availability in the distribution of archaeal groups in lakes, which is relevant to constrain and validate temperature proxies based on archaeal GDGTs (i.e. TEX86 ). © 2013 John Wiley & Sons Ltd and Society for Applied Microbiology.

Hazardous thunderstorm intensification over Lake Victoria

PubMed Central

Thiery, Wim; Davin, Edouard L.; Seneviratne, Sonia I.; Bedka, Kristopher; Lhermitte, Stef; van Lipzig, Nicole P. M.

2016-01-01

Weather extremes have harmful impacts on communities around Lake Victoria, where thousands of fishermen die every year because of intense night-time thunderstorms. Yet how these thunderstorms will evolve in a future warmer climate is still unknown. Here we show that Lake Victoria is projected to be a hotspot of future extreme precipitation intensification by using new satellite-based observations, a high-resolution climate projection for the African Great Lakes and coarser-scale ensemble projections. Land precipitation on the previous day exerts a control on night-time occurrence of extremes on the lake by enhancing atmospheric convergence (74%) and moisture availability (26%). The future increase in extremes over Lake Victoria is about twice as large relative to surrounding land under a high-emission scenario, as only over-lake moisture advection is high enough to sustain Clausius–Clapeyron scaling. Our results highlight a major hazard associated with climate change over East Africa and underline the need for high-resolution projections to assess local climate change. PMID:27658848

IDEAL Symposium on the East African Lakes

NASA Astrophysics Data System (ADS)

Johnson, T. C.; Kelts, K.; Lehman, J. T.; Wuest, A.

A vast array of interdisciplinary problems presented by the African Great Lakes were highlighted at the International Symposium on the Limnology, Climatology and Paleoclimatology of the East African Lakes, organized by the International Decade for the East African Lakes (IDEAL) February 17-21 in Jinja, Uganda. Approximately 125 scientists attended from North America, Europe, Africa, and New Zealand. Jinja is located on the northern shore of Lake Victoria at the head-waters of the Nile and is the site of the host institution for the symposium, the Uganda Freshwater Fisheries Research Organization (UFFRO). The conveners of the symposium were Tom Johnson of Duke University, George Kitaka of UNESCO-ROSTA, and Eric Odada of the University of Nairobi.

Delivery cost analysis of a reactive mass cholera vaccination campaign: a case study of Shanchol™ vaccine use in Lake Chilwa, Malawi.

PubMed

Ilboudo, Patrick G; Le Gargasson, Jean-Bernard

2017-12-19

Cholera is a diarrheal disease that produces rapid dehydration. The infection is a significant cause of mortality and morbidity. Oral cholera vaccine (OCV) has been propagated for the prevention of cholera. Evidence on OCV delivery cost is insufficient in the African context. This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi. The vaccination campaign was implemented in two rounds in February and March 2016. Structured questionnaires were used to collect costs incurred for each vaccination related activity, including vaccine procurement and shipment, training, microplanning, sensitization, social mobilization and vaccination rounds. Costs collected, including financial and economic costs were analyzed using Choltool, a standardized cholera cost calculator. In total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480275 while the economic cost was US$588637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97. This study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partners' personnel may represent a substantial share of campaign's costs, affecting unit and vaccine

Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa.

PubMed

Keenan, Jeremy D; Bailey, Robin L; West, Sheila K; Arzika, Ahmed M; Hart, John; Weaver, Jerusha; Kalua, Khumbo; Mrango, Zakayo; Ray, Kathryn J; Cook, Catherine; Lebas, Elodie; O'Brien, Kieran S; Emerson, Paul M; Porco, Travis C; Lietman, Thomas M

2018-04-26

We hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations. In this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses. A total of 1533 communities underwent randomization, 190,238 children were identified in the census at baseline, and 323,302 person-years were monitored. The mean (±SD) azithromycin and placebo coverage over the four twice-yearly distributions was 90.4±10.4%. The overall annual mortality rate was 14.6 deaths per 1000 person-years in communities that received azithromycin (9.1 in Malawi, 22.5 in Niger, and 5.4 in Tanzania) and 16.5 deaths per 1000 person-years in communities that received placebo (9.6 in Malawi, 27.5 in Niger, and 5.5 in Tanzania). Mortality was 13.5% lower overall (95% confidence interval [CI], 6.7 to 19.8) in communities that received azithromycin than in communities that received placebo (P<0.001); the rate was 5.7% lower in Malawi (95% CI, -9.7 to 18.9), 18.1% lower in Niger (95% CI, 10.0 to 25.5), and 3.4% lower in Tanzania (95% CI, -21.2 to 23.0). Children in the age group of 1 to 5 months had the greatest effect from azithromycin (24.9% lower mortality than that with placebo; 95% CI, 10.6 to 37.0). Serious adverse events occurring within a week after administration of the trial drug or placebo were uncommon, and the rate did not differ significantly between the groups. Evaluation of selection

Tectonic controls on rift basin morphology: Evolution of the northern Malawi (Nyasa) rift

NASA Technical Reports Server (NTRS)

Ebinger, C. J.; Deino, A. L.; Tesha, A. L.; Becker, T.; Ring, U.

1993-01-01

Radiometric (K-Ar and Ar-40/Ar-39) age determinations of volcanic and volcaniclastic rocks, combined with structural, gravity, and seismic reflection data, are used to constrain the age of sedimentary strata contained within the seismically and volcanically active northern Malawi (Nyasa) rift and to characterize changes in basin and flank morphologies with time. Faulting and volcanism within the Tukuyu-Karonga basin began at approximately 8.6 Ma, when sediments were deposited in abroad, initially asymmetric lake basin bounded on its northeastern side by a border fault system with minor topographic relief. Extensions, primarily by a slip along the border fault, and subsequent regional isostatic compensation led to the development of a 5-km-deep basin bounded by broad uplifted flanks. Along the low-relief basin margin opposite border fault, younger stratigraphic sequences commonly onlap older wedge-shaped sequences, although their internal geometry is often progradational. Intrabasinal faulting, flankuplift, and basaltic and felsic volcanism from centers at the northern end of the basin became more important at about 2.5 Ma when cross-rift transfer faults developed to link the Tukuyu-Karonga basin to the Rukwa basin. Local uplift and volcanic construction at the northern end of the basin led to a southeastward shift in the basin's depocenter. Sequence boundaries are commonly erosional along this low-relief (hanging wall) margin and conformable in the deep lake basin. The geometry of stratigraphic sequences and the distribution of the erosion indicate that horizontal and vertical crustal movements both across and along the length of the rift basin led to changes in levels of the lake, irrespective of paleoclimatic fluctuations.

Renewable Energy Zones for the Africa Clean Energy Corridor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Grace C.; Deshmukh, Ranjit; Ndhlukula, Kudakwashe

Multi-criteria Analysis for Planning Renewable Energy (MapRE) is a study approach developed by the Lawrence Berkeley National Laboratory with the support of the International Renewable Energy Agency (IRENA). The approach combines geospatial, statistical, energy engineering, and economic methods to comprehensively identify and value high-quality wind, solar PV, and solar CSP resources for grid integration based on techno-economic criteria, generation profiles (for wind), and socio-environmental impacts. The Renewable Energy Zones for the Africa Clean Energy Corridor study sought to identify and comprehensively value high-quality wind, solar photovoltaic (PV), and concentrating solar power (CSP) resources in 21 countries in the East andmore » Southern Africa Power Pools to support the prioritization of areas for development through a multi-criteria planning process. These countries include Angola, Botswana, Burundi, Djibouti, Democratic Republic of Congo, Egypt, Ethiopia, Kenya, Lesotho, Libya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The study includes the methodology and the key results including renewable energy potential for each region.« less

New Insights Into the Climate and Vegetation History of the subtropical Crater Lake 'Tswaing', South Africa, for the Last 300,000 Year

NASA Astrophysics Data System (ADS)

Kristen, I.; Fuhrmann, A.; Haug, G. H.; Horsfield, B.; Oberhänsli, H.; Partridge, T. C.; Thorpe, J.; Wilkes, H.

2005-12-01

Deeper time palaeoclimate reconstructions are still rare on the continental southern hemisphere. Here we present new biogeochemical data from a core retrieved in crater lake 'Tswaing' (formerly 'Pretoria saltpan'). This opens a novel chance to get a more detailed view into climate variability of the subtropical region of South Africa on the glacial/interglacial time scale. The crater 'Tswaing' was formed around 220±52 kyr ago by a meteorite impact. However, new U/Th analyses of authigenic carbonates provide preliminary evidence that the lake might be older than 300 kyr. Today the basin contains a shallow (< 3 m water depth), hypersaline (pH ~10) lake with a diameter of about 300 m in an about 1 km wide crater. Hence, the lake catchment is small with no water in- or outflow. Therefore, the lake is sensitive for variations in rainfall and probably wind stress. Our 90 m composite core profile consists of partly fine-laminated lake sediments intercalated with mudflow deposits. Previous investigations and our new data reveal a considerable variability of bulk geochemical proxies such as total inorganic carbon (TIC), total organic carbon (TOC) and the C/N ratio. The upper half of the core is dominated by fluctuations in TOC while TIC controls the variation in the lower half of the core. These data argue for substantial changes in the depositional environment of the lake system. They are complemented by facies analyses in thin sections, major element patterns derived from μXRF scanning , the carbon isotopic composition of the bulk sediment, maceral analysis, and lipid biomarkers of the organic material in the sediments. First results allow to distinguish intervals with completely different ecosystems and hydrology during lake history. Intervals with dinoflagellates and algae as main primary producers alternate with phases dominated by bacteria and ciliates feeding on them. Future detailed analyses will provide new insights into the development of these climate sensitive

A cross-sectional study of household biomass fuel use among a periurban population in Malawi.

PubMed

Piddock, Katy C; Gordon, Stephen B; Ngwira, Andrew; Msukwa, Malango; Nadeau, Gilbert; Davis, Kourtney J; Nyirenda, Moffat J; Mortimer, Kevin

2014-07-01

The Global Burden of Disease Study suggests almost 3.5 million people die as a consequence of household air pollution every year. Respiratory diseases including chronic obstructive pulmonary disease and pneumonia in children are strongly associated with exposure to household air pollution. Smoke from burning biomass fuels for cooking, heating, and lighting is the main contributor to high household air pollution levels in low-income countries like Malawi. A greater understanding of biomass fuel use in Malawi should enable us to address household air pollution-associated communicable and noncommunicable diseases more effectively. To conduct a cross-sectional analysis of biomass fuel use and population demographics among adults in Blantyre, Malawi. We used global positioning system-enabled personal digital assistants to collect data on location, age, sex, marital status, education, occupation, and fuel use. We describe these data and explore associations between demographics and reported fuel type. A total of 16,079 adults participated (nine households refused); median age was 30 years, there was a similar distribution of men and women, 60% were married, and 62% received secondary school education. The most commonly reported occupation for men and women was "salaried employment" (40.7%) and "petty trader and marketing" (23.5%), respectively. Charcoal (81.5% of households), wood (36.5%), and electricity (29.1%) were the main fuels used at home. Only 3.9% of households used electricity exclusively. Lower educational and occupational attainment was associated with greater use of wood. This large cross-sectional study has identified extensive use of biomass fuels in a typical sub-Saharan Africa periurban population in which women and people of lower socioeconomic status are disproportionately affected. Biomass fuel use is likely to be a major driver of existing communicable respiratory disease and the emerging noncommunicable disease (especially respiratory and

A Cross-Sectional Study of Household Biomass Fuel Use among a Periurban Population in Malawi

PubMed Central

Piddock, Katy C.; Gordon, Stephen B.; Ngwira, Andrew; Msukwa, Malango; Nadeau, Gilbert; Davis, Kourtney J.; Nyirenda, Moffat J.; Mortimer, Kevin

2016-01-01

Rationale The Global Burden of Disease Study suggests almost 3.5 million people die as a consequence of household air pollution every year. Respiratory diseases including chronic obstructive pulmonary disease and pneumonia in children are strongly associated with exposure to household air pollution. Smoke from burning biomass fuels for cooking, heating, and lighting is the main contributor to high household air pollution levels in low-income countries like Malawi. A greater understanding of biomass fuel use in Malawi should enable us to address household air pollution–associated communicable and noncommunicable diseases more effectively. Objectives To conduct a cross-sectional analysis of biomass fuel use and population demographics among adults in Blantyre, Malawi. Methods We used global positioning system–enabled personal digital assistants to collect data on location, age, sex, marital status, education, occupation, and fuel use. We describe these data and explore associations between demographics and reported fuel type. Measurements and Main Results A total of 16,079 adults participated (nine households refused); median age was 30 years, there was a similar distribution of men and women, 60% were married, and 62% received secondary school education. The most commonly reported occupation for men and women was “salaried employment” (40.7%) and “petty trader and marketing” (23.5%), respectively. Charcoal (81.5% of households), wood (36.5%), and electricity (29.1%) were the main fuels used at home. Only 3.9% of households used electricity exclusively. Lower educational and occupational attainment was associated with greater use of wood. Conclusions This large cross-sectional study has identified extensive use of biomass fuels in a typical sub-Saharan Africa periurban population in which women and people of lower socioeconomic status are disproportionately affected. Biomass fuel use is likely to be a major driver of existing communicable respiratory

Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi.

PubMed

Sherr, Lorraine; Macedo, Ana; Tomlinson, Mark; Skeen, Sarah; Cluver, Lucie Dale

2017-05-12

Social protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. Less is known about the role of social protection on younger HIV affected populations. This study explored the impact of cash grants on children's cognitive development. Additionally, we examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes. The sample included 854 children, aged 5 - 15, participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi. Data on child cognitive functioning were gathered by a combination of caregiver report and observer administered tests. Primary caregivers also reported on the economic situation of the family, cash receipt into the home, child and household HIV status. Parenting was measured on a 10 item scale with good parenting defined as a score of 8 or above. About half of families received cash (55%, n = 473), only 6% (n = 51) reported good parenting above the cut-off point but no cash, 18% (n = 151) received combined cash support and reported good parenting, and 21% (n = 179) had neither. Findings show that cash receipt was associated with enhanced child cognitive outcomes in a number of domains including verbal working memory, general cognitive functioning, and learning. Furthermore, cash plus good parenting provided an additive effect. Child HIV status had a moderating effect on the association between cash or/plus good parenting and cognitive outcomes. The association between cash and good parenting and child cognitive outcomes remained significant among both HIV positive and negative children, but overall the HIV negative group benefited more. This study shows the importance of cash transfers and good parenting on cognitive development of young children living in HIV affected environments. Our data clearly

Sources of core and intact branched tetraether membrane lipids in the lacustrine environment: Anatomy of Lake Challa and its catchment, equatorial East Africa

NASA Astrophysics Data System (ADS)

Buckles, Laura K.; Weijers, Johan W. H.; Verschuren, Dirk; Sinninghe Damsté, Jaap S.

2014-09-01

The MBT/CBT palaeotemperature proxy uses the distribution of branched glycerol dialkyl glycerol tetraethers (brGDGTs), membrane lipids that are supposed to derive from soil bacteria, to reconstruct mean annual air temperature (MAAT). Applied successfully in coastal marine sediments, its extension to lake-sediment records with potentially high time resolution would greatly expand its utility. Over the last years, however, studies have indicated the presence of additional sources of brGDGTs within lake systems. To constrain the factors influencing the MBT/CBT palaeotemperature proxy in lakes, detailed investigation of brGDGT fluxes in a modern lake system is necessary to identify their potential sources. This study concentrates on Lake Challa, a permanently stratified crater lake in equatorial East Africa with limited catchment area. An almost 3-year time series of approximately monthly samples of settling particles, supplemented with a depth profile of suspended particulate matter (SPM) and sets of profundal surface-sediment and catchment soil samples, were analysed for both the 'living' intact polar lipids (IPLs) and 'fossil' core lipids (CLs) of GDGTs. We found that brGDGTs are produced in oxic, suboxic and anoxic zones of the water column, and in substantial amounts compared to influxes from catchment soils. Additional in situ production within the lake sediments is most probable, but cannot be definitely confirmed at this time. These lacustrine brGDGTs display a different response to temperature variation than soil-derived brGDGTs, signifying either a different physiological adaptation to changing conditions within the water column and/or a different composition of the respective bacterial communities. Using this specific relationship with temperature, a local calibration based on brGDGT distributions in SPM generates relatively accurate water temperature estimates from settling particles but fails for surface sediments.

Gaps in universal health coverage in Malawi: A qualitative study in rural communities

PubMed Central

2014-01-01

Background In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities’ perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. Methods We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. Results The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers’ attitudes, distance and transportation difficulties, and perceived poor quality of health services. Conclusions Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions

Geographical disparities in HIV prevalence and care among men who have sex with men in Malawi: results from a multisite cross-sectional survey.

PubMed

Wirtz, Andrea L; Trapence, Gift; Kamba, Dunker; Gama, Victor; Chalera, Rodney; Jumbe, Vincent; Kumwenda, Rosemary; Mangochi, Marriam; Helleringer, Stephane; Beyrer, Chris; Baral, Stefan

2017-06-01

Epidemiological assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) is necessary to inform HIV prevention and care strategies in the more generalised HIV epidemics across sub-Saharan Africa, including Malawi. We aimed to measure the HIV prevalence, risks, and access to HIV care among MSM across multiple localities to better inform HIV programming for MSM in Malawi. Between Aug 1, 2011, and Sept 13, 2014, we recruited MSM into cross-sectional research via respondent-driven sampling (RDS) in seven districts of Malawi. RDS and site weights were used to estimate national HIV prevalence and engagement in care and in multilevel regression models to identify correlates of prevalent HIV infection. The comparative prevalence ratio of HIV among MSM relative to adult men was calculated by use of direct age-stratification. 2453 MSM were enrolled with a population HIV prevalence of 18·2% (95% CI 15·5-21·2), as low as 4·1% (2·2-7·6) in Mzuzu and as high as 24·5% (19·5-30·3) in Mulanje. The comparative HIV prevalence ratio was 2·52 when comparing MSM with the adult male population. Age-stratified HIV prevalence showed early onset of infection with 11·8% (95% CI 7·3-18·4) of MSM aged 18-19 years HIV infected. Factors positively associated with HIV infection included being aged 21-30 years and reporting female or transgender identity. Among HIV infected MSM, less than 1% reported ever being diagnosed with HIV infection (0·9%, 95% CI 0·4-2·5) and initiated antiretroviral treatment (0·2%, 0·2-0·3). HIV disproportionately affects MSM in Malawi with disparities sustained across the HIV care continuum. These issues are geographically heterogeneous and begin among young MSM, supporting geographically focused and age-specific approaches to confidential HIV testing with linkage to HIV services. Malawi Department of Nutrition, HIV and AIDS (DNHA), UNDP, UNFPA, UNAIDS, and UNICEF. Copyright © 2017 Elsevier Ltd. All rights reserved.

Climate Change in Africa: Impacts and Effects on the Inhabitants of the Lake Chad Region.

NASA Astrophysics Data System (ADS)

Abubakar, B.; Tahir, S. M.; Olisa, O.

2009-05-01

The Department of Energy and Climate Change defined climate as the average weather experienced over a long period. This includes temperature, wind and rainfall patterns. The climate of the Earth is not static, and has changed many times in response to a variety of natural causes. Due to human activities in emmiting green house gases has resulted the Earth to get warmed by 0.74°C over the last hundred years. Around 0.4°C of this warming has occurred since the 1970s. Climate is now one of the major phenomenon threatening lives and humanity in general since the beginning of industrial revolution. Climate exerts a profound influence on the lives of poor populations in the Lake Chad region of Africa who depend on fishing and crop cultivation for livelihood and sustenance, who are unprotected against climate-related diseases, who lacked secure access to water and food and who are vulnerable to hydro meteorological hazard. The effects of climate change on the study area are many and include diminishing resources and conflicts over the available limited water resources. The Lake Chad region is a fragile area with high climate variability and extremes of weather. As this inland water is used for domestic and agricultural purposes, salt mining, as well as transportation by Nigerians, Nigeriens, Chadian and Cameroonians, it is an area of trans-boundary water conflicts. This paper examines the part played by climate change in the decline of fishery resources and livelihood activities in the Lake Chad region. Data from field studies, structured interview and secondary sources show that fish catches and livelihood activities have declined tremendously in recent times due to several factors including overexploitation and increasing demands on the aquatic resources. Findings from the study show that droughty periods have resulted in the reduction of open lake water surface from about 25,000 km2 in 1973 to less than 2,000 km2 in the 1990s. This has led to the diminishing aquatic

Weaving networks of responsibility: community work in development programs in rural Malawi.

PubMed

Rosenthal, Anat

2012-01-01

The need to cope with the impact of the AIDS epidemic on communities in Africa has resulted in the emergence of numerous community health and development programs. Initiated by governments, international nongovernmental organizations (NGOs), and local organizations, such programs target local communities with the goal of building care and support mechanisms in the local level. Based on ethnographic field research in rural Malawi, and drawing from the cross-disciplinary debate on development work, the article explores the work of an NGO offering health and care programs to orphans and vulnerable children. Through analyzing the organization's scope of work, the article demonstrates how the NGO acts to structure local social networks as instruments of care and offers a new reading of the role of NGOs in which the limitations of development work and the work of NGOs are understood within their local context and not only in the context of broad cultural critique.

Availability and affordability of antimalarial and antibiotic medicines in Malawi

PubMed Central

Khuluza, Felix

2017-01-01

Background Availability and affordability of medicines are key determinants of universal health coverage, yet achieving them presents a major challenge especially in low-income countries. We here present an analysis of availability and prices of antimalarial and antibiotic medicines in public, faith-based and private health facilities in Malawi. Medicines are provided free of charge in the public health care system of Malawi. In contrast, facilities of the Christian Health Association of Malawi (CHAM) usually charge their patients for medicines, as do private for-profit facilities. Methods As part of a study on medicine quality, samples of six antimalarial and six antibiotic medicines were collected in 31 health facilities in four districts of southern Malawi. These included 15 public facilities (i.e. health centres, district hospitals and central hospitals), eight CHAM and eight private facilities. Random selection was used in choosing the included health facilities. The availability of medicines was recorded, including the number of units which could be collected of each medicine, as well as the prices of medicines which were charged in CHAM and private facilities. These data were analyzed using the standard methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Results Availability of the antimalarials artemether/lumefantrine and sulfadoxine/pyrimethamine, which are provided with financial support from international donors, was high in public and CHAM facilities (93% and 100%, respectively). However, availability of antibiotics was much lower (e.g. 40% availability of amoxicillin tablets/capsules in public health centres). Medicine prices were lower than reported from many other countries. The median price ratio (MPR) to a wholesale international procurement price was 2.8 in CHAM facilities and even lower in the private sector (MPR 2.3). Nevertheless, for 10 of the 12 investigated medicines the cost for one course of

Socially disempowered women as the key to addressing change in Malawi: how do they do it?

PubMed

Macintyre, Linda M; Rankin, Sally; Pinderhughes, Howard; Waters, Catherine M; Schell, Ellen; Fiedler, Rachel

2013-01-01

Malawi women are in the ironic juxtaposition of being socially disempowered while, at the same time, thought to hold the key to shaping an effective community response to the HIV crisis. Based on this juxtaposition, a descriptive, qualitative study was conducted in Malawi and the United States where 26 participants from nongovernmental organizations (NGOs) and community-based organizations (CBOs) discussed the roles of Malawi women. Interviews were audiotaped, transcribed, and analyzed. We identified an improvement in women's economic status as the strongest factor in reducing gender inequities. Through providing stipends for rural Malawi women, one NGO created unintended changes in gender roles.

Assessing infection control practices to protect health care workers and patients in Malawi from nosocomial transmission of Mycobacterium tuberculosis

PubMed Central

Simon, Katherine; Hosseinipour, Mina; Kim, Maria H.; Mlauzi, Lameck; Kazembe, Peter N.; Ahmed, Saeed

2017-01-01

Transmission of Mycobacterium tuberculosis (TB) in health settings threatens health care workers and people living with HIV in sub-Saharan Africa. Nosocomial transmission is reduced with implementation of infection control (IC) guidelines. The objective of this study is to describe implementation of TB IC measures in Malawi. We conducted a cross-sectional study utilizing anonymous health worker questionnaires, semi-structured interviews with facility managers, and direct observations at 17 facilities in central Malawi. Of 592 health care workers surveyed, 34% reported that all patients entering the facility were screened for cough and only 8% correctly named the four most common signs and symptoms of TB in adults. Of 33 managers interviewed, 7 (21%) and 1 (3%) provided the correct TB screening questions for use in adults and children, respectively. Of 592 health workers, only 2.4% had been screened for TB in the previous year. Most (90%) reported knowing their HIV status, 53% were tested at their facility of employment, and half reported they would feel comfortable receiving ART or TB treatment at their facility of employment. We conclude that screening is infrequently conducted and knowledge gaps may undercut its effectiveness. Further, health care workers do not routinely access TB and HIV diagnostic and treatment services at their facility of employment. PMID:29211793

Assessing infection control practices to protect health care workers and patients in Malawi from nosocomial transmission of Mycobacterium tuberculosis.

PubMed

Flick, Robert J; Munthali, Adamson; Simon, Katherine; Hosseinipour, Mina; Kim, Maria H; Mlauzi, Lameck; Kazembe, Peter N; Ahmed, Saeed

2017-01-01

Transmission of Mycobacterium tuberculosis (TB) in health settings threatens health care workers and people living with HIV in sub-Saharan Africa. Nosocomial transmission is reduced with implementation of infection control (IC) guidelines. The objective of this study is to describe implementation of TB IC measures in Malawi. We conducted a cross-sectional study utilizing anonymous health worker questionnaires, semi-structured interviews with facility managers, and direct observations at 17 facilities in central Malawi. Of 592 health care workers surveyed, 34% reported that all patients entering the facility were screened for cough and only 8% correctly named the four most common signs and symptoms of TB in adults. Of 33 managers interviewed, 7 (21%) and 1 (3%) provided the correct TB screening questions for use in adults and children, respectively. Of 592 health workers, only 2.4% had been screened for TB in the previous year. Most (90%) reported knowing their HIV status, 53% were tested at their facility of employment, and half reported they would feel comfortable receiving ART or TB treatment at their facility of employment. We conclude that screening is infrequently conducted and knowledge gaps may undercut its effectiveness. Further, health care workers do not routinely access TB and HIV diagnostic and treatment services at their facility of employment.

Environmental change in subtropical southern Africa since the Last Glacial Maximum: a case study from Etosha Pan

NASA Astrophysics Data System (ADS)

Mauz, Barbara

2014-05-01

Millennial-scale climate shifts described by Heinrich Events and Dansgard-Oeschger Cycles occurred in the Northern and Southern Hemispheres asynchronously. It has been suggested that combined influence of the oceanic bipolar seesaw and the southward displacement of the south hemisphere (SH) westerlies, both linked to northern stadials, allowed the high southern latitudes to warm as a result of melting and collapse of NH ice sheets (Denton et al. 2010). For tropical southern Africa most terrestrial records delivering observational data for such climate scenario are derived from east African rift valley lakes (e.g. Olaka et al., 2010) but further to the west data are sparse. Here we report about a palaeoclimate proxy extracted from Etosha Pan, a vast endorheic plain in southern west Africa. It is situated at the southern border of tropical Africa, at the eastern border of the coastal area influenced by the Benguela current and at the western border of inland Africa influenced by the Indian Ocean. It is therefore supposed to be sensitive to climate change and provides the opportunity to link its lake record with the drastic hydrological changes that occurred in east African rift-valley lakes during deglaciation. Using OSL dating and sediment analysis to constrain lake shorelines of perennial lakes in time and space, we found high lake levels during the late Pleistocene and a drastic drop shortly after 10 ka. This lake water-level reconstruction is not in line with the histories of ITCZ migration and strength of Benguela current upwelling. We confirm that the linkages between the evolution of the Etosha Pan and the climate mechanisms driving hydrological changes in subtropical southwest Africa are poorly resolved and need further investigation. The paper discusses these findings in the context of SH palaeoclimate records.

The YES Africa 2011 Symposium: A Key to Developing the Future Geoscience Workforce in Africa

NASA Astrophysics Data System (ADS)

Nkhonjera, E.

2011-12-01

Africa is facing serious challenges in geoscience education. This has been as a result of absence of or very young/small Earth Science Departments in some universities (e.g., Mauritius, Namibia, Botswana, Swaziland, Malawi): Limited capacity (staff and equipment needed for practicals) to cope with the growing number of students, compounded by brain drain of academic staffs and the fact that current tertiary programmes do not seem to produce graduates suitable for the industry are some of the contributing factors to the challenges, (UNESCO-AEON Report, 2009). As such Earth Science studies in Africa have been one of the career paths that has not been promoted or highly preferred by many students. In January 2011, the YES Network African chapter was launched through the YES Africa 2011 Symposium that took place at the University of Johannesburg South Africa in Conjunction with the 23rd Colloquium of Africa Geology from the 08-14th January 2011. The YES Africa 2011 Symposium was organized by five YES African National networks from Southern, Central, Eastern and Northern Africa to bring young geoscientists from all regions of Africa together to present their research about African geoscience topics. The symposium also included roundtable discussions about increasing the involvement of youth's participation in geoscience issues in Africa, about how to increase the number of youths in African geosciences education university programs, and about how to promote geoscience careers to university students in Africa c. Roundtable discussions revealed that many African colleges and universities do not provide adequate infrastructure and resources to support the students studying in the department. As such, most students graduate with poor preparation for geoscience careers, having gained a theoretical understanding of geology, but not the practical application of the discipline. The recommendations from the YES Africa 2011 Symposium also highlighted on the best ways of

Surviving life as a woman: a critical ethnography of violence in the lives of female domestic workers in Malawi.

PubMed

Mkandawire-Valhmu, Lucy; Rodriguez, Rachel; Ammar, Nawal; Nemoto, Keiko

2009-09-01

A common form of employment for low-income third world women is domestic work. The power dynamics in this type of employer-employee relationship may place women at risk for abuse. Our aim in conducting this qualitative inquiry was to describe the experiences of violence in the lives of young female domestic workers in Malawi, a small country in South East Africa. Forty-eight women participated in focus group and individual interviews. "Surviving" was the main theme identified, with women employing creative ways of surviving the challenges they met at various points in their lives. This study provides information that health care professionals could use in assisting women through the process of surviving.

Carbon Cycling of Lake Kivu (East Africa): Net Autotrophy in the Epilimnion and Emission of CO2 to the Atmosphere Sustained by Geogenic Inputs

PubMed Central

Borges, Alberto V.; Morana, Cédric; Bouillon, Steven; Servais, Pierre; Descy, Jean-Pierre; Darchambeau, François

2014-01-01

We report organic and inorganic carbon distributions and fluxes in a large (>2000 km2) oligotrophic, tropical lake (Lake Kivu, East Africa), acquired during four field surveys, that captured the seasonal variations (March 2007–mid rainy season, September 2007–late dry season, June 2008–early dry season, and April 2009–late rainy season). The partial pressure of CO2 (pCO2) in surface waters of the main basin of Lake Kivu showed modest spatial (coefficient of variation between 3% and 6%), and seasonal variations with an amplitude of 163 ppm (between 579±23 ppm on average in March 2007 and 742±28 ppm on average in September 2007). The most prominent spatial feature of the pCO2 distribution was the very high pCO2 values in Kabuno Bay (a small sub-basin with little connection to the main lake) ranging between 11213 ppm and 14213 ppm (between 18 and 26 times higher than in the main basin). Surface waters of the main basin of Lake Kivu were a net source of CO2 to the atmosphere at an average rate of 10.8 mmol m−2 d−1, which is lower than the global average reported for freshwater, saline, and volcanic lakes. In Kabuno Bay, the CO2 emission to the atmosphere was on average 500.7 mmol m−2 d−1 (∼46 times higher than in the main basin). Based on whole-lake mass balance of dissolved inorganic carbon (DIC) bulk concentrations and of its stable carbon isotope composition, we show that the epilimnion of Lake Kivu was net autotrophic. This is due to the modest river inputs of organic carbon owing to the small ratio of catchment area to lake surface area (2.15). The carbon budget implies that the CO2 emission to the atmosphere must be sustained by DIC inputs of geogenic origin from deep geothermal springs. PMID:25314144

Sources of Social Capital for Malawi People Living With HIV

PubMed Central

Rankin, Sally H.; Jong, SoSon; Matovu, Schola; Youmans, Sharon; Lindgren, Teri

2016-01-01

With one of the highest rates of poverty and HIV in the world, Malawi faith-based organizations (FBOs), non-governmental organizations (NGOs), and community-based organizations (CBOs) are expected to provide tangible and emotional support to people living with HIV (PLWH). Using Lin’s social capital theoretical approach, we examine the perspective of PLWH regarding the adequacy of support responses. Forty-six rural Malawi HIV+ adults provided interviews that were recorded digitally, translated, and transcribed by Malawi research assistants. Atlas.ti was used to organize the data and to aid in the analytic process. Participants expressed disappointment in the lack of resources that could be accessed through the FBOs although their expectations may have been unrealistic. Outcomes from accessing and mobilizing the FBO network were negative in terms of stigmatization by FBO leaders and members, whereas outcomes related to CBOs and NGOs were generally positive in terms of empowerment through HIV information and attendance at support groups. PMID:28462349

Holistic view to integrated climate change assessment and extreme weather adaptation in the Lake Victoria Basin East Africa

NASA Astrophysics Data System (ADS)

Mutua, F.; Koike, T.

2013-12-01

Extreme weather events have been the leading cause of disasters and damage all over the world.The primary ingredient to these disasters especially floods is rainfall which over the years, despite advances in modeling, computing power and use of new data and technologies, has proven to be difficult to predict. Also, recent climate projections showed a pattern consistent with increase in the intensity and frequency of extreme events in the East African region.We propose a holistic integrated approach to climate change assessment and extreme event adaptation through coupling of analysis techniques, tools and data. The Lake Victoria Basin (LVB) in East Africa supports over three million livelihoods and is a valuable resource to five East African countries as a source of water and means of transport. However, with a Mesoscale weather regime driven by land and lake dynamics,extreme Mesoscale events have been prevalent and the region has been on the receiving end during anomalously wet years in the region. This has resulted in loss of lives, displacements, and food insecurity. In the LVB, the effects of climate change are increasingly being recognized as a significant contributor to poverty, by its linkage to agriculture, food security and water resources. Of particular importance are the likely impacts of climate change in frequency and intensity of extreme events. To tackle this aspect, this study adopted an integrated regional, mesoscale and basin scale approach to climate change assessment. We investigated the projected changes in mean climate over East Africa, diagnosed the signals of climate change in the atmosphere, and transferred this understanding to mesoscale and basin scale. Changes in rainfall were analyzed and similar to the IPCC AR4 report; the selected three General Circulation Models (GCMs) project a wetter East Africa with intermittent dry periods in June-August. Extreme events in the region are projected to increase; with the number of wet days

LakeMIP Kivu: Evaluating the representation of a large, deep tropical lake by a set of 1-dimensional lake models

NASA Astrophysics Data System (ADS)

Thiery, Wim; Stepanenko, Viktor; Darchambeau, François; Joehnk, Klaus; Martynov, Andrey; Mironov, Dmitrii; Perroud, Marjorie; van Lipzig, Nicole

2013-04-01

The African great lakes are of utmost importance for the local economy (fishing), as well as being essential to the survival of the local people. During the last decades, these lakes experienced fast changes in ecosystem structure and functioning and their future evolution is a major concern. In this study, for the first time a set of one-dimensional lake models are evaluated over East-Africa, in particular over Lake Kivu (2.28 °S; 28.98 °E). The unique limnology of meromictic Lake Kivu, with the importance of salinity and geothermal springs in a tropical high-altitude climate, presents a worthy challenge to the 1D-lake models currently involved in the Lake Model Intercomparison Project (LakeMIP). Furthermore, this experiment will serve as the basis for a future, more complex intercomparison, coupling lake models with atmospheric circulation models to analyse climate change effects on the lake. Meteorological observations from two automatic weather stations, one at Kamembe airport (Rwanda, 2003-2008), the other at ISP Bukavu (DRC, 2003-2011), are used to drive each of these models. For the evaluation, a unique dataset is used which contains over 150 temperature profiles recorded since 2002. The standard LakeMIP protocol is adapted to mirror the limnological conditions in Lake Kivu and to unify model parameters as far as possible. Since some lake models do not account for salinity and its effect upon lake stratification, two sets of simulations are performed with each model: one for the freshwater layer only (60 m) and one for the average lake depth (240 m) including salinity. Therewith, on the one hand it is investigated whether each model is able to reproduce the correct mixing regime in Lake Kivu and captures the controlling of this seasonality by the relative humidity, which constrains evaporation except during summer (JJA). On the other hand, the ability of different models to simulate salinity- and geothermal-induced effects upon deep water stratification is

Population structure of an invasive parthenogenetic gastropod in coastal lakes and estuaries of northern KwaZulu-Natal, South Africa.

PubMed

Miranda, Nelson A F; Perissinotto, Renzo; Appleton, Christopher C

2011-01-01

Estuaries and coastal lakes receive little attention despite being heavily invaded by non-indigenous invasive species (NIS). In these situations, studies of population dynamics in invaded habitats can provide valuable insights into how NIS interact with new environments. Tarebia granifera is a prosobranch gastropod from south-east Asia which has invaded other sub-tropical parts of the world. This study addresses whether a small number of key environmental factors influences gastropod communities, and specifically how the population density and size structure of T. granifera were influenced by environmental change in estuaries and coastal lakes in southern Africa. T. granifera's density, number of brooded juveniles and size structure were measured at the St. Lucia Estuary, Mgobozeleni Estuary, Lake Sibaya and Lake Nhlange. Size structure was classified according to shell height (SH). All dissected individuals were found to be female and free from trematode infection. Salinity, water depth, temperature, and pH were the main factors correlated with population density of gastropod communities. T. granifera often reached densities well over 1000 ind. m(-2), displacing indigenous gastropods and becoming a dominant component of the benthic community. T. granifera successfully invaded estuaries despite frequent exposure to high salinity and desiccation, which could together eliminate >97% of the population. The persistence of T. granifera was ensured due to its high fecundity and the environmental tolerance of large adults (20-30 mm SH) which carried an average of 158±12.8 SD brooded juveniles. Repeat introductions were not essential for the success of this parthenogenetic NIS. There is a need for a broader study on the reproductive biology of T. granifera (including the previously overlooked "brood pouch ecology"), which affects population dynamics and may be relevant to other parthenogenetic NIS, such as Melanoides tuberculata and Potamopyrgus antipodarum.

Reframing noncommunicable diseases and injuries for the poorest Malawians: the Malawi National NCDI Poverty Commission.

PubMed

Cundale, Katie; Wroe, Emily; Matanje-Mwagomba, Beatrice L; Muula, Adamson S; Gupta, Neil; Berman, Josh; Kasomekera, Noel; Masiye, Jones

2017-06-01

Noncommunicable diseases and injuries (NCDIs) account for nearly 70% of deaths worldwide, with an estimated 75% of these deaths occurring in low- and middle-income countries. Globally, the burden of disease from noncommunicable diseases (NCDs) is most often caused by the "big 4," namely: diabetes, cardiovascular diseases, cancer, and chronic lung diseases. However, in Malawi, these 4 conditions account for only 29% of the NCDI disease burden. The Malawi National NCDI Poverty Commission was launched in November 2016 and will describe and evaluate the current NCDI situation in Malawi, with a focus on the poorest populations. The National Commission will investigate which NCDIs cause the biggest burden, which are more present in the young, and which interventions are available to avert death and disability from NCDIs in Malawi, particularly among the poorest segments of the population. The evidence gained through the work of this Commission will help inform research, policy, and programme interventions, all through an advocacy lens, as we strive to address the impact of NCDIs among all populations in Malawi.

Predaceous water beetles (Coleoptera, Hydradephaga) of the Lake St Lucia system, South Africa: biodiversity, community ecology and conservation implications

PubMed Central

Perissinotto, Renzo; Bird, Matthew S.; Bilton, David T.

2016-01-01

Abstract Water beetles are one of the dominant macroinvertebrate groups in inland waters and are excellent ecological indicators, reflecting both the diversity and composition of the wider aquatic community. The predaceous water beetles (Hydradephaga) make up around one-third of known aquatic Coleoptera and, as predators, are a key group in the functioning of many aquatic habitats. Despite being relatively well-known taxonomically, ecological studies of these insects in tropical and subtropical systems remain rare. A dedicated survey of the hydradephagan beetles of the Lake St Lucia wetlands (South Africa) was undertaken between 2013 and 2015, providing the first biodiversity census for this important aquatic group in the iSimangaliso Wetland Park, a UNESCO World Heritage Site within the Maputaland biodiversity hotspot. A total of 32 sites covering the entire spectrum of waterbody types were sampled over the course of three collecting trips. The Lake St Lucia wetlands support at least 68 species of Hydradephaga, a very high level of diversity comparing favourably with other hotspots on the African continent and elsewhere in the world and a number of taxa are reported for South Africa for the first time. This beetle assemblage is dominated by relatively widespread Afrotropical taxa, with few locally endemic species, supporting earlier observations that hotspots of species richness and centres of endemism are not always coincident. Although there was no significant difference in the number of species supported by the various waterbody types sampled, sites with the highest species richness were mostly temporary depression wetlands. This contrasts markedly with the distribution of other taxa in the same system, such as molluscs and dragonflies, which are most diverse in permanent waters. Our study is the first to highlight the importance of temporary depression wetlands and emphasises the need to maintain a variety of wetland habitats for aquatic conservation in this

Community-supported models of care for people on HIV treatment in sub-Saharan Africa.

PubMed

Bemelmans, Marielle; Baert, Saar; Goemaere, Eric; Wilkinson, Lynne; Vandendyck, Martin; van Cutsem, Gilles; Silva, Carlota; Perry, Sharon; Szumilin, Elisabeth; Gerstenhaber, Rodd; Kalenga, Lucien; Biot, Marc; Ford, Nathan

2014-08-01

Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by Médecins Sans Frontières together with Ministries of Health in four countries in sub-Saharan Africa. Using routine programme data, four approaches to simplify ART delivery for stable patients on ART were assessed from a patient and health system perspective: appointment spacing for clinical and drug refill visits in Malawi, peer educator-led ART refill groups in South Africa, community ART distribution points in DRC and patient-led community ART groups in Mozambique. All four approaches lightened the burden for both patients (reduced travel and lost income) and health system (reduced clinic attendance). Retention in care is high: 94% at 36 months in Malawi, 89% at 12 months in DRC, 97% at 40 months in South Africa and 92% at 48 months in Mozambique. Where evaluable, service provider costs are reported to be lower. Separating ART delivery from clinical assessments was found to benefit patients and programmes in a range of settings. The success of community ART models depends on sufficient and reliable support and resources, including a flexible and reliable drug supply, access to quality clinical management, a reliable monitoring system and a supported lay workers cadre. Such models require ongoing evaluation and further adaptation to be able to reach out to more patients, including specific groups who may be challenged to meet the demands of frequent clinic visits and the integrated delivery of other essential chronic disease interventions. © 2014 John Wiley & Sons Ltd.

The impact of family transitions on child fostering in rural Malawi.

PubMed

Grant, Monica J; Yeatman, Sara

2014-02-01

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.

The Impact of Family Transitions on Child Fostering in Rural Malawi

PubMed Central

Grant, Monica J.; Yeatman, Sara

2013-01-01

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3–14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children’s current foster homes offers new insights into the reasons children are sent to live with others besides their parents. PMID:24019099

Mantle Flow Implications across Easter and Southern Africa from Shear Wave Splitting Measurements

NASA Astrophysics Data System (ADS)

Ramirez, C.; Nyblade, A.; Bagley, B. C.; Mulibo, G. D.; Tugume, F.; Wysession, M. E.; Wiens, D.; van der Meijde, M.

2015-12-01

In this study, we present new shear wave splitting results from broadband seismic stations in Botswana and Namibia, and combine them with previous results from stations in Kenya, Uganda, Tanzania, Malawi, Zambia, South Africa, Mozambique, Zimbabwe, and Angola to further examine the pattern of seismic anisotropy across southern Africa. The new results come from stations in northern Namibia and Botswana, which help to fill in large gaps in data coverage. Our preliminary results show that fast polarization directions overall trend in a NE orientation. The most noticeable measurements that deviate from this pattern are located around the Archean Tanzania Craton in eastern Africa. The general NE pattern of fast polarization directions is attributed to mantle flow linked to the African superplume. Smaller scale variations from this general direction can be explained by shape anisotropy in the lithosphere in magmatic regions in the East African rift system and to fossil anisotropy in the Precambrian lithosphere.

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study.

PubMed

Wang, Qun; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2016-09-01

Evidence from population-based studies on the economic burden imposed by chronic non-communicable diseases (CNCDs) is still sparse in Sub-Saharan Africa. Our study aimed to fill this existing gap in knowledge by estimating both the household direct, indirect, and total costs incurred due to CNCDs and the economic burden households bear as a result of these costs in Malawi. The study used data from the first round of a longitudinal household health survey conducted in 2012 in three rural districts in Malawi. A cost-of-illness method was applied to estimate the economic burden of CNCDs. Indicators of catastrophic spending and impoverishment were used to estimate the economic burden imposed by CNCDs on households. A total 475 out of 5643 interviewed individuals reported suffering from CNCDs. Mean total costs of all reported CNCDs were 1,040.82 MWK, of which 56.8 % was contributed by direct costs. Individuals affected by chronic cardiovascular conditions and chronic neuropsychiatric conditions bore the highest levels of direct, indirect, and total costs. Using a threshold of 10 % of household non-food expenditure, 21.3 % of all households with at least one household member reporting a CNCD and seeking care for such a condition incurred catastrophic spending due to CNCDs. The poorest households were more likely to incur catastrophic spending due to CNCDs. An additional 1.7 % of households reporting a CNCD fell under the international poverty line once considering direct costs due to CNCDs. Our study showed that the economic burden of CNCDs is high, causes catastrophic spending, and aggravates poverty in rural Malawi, a country where in principle basic care for CNCDs should be offered free of charge at point of use through the provision of an Essential Health Package (EHP). Our findings further indicated that particularly high direct, indirect, and total costs were linked to specific diagnoses, although costs were high even for conditions targeted by the EHP. Our

Oral cholera vaccine coverage in hard-to-reach fishermen communities after two mass Campaigns, Malawi, 2016.

PubMed

Sauvageot, Delphine; Saussier, Christel; Gobeze, Abebe; Chipeta, Sikhona; Mhango, Innocent; Kawalazira, Gift; Mengel, Martin A; Legros, Dominique; Cavailler, Philippe; M'bang'ombe, Maurice

2017-09-12

From December 2015 to August 2016, a large epidemic of cholera affected the fishermen of Lake Chilwa in Malawi. A first reactive Oral Cholera Vaccines (OCV) campaign was organized, in February, in a 2km radius of the lake followed by a preemptive one, conducted in November, in a 25km radius. We present the vaccine coverage reached in hard-to-reach population using simplified delivery strategies. We conducted two-stage random-sampling cross-sectional surveys among individuals living in a 2km and 25km radius of Lake Chilwa (islands and floating homes included). Individuals aged 12months and older from Machinga and Zomba districts were sampled: 43 clusters of 14 households were surveyed. Simplified strategies were used for those living in islands and floating homes: self- delivery and community-supervised delivery of the second dose. Vaccine coverage (VC) for at-least-two-doses was estimated taking into account sampling weights and design effects. A total of 1176 households were surveyed (2.7% of non-response). Among the 2833 individuals living in the 2km radius of Lake and the 2915 in the 25km radius: 457 (16.1%) and 239 (8.2%) lived in floating homes or on islands at some point in the year, respectively. For the overall population, VC was 75.6% and 54.2%, respectively. In the 2km radius, VC was 92.2% for those living on the lake at some point of the year: 271 (64.8%) used the simplified strategies. The main reasons for non-vaccination were absence during the campaign and vaccine shortage. Few adverse events occurring in the 24h following vaccination was reported. We reached a high two-dose coverage of the most at-risk population using simplified delivery strategies. Because of the high fishermen mobility, regular catch-up campaigns or another strategy specifically targeting fishermen need to be assessed for more efficient vaccines use. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Environmental changes and microbiological health risks. Satellite-derived turbidity: an indicator of "health hazard" for surface water in West Africa (Bagre lake, Burkina Faso).

NASA Astrophysics Data System (ADS)

Robert, E.; Grippa, M.; Kergoat, L.; Martinez, J.; Pinet, S.; Gal, L.; Soumaguel, N.

2015-12-01

A significant correlation exists between the concentration of parasites, bacteria and some water quality parameters including surface suspended solids (SSS) and turbidity. Suspended particles can carry viruses and pathogenic bacteria affecting human health and foster their development. High SSS, associated with high turbidity, can therefore be considered as a vector of microbiological contaminants, causing diarrheal diseases. Few studies have focused on the turbidity parameter in rural Africa, while many cases of intestinal parasitic infections are due to the consumption of unsafe water from ponds, lakes, and rivers. Monitoring turbidity may therefore contribute to health hazard monitoring. Turbidity refers to the optical properties of water and is known to impact water reflectance in the visible and near-infrared domain. Ideally, its spatial and temporal variability requires the use of high temporal resolution (MODIS) and spatial resolution (Landsat, SPOT, Sentinel-2). Here we investigate turbidity in West-Africa. Various algorithms and indices proposed in the literature for inland waters are applied to MODIS series and to Landsat 7 and 8 CDR images, and SPOT5 images. The data and algorithms are evaluated with field measurements: turbidity, SSS, and hyperspectral ground radiometry. We show that turbidity of the Bagre Lake displays a strong increase over 2000-2015, associated with the corresponding increase of the red and NIR reflectances, as well as a reduction of the seasonal variations. Water level derived from the Jason 2 altimeter does not explain such variations. The most probable hypothesis is a change in land use (increase in bare and degraded soils), that leads to an increase in the particles transported by surface runoff to the lake. Such an increase in turbidity reinforces the health risk. We will discuss the link between turbidity and health in view of data from health centers on diarrheal diseases as well as data on practices and uses of populations.

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis.

PubMed

Mills, Edward J; Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-11-23

To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Human capital cost analysis using publicly accessible data. Sub-Saharan African countries. Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21,000 (£13,000; €15,000) in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

PubMed Central

Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-01-01

Objective To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Design Human capital cost analysis using publicly accessible data. Settings Sub-Saharan African countries. Participants Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. Main outcome measures The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. Results In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Conclusions Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should

National health research system in Malawi: dead, moribund, tepid or flourishing?

PubMed

Kirigia, Joses Muthuri; Kathyola, Damson D; Muula, Adamson S; Ota, Martin Matthew Okechukwu

2015-03-31

Several instruments at both the global and regional levels to which countries in the WHO African Region are party call for action by governments to strengthen national health research systems (NHRS). This paper debates the extent to which Malawi has fulfilled this commitment. Some research literature has characterized African research - and by implication NHRS - as moribund. In our view, the Malawi government, with partner support, has made effort to strengthen the capacities of individuals and institutions that generate scientific knowledge. This is reflected in the Malawi national NHRS index (MNSR4HI) of 51%, which is within the 50%-69% range, and thus, it should be characterized as tepid with significant potential to flourish. Governance of research for health (R4H) has improved with the promulgation of the Malawi Science and Technology Act in 2003. However, lack of an explicit R4H policy, a strategic plan and a national R4H management forum undermines the government's effectiveness in overseeing the operation of the NHRS. The mean index of 'governance of R4H' sub-functions was 67%, implying that research governance is tepid. Malawi has a national health research focal point, an R4H program, and four public and 11 private universities. The average index of 'creating and sustaining resources' sub-functions was 48.6%, meaning that R4H human and infrastructural resources can be considered to be in a moribund state. The average index of 'producing and using research' sub-functions of 50.4% implies that production and utilization of research findings in policy development and public health practice can best be described as tepid. Efforts need to be intensified to boost national research productivity. Over the five financial years 2011-2016 the government plans to spend 0.26% of its total health budget on R4H. The mean index of 'financing' sub-functions of 23.6% is within the range of 1-49%, which is considered moribund. A functional NHRS is a prerequisite for the

Using multi-source satellite data for lake level modelling in ungauged basins: A case study for Lake Turkana, East Africa

USGS Publications Warehouse

Velpuri, N.M.; Senay, G.B.; Asante, K.O.

2011-01-01

Managing limited surface water resources is a great challenge in areas where ground-based data are either limited or unavailable. Direct or indirect measurements of surface water resources through remote sensing offer several advantages of monitoring in ungauged basins. A physical based hydrologic technique to monitor lake water levels in ungauged basins using multi-source satellite data such as satellite-based rainfall estimates, modelled runoff, evapotranspiration, a digital elevation model, and other data is presented. This approach is applied to model Lake Turkana water levels from 1998 to 2009. Modelling results showed that the model can reasonably capture all the patterns and seasonal variations of the lake water level fluctuations. A composite lake level product of TOPEX/Poseidon, Jason-1, and ENVISAT satellite altimetry data is used for model calibration (1998-2000) and model validation (2001-2009). Validation results showed that model-based lake levels are in good agreement with observed satellite altimetry data. Compared to satellite altimetry data, the Pearson's correlation coefficient was found to be 0.81 during the validation period. The model efficiency estimated using NSCE is found to be 0.93, 0.55 and 0.66 for calibration, validation and combined periods, respectively. Further, the model-based estimates showed a root mean square error of 0.62 m and mean absolute error of 0.46 m with a positive mean bias error of 0.36 m for the validation period (2001-2009). These error estimates were found to be less than 15 % of the natural variability of the lake, thus giving high confidence on the modelled lake level estimates. The approach presented in this paper can be used to (a) simulate patterns of lake water level variations in data scarce regions, (b) operationally monitor lake water levels in ungauged basins, (c) derive historical lake level information using satellite rainfall and evapotranspiration data, and (d) augment the information provided by the

Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study

PubMed Central

2011-01-01

. Dignitas and Ministry of Health have facilitated interaction with implementers and policy-makers. Challenges and successes This initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Our success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings. PMID:22166125

Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study.

PubMed

Sodhi, Sumeet; Banda, Hastings; Kathyola, Damson; Burciul, Barry; Thompson, Sandy; Joshua, Martias; Bateman, Eric; Fairall, Lara; Martiniuk, Alexandra; Cornick, Ruth; Faris, Gill; Draper, Beverley; Mondiwa, Martha; Katengeza, Egnat; Sanudi, Lifah; Zwarenstein, Merrick; Schull, Michael J

2011-11-08

implementers and policy-makers. This initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Our success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings.

Traditional birth attendants in Malawi.

PubMed

Smit, J J

1994-06-01

Traditional Birth Attendants (TBAs) and traditional healers form an important link in the chain of health personnel providing primary health care in Malawi. In spite of the establishment of hospitals and health centres, it is to these traditional healers and TBAs that the majority of people turn in times of sickness and child-birth. Approximately 60 per cent of all deliveries in Malawi occur in the villages. It is therefore important that due regard be paid to the activities of these traditional practitioners in order to ensure the achievement of the goal--"Health for all by the year 2000". The training of TBAs is seen as part of the Maternal and Child Health Services in the country. The Ministry of Health is responsible for the training and control of Traditional Birth Attendants and in 1976 opened a register in order to list all those trained. In early 1978 a training course for selected TBAs was conducted at the Kamuzu Central Hospital, Lilongwe and from 1982 the training programme evolved into a national training programme for TBAs. By February 1987, a total of 841 Traditional birth Attendants had been trained and the programme is still continuing.

Forest Cover Associated with Improved Child Health and Nutrition: Evidence from the Malawi Demographic and Health Survey and Satellite Data

NASA Technical Reports Server (NTRS)

Johnson, Kiersten B.; Jacob, Anila; Brown, Molly Elizabeth

2013-01-01

Healthy forests provide human communities with a host of important ecosystem services, including the provision of food, clean water, fuel, and natural medicines. Yet globally, about 13 million hectares of forests are lost every year, with the biggest losses in Africa and South America. As biodiversity loss and ecosystem degradation due to deforestation continue at unprecedented rates, with concomitant loss of ecosystem services, impacts on human health remain poorly understood. Here, we use data from the 2010 Malawi Demographic and Health Survey, linked with satellite remote sensing data on forest cover, to explore and better understand this relationship. Our analysis finds that forest cover is associated with improved health and nutrition outcomes among children in Malawi. Children living in areas with net forest cover loss between 2000 and 2010 were 19% less likely to have a diverse diet and 29% less likely to consume vitamin A-rich foods than children living in areas with no net change in forest cover. Conversely, children living in communities with higher percentages of forest cover were more likely to consume vitamin A-rich foods and less likely to experience diarrhea. Net gain in forest cover over the 10-year period was associated with a 34% decrease in the odds of children experiencing diarrhea (P5.002). Given that our analysis relied on observational data and that there were potential unknown factors for which we could not account, these preliminary findings demonstrate only associations, not causal relationships, between forest cover and child health and nutrition outcomes. However, the findings raise concerns about the potential short- and long-term impacts of ongoing deforestation and ecosystem degradation on community health in Malawi, and they suggest that preventing forest loss and maintaining the ecosystems services of forests are important factors in improving human health and nutrition outcomes.

Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania.

PubMed

Eliah, Edson; Lewallen, Susan; Kalua, Khumbo; Courtright, Paul; Gichangi, Michael; Bassett, Ken

2014-01-01

This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya. Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA. Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff. High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.

Deep Sequencing Reveals a Divergent Ugandan cassava brown streak virus Isolate from Malawi

PubMed Central

Winter, Stephan; Mukasa, Settumba; Tairo, Fred; Sseruwagi, Peter; Ndunguru, Joseph; Duffy, Siobain

2017-01-01

ABSTRACT Illumina sequencing of RNA from a cassava cutting from northern Malawi produced a genome of Ugandan cassava brown streak virus (UCBSV-MW-NB7_2013). Sequence comparisons revealed stronger similarity to an isolate from nearby Tanzania (93.4% pairwise nucleotide identity) than to those previously reported from Malawi (86.9 to 87.0%). PMID:28818908

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.

PubMed

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-12-01

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

Biomass Cooking Fuels and Health Outcomes for Women in Malawi.

PubMed

Das, Ipsita; Jagger, Pamela; Yeatts, Karin

2017-03-01

In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.

Rifting mechanisms constrained by InSAR, seismicity, GPS, and surface rupture from the Karonga earthquake sequence in northern Lake Malawi (Nyasa)

NASA Astrophysics Data System (ADS)

Zheng, W.; Pritchard, M. E.; Henderson, S. T.; Gaherty, J. B.; Shillington, D. J.; Oliva, S. J.; Ebinger, C.; Nooner, S. L.; Elliott, J.; Saria, E.; Ntambila, D.; Chindandali, P. R. N.

2017-12-01

The Malawi rift is part of the archetypal East African rift where early-stage crustal extension is dominated by faulting. In the Karonga region of northern Malawi, a sequence of earthquakes in late 2009, with 15 teleseismically detected (Mw 4.5-6.0) over 13 days, provides a uniqueopportunity to evaluate faulting processes controlling present-day extension in an early-stage rift. We describe observations of this sequence including hundreds of aftershocks located by a temporary seismic array installed in 2010, ground deformation from satellite interferograms, and surface rupture from field surveys published by others. We use all of these data to model fault geometry and slip. The aftershocks from January-May 2010 suggest the involvement of multiple faults, and we test the extent that this can be resolved by the InSAR data. The InSAR and surface rupture both suggest that the major slip occurred at shallow depth (<5 km). Our preferred aftershock locations appear to correlate with this principal slip zone, although uncertainty in the shallow velocity structure can allow for a bulk of the events to fall down-dip of the geodetically constrained slip. Subsequent deformation, including that associated with a December 2014 Mw 5.1 earthquake, can be constrained from multidisciplinary data collected during the SEGMeNT (Study of Extension and maGmatism in Malawi aNd Tanzania) project, which includes the Karonga region and spans 2013-2015. We find 3 cm of potential ground movement at the location of the earthquake as determined by the SEGMeNT seismic array from Sentinel-1. Geodetic fault slip is consistent with the focal mechanism and depth determined by the local array. The location is at the northern end of the 2009-2010 aftershock zone, and aftershocks suggest some linkage with faults that slipped in 2009. InSAR observations do not provide any evidence for large aseismic slip or fluid movements during or after the 2014 sequence, which had <200 aftershocks above the network

The use and management of water in the Likangala Irrigation Scheme Complex in Southern Malawi

NASA Astrophysics Data System (ADS)

Mulwafu, Wapulumuka O.; Nkhoma, Bryson G.

This paper examines the uses and management of water for agriculture in Lake Chilwa catchment area in Zomba district of Southern Malawi. It focuses on the Likangala Rice Irrigation Scheme Complex situated along the Likangala River. The scheme is one of the largest government-run schemes. Established in the late 1960s by the government to meet the growing demand for rice, the scheme contributes greatly to the agricultural industry of the country. Besides, the scheme was established to ensure maximum utilization of Malawi's largest wetland, which, due to its hydromorphic soils and the littoral floodplains, does not favour the production of traditional upland seasonal crops such as maize. The scheme's overdependence on water from the Likangala River has attracted a considerable degree of academic interest in the use and management of the river to ensure that there is equity and efficiency for both productive and domestic users. The paper focuses on four main issues: the historical development of the scheme, the distribution of water to farmers, social relations, and the overall contribution of the scheme towards the social and economic development of the area and the country in general. The paper contends that the growing population of the basin and the increase in the number of formal and informal smallholder farmers, contributes greatly to the growth of competition and conflicts over water, which tends to undermine the economic potential of the scheme. Furthermore, the paper provides clearest indication of the need for a realistic and informed water management policy and strategy to solve the growing problem of social inequity without necessarily compromising the production of rice in the scheme.

Estimating the Enduring Effects of Fertiliser Subsidies on Commercial Fertiliser Demand and Maize Production: Panel Data Evidence from Malawi.

PubMed

Ricker-Gilbert, Jacob; Jayne, T S

2017-02-01

Most studies of input subsidy programmes confine their analyses to measuring programme effects over a one-year period. This article estimates the potential longer-run or enduring effects of fertiliser subsidy programmes on smallholder farm households' demand for commercial fertiliser and maize production over time. We use four waves of panel data on 462 farm households in Malawi for whom fertiliser use can be tracked for eight consecutive seasons between 2003/2004 and 2010/2011. Panel estimation methods are used to control for potential endogeneity of subsidised fertiliser acquisition. Results indicate that farmers acquiring subsidised fertiliser in three consecutive prior years are found to purchase slightly more commercial fertiliser in the next year. This suggests a small amount of crowding in of commercial fertiliser from the receipt of subsidised fertiliser in prior years. In addition, acquiring subsidised fertiliser in a given year has a modest positive impact on increasing maize output in that same year. However, acquiring subsidised fertiliser in multiple prior years generates no statistically significant effect on maize output in the current year. These findings indicate that potential enduring effects of the Malawi fertiliser subsidy programme on maize production are limited. Additional interventions that increase soil fertility can make using inorganic fertiliser more profitable and sustainable for smallholders in sub-Saharan Africa and thereby increase the cost-effectiveness of input subsidy programmes.

Population-structure and genetic diversity in a haplochromine cichlid fish [corrected] of a satellite lake of Lake Victoria.

PubMed

Abila, Romulus; Barluenga, Marta; Engelken, Johannes; Meyer, Axel; Salzburger, Walter

2004-09-01

The approximately 500 species of the cichlid fish species flock of Lake Victoria, East Africa, have evolved in a record-setting 100,000 years and represent one of the largest adaptive radiations. We examined the population structure of the endangered cichlid species Xystichromis phytophagus from Lake Kanyaboli, a satellite lake to Lake Victoria in the Kenyan Yala wetlands. Two sets of molecular markers were analysed--sequences of the mitochondrial control region as well as six microsatellite loci--and revealed surprisingly high levels of genetic variability in this species. Mitochondrial DNA sequences failed to detect population structuring among the three sample populations. A model-based population assignment test based on microsatellite data revealed that the three populations most probably aggregate into a larger panmictic population. However, values of population pairwise FST indicated moderate levels of genetic differentiation for one population. Eleven distinct mitochondrial haplotypes were found among 205 specimens of X. phytophagus, a relatively high number compared to the total number of 54 haplotypes that were recovered from hundreds of specimens of the entire cichlid species flock of Lake Victoria. Most of the X. phytophagus mitochondrial DNA haplotypes were absent from the main Lake Victoria, corroborating the putative importance of satellite lakes as refugia for haplochromine cichlids that went extinct from the main lake in the last decades and possibly during the Late Pleistocene desiccation of Lake Victoria.

Study on the feasibility of provision of distance learning programmes in surgery to Malawi.

PubMed

Mains, Edward A A; Blackmur, James P; Dewhurst, David; Ward, Ross M; Garden, O James; Wigmore, Stephen J

2011-12-01

Medical educational opportunities and resources are considerably limited in the developing world. The expansion of computing and Internet access means that there exists a potential to provide education to students through distance learning programmes. This study investigated the feasibility of providing distance learning course in surgery in Malawi. The study investigated the user requirements, technical requirements and Internet connections in two teaching hospitals in Malawi. In addition the appropriateness of current course material from the Edinburgh Surgical Sciences Qualification to Malawi trainees was assessed. The study found a high degree of interest from Malawian trainees in distance learning. The provision of basic science modules such as anatomy and physiology and the ability to access journals were considered highly desirable. The current ESSQ course would require extensive re-modelling to make it suitable to an African trainee's requirements. Internet speeds remain slow and access is currently expensive. There is considerable interest in distance learning programmes in Malawi but access to them is limited partly because of slow and expensive Internet access. Understanding the needs of trainees in countries such as Malawi will allow better direction of educational aid and resources to support surgical training. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Parental Divorce and Children’s Schooling in Rural Malawi

PubMed Central

Chae, Sophia

2016-01-01

A growing body of literature has examined the impact of different types of family structures on children’s schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children’s schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children’s schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children’s schooling. PMID:27822897

HIV Risk Perceptions, the Transition to Marriage, and Divorce in Southern Malawi

PubMed Central

Grant, Monica J.; Soler-Hampejsek, Erica

2014-01-01

Little is known about whether young people in sub-Saharan Africa use the timing of marriage as a strategy to avoid HIV infection. Using five rounds of longitudinal data from the Malawi Schooling and Adolescent Survey, we do not find support for the hypothesis that young women’s perceived chances of future HIV infection are associated with the transition to marriage, but do find evidence that young married women who see themselves at risk of future infection have a higher hazard of divorce relative to women who perceive no chance of future infection. We also use individual level fixed effect regressions to examine how the transition to marriage affects respondents’ expectations of future HIV infection. Respondents are consistently more likely to perceive any chance of future HIV infection in the years following marriage. Our findings suggest that young women revise their risk perceptions based on their marital experiences, and that divorce may serve as a protective strategy for young married women concerned about their chance of future HIV infection. PMID:25207495

Validation of screening tools for antenatal depression in Malawi--a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire.

PubMed

Stewart, Robert C; Umar, Eric; Tomenson, Barbara; Creed, Francis

2013-09-25

The detection of antenatal depression in resource-limited settings such as Malawi, Africa, is important and requires an accurate and practical screening tool. It is not known which questionnaire would be most suitable for this purpose. A rigorously translated and modified Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS) was developed. The Chichewa EPDS and an existing Chichewa version of the Self Reporting Questionnaire (SRQ) were validated in women attending an antenatal clinic in rural Malawi, using DSM-IV major and major-or-minor depressive episode as the gold standard diagnoses, determined with Structured Clinical Interview for DSM-IV (SCID). Weighted test characteristics for each possible cut-off were calculated and Receiver Operator Characteristic (ROC) curves derived. The participants were 224 pregnant women, 92 of whom were interviewed using the SCID. The area under the ROC curve (AUC) for detection of current major depressive disorder for the EPDS was 0.811 (95% CI 0.734-0.889) and for the SRQ was 0.833 (95% CI 0.770-0.897). AUC for major-or-minor depressive disorder for the EPDS was 0.767 (95% CI 0.695-0.839) and for the SRQ was 0.883 (95% CI 0.839-0.927). These were not significant differences. Internal consistency was high for both the SRQ (Cronbach's alpha 0.825) and the EPDS (Cronbach's alpha 0.904). Inter-rater reliability testing was not done. The relatively small sample size resulted in wide confidence intervals around AUCs. The study was conducted amongst antenatal clinic attenders only, limiting generalisability to all pregnant women in this setting. The Chichewa versions of the EPDS and SRQ both show utility as brief screening measures for detection of antenatal depression in rural Malawi. © 2013 Elsevier B.V. All rights reserved.

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities

ERIC Educational Resources Information Center

Lupafya, Phindile Chitsulo; Mwagomba, Beatrice L. Matanje; Hosig, Kathy; Maseko, Lucy M.; Chimbali, Henry

2016-01-01

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control…

The genomic substrate for adaptive radiation in African cichlid fish.

PubMed

Brawand, David; Wagner, Catherine E; Li, Yang I; Malinsky, Milan; Keller, Irene; Fan, Shaohua; Simakov, Oleg; Ng, Alvin Y; Lim, Zhi Wei; Bezault, Etienne; Turner-Maier, Jason; Johnson, Jeremy; Alcazar, Rosa; Noh, Hyun Ji; Russell, Pamela; Aken, Bronwen; Alföldi, Jessica; Amemiya, Chris; Azzouzi, Naoual; Baroiller, Jean-François; Barloy-Hubler, Frederique; Berlin, Aaron; Bloomquist, Ryan; Carleton, Karen L; Conte, Matthew A; D'Cotta, Helena; Eshel, Orly; Gaffney, Leslie; Galibert, Francis; Gante, Hugo F; Gnerre, Sante; Greuter, Lucie; Guyon, Richard; Haddad, Natalie S; Haerty, Wilfried; Harris, Rayna M; Hofmann, Hans A; Hourlier, Thibaut; Hulata, Gideon; Jaffe, David B; Lara, Marcia; Lee, Alison P; MacCallum, Iain; Mwaiko, Salome; Nikaido, Masato; Nishihara, Hidenori; Ozouf-Costaz, Catherine; Penman, David J; Przybylski, Dariusz; Rakotomanga, Michaelle; Renn, Suzy C P; Ribeiro, Filipe J; Ron, Micha; Salzburger, Walter; Sanchez-Pulido, Luis; Santos, M Emilia; Searle, Steve; Sharpe, Ted; Swofford, Ross; Tan, Frederick J; Williams, Louise; Young, Sarah; Yin, Shuangye; Okada, Norihiro; Kocher, Thomas D; Miska, Eric A; Lander, Eric S; Venkatesh, Byrappa; Fernald, Russell D; Meyer, Axel; Ponting, Chris P; Streelman, J Todd; Lindblad-Toh, Kerstin; Seehausen, Ole; Di Palma, Federica

2014-09-18

Cichlid fishes are famous for large, diverse and replicated adaptive radiations in the Great Lakes of East Africa. To understand the molecular mechanisms underlying cichlid phenotypic diversity, we sequenced the genomes and transcriptomes of five lineages of African cichlids: the Nile tilapia (Oreochromis niloticus), an ancestral lineage with low diversity; and four members of the East African lineage: Neolamprologus brichardi/pulcher (older radiation, Lake Tanganyika), Metriaclima zebra (recent radiation, Lake Malawi), Pundamilia nyererei (very recent radiation, Lake Victoria), and Astatotilapia burtoni (riverine species around Lake Tanganyika). We found an excess of gene duplications in the East African lineage compared to tilapia and other teleosts, an abundance of non-coding element divergence, accelerated coding sequence evolution, expression divergence associated with transposable element insertions, and regulation by novel microRNAs. In addition, we analysed sequence data from sixty individuals representing six closely related species from Lake Victoria, and show genome-wide diversifying selection on coding and regulatory variants, some of which were recruited from ancient polymorphisms. We conclude that a number of molecular mechanisms shaped East African cichlid genomes, and that amassing of standing variation during periods of relaxed purifying selection may have been important in facilitating subsequent evolutionary diversification.

Do not forget the boys – gender differences in children living in high HIV-affected communities in South Africa and Malawi in a longitudinal, community-based study

PubMed Central

Hensels, I. S.; Sherr, L.; Skeen, S.; Macedo, A.; Roberts, K. J.; Tomlinson, M.

2016-01-01

ABSTRACT Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12–15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys’ worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are

Farmer Experience of Pluralistic Agricultural Extension, Malawi

ERIC Educational Resources Information Center

Chowa, Clodina; Garforth, Chris; Cardey, Sarah

2013-01-01

Purpose: Malawi's current extension policy supports pluralism and advocates responsiveness to farmer demand. We investigate whether smallholder farmers' experience supports the assumption that access to multiple service providers leads to extension and advisory services that respond to the needs of farmers. Design/methodology/approach: Within a…

Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda.

PubMed

Abongomera, George; Chiwaula, Levison; Revill, Paul; Mabugu, Travor; Tumwesige, Edward; Nkhata, Misheck; Cataldo, Fabian; van Oosterhout, J; Colebunders, Robert; Chan, Adrienne K; Kityo, Cissy; Gilks, Charles; Hakim, James; Seeley, Janet; Gibb, Diana M; Ford, Deborah

2018-01-01

The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda. We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time. © The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.

Spatial quantile regression using INLA with applications to childhood overweight in Malawi.

PubMed

Mtambo, Owen P L; Masangwi, Salule J; Kazembe, Lawrence N M

2015-04-01

Analyses of childhood overweight have mainly used mean regression. However, using quantile regression is more appropriate as it provides flexibility to analyse the determinants of overweight corresponding to quantiles of interest. The main objective of this study was to fit a Bayesian additive quantile regression model with structured spatial effects for childhood overweight in Malawi using the 2010 Malawi DHS data. Inference was fully Bayesian using R-INLA package. The significant determinants of childhood overweight ranged from socio-demographic factors such as type of residence to child and maternal factors such as child age and maternal BMI. We observed significant positive structured spatial effects on childhood overweight in some districts of Malawi. We recommended that the childhood malnutrition policy makers should consider timely interventions based on risk factors as identified in this paper including spatial targets of interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ring complexes and related rocks in Africa

NASA Astrophysics Data System (ADS)

Vail, J. R.

Over 625 igneous complexes throughout Africa and Arabia have been selected and classified on the basis of petrographic association and chronology into six broad age groups forming 29 provinces. The groups range from Mid-Proterozoic to Tertiary and include gabbro, granite, syenite, foid syenite and carbonatite plutonic rocks, the majority in the form of ring-dykes, cone-sheets, plugs, circular intrusions, and their associated extrusive phases. Pan-African late or post-orogenic complexes (720-490 Ma) are common in the Arabian-Nubian and Tuareg shields of north Africa originating from subduction zone derived magmatism. Anorogenic complexes in Egypt, NE and central Sudan, Niger, Nigeria, Cameroon, Zaïre-Burundi, Malawi, Mozambique, Zimbabwe, Namibia and Angola span 550 to 50 Ma and are dominantly alkali granites and foid syenites. Many groups occur as en-echelon bands within linear arrays, and show migrating centres of intrusion in variable directions. In W. Africa there was a progressive shift of emplacement southwards during early Ordovician to Mid-Cretaceous times. Distribution patterns suggest thatdeep seated features, such as shear zones associated with lithospheric plate movements,controlled melting, and the resultant location of the complexes. Economic mineralization is not widespread in the rocks of the African ring complexes and is mainly restricted to small deposits of Sn, W, F, U and Nb.

Non-Life Threatening Maternal Morbidity: Cross Sectional Surveys from Malawi and Pakistan.

PubMed

Zafar, Shamsa; Jean-Baptiste, Rachel; Rahman, Atif; Neilson, James P; van den Broek, Nynke R

2015-01-01

For more accurate estimation of the global burden of pregnancy associated disease, clarity is needed on definition and assessment of non-severe maternal morbidity. Our study aimed to define maternal morbidity with clear criteria for identification at primary care level and estimate the distribution of and evaluate associations between physical (infective and non-infective) and psychological morbidities in two different low-income countries. Cross sectional study with assessment of morbidity in early pregnancy (34%), late pregnancy (35%) and the postnatal period (31%) among 3459 women from two rural communities in Pakistan (1727) and Malawi (1732). Trained health care providers at primary care level used semi-structured questionnaires documenting signs and symptoms, clinical examination and laboratory tests which were bundled to reflect infectious, non-infectious and psychological morbidity. One in 10 women in Malawi and 1 in 5 in Pakistan reported a previous pregnancy complication with 1 in 10 overall reporting a previous neonatal death or stillbirth. In the index pregnancy, 50.1% of women in Malawi and 53% in Pakistan were assessed to have at least one morbidity (infective or non-infective). Both infective (Pakistan) and non-infective morbidity (Pakistan and Malawi) was lower in the postnatal period than during pregnancy. Multiple morbidities were uncommon (<10%). There were marked differences in psychological morbidity: 26.9% of women in Pakistan 2.6% in Malawi had an Edinburgh Postnatal Depression Score (EPDS) > 9. Complications during a previous pregnancy, infective morbidity (p <0.001), intra or postpartum haemorrhage (p <0.02) were associated with psychological morbidity in both settings. Our findings highlight the need to strengthen the availability and quality of antenatal and postnatal care packages. We propose to adapt and improve the framework and criteria used in this study, ensuring a basic set of diagnostic tests is available, to ensure more robust

U-series dating of Lake Nyos maar basalts, Cameroon (West Africa): Implications for potential hazards on the Lake Nyos dam

NASA Astrophysics Data System (ADS)

Aka, Festus T.; Yokoyama, Tetsuya; Kusakabe, Minoru; Nakamura, Eizo; Tanyileke, Gregory; Ateba, Bekoa; Ngako, Vincent; Nnange, Joseph; Hell, Joseph

2008-09-01

From previously published 14C and K-Ar data, the age of formation of Lake Nyos maar in Cameroon is still in dispute. Lake Nyos exploded in 1986, releasing CO 2 that killed 1750 people and over 3000 cattle. Here we report results of the first measurements of major elements, trace elements and U-series disequilibria in ten basanites/trachy-basalts and two olivine tholeiites from Lake Nyos. It is the first time tholeiites are described in Lake Nyos. But for the tholeiites which are in 238U- 230Th equilibrium, all the other samples possess 238U- 230Th disequilibrium with 15 to 28% enrichment of 230Th over 238U. The ( 226Ra/ 230Th) activity ratios of these samples indicate small (2 to 4%) but significant 226Ra excesses. U-Th systematics and evidence from oxygen isotopes of the basalts and Lake Nyos granitic quartz separates show that the U-series disequilibria in these samples are source-based and not due to crustal contamination or post-eruptive alteration. Enrichment of 230Th is strong prima facie evidence that Lake Nyos is younger than 350 ka. The 230Th- 226Ra age of Nyos samples calculated with the ( 226Ra/ 230Th) ratio for zero-age Mt. Cameroon samples is 3.7 ± 0.5 ka, although this is a lower limit as the actual age is estimated to be older than 5 ka, based on the measured mean 230Th/ 238U activity ratio. The general stability of the Lake Nyos pyroclastic dam is a cause for concern, but judging from its 230Th- 226Ra formation age, we do not think that in the absence of a big rock fall or landslide into the lake, a big earthquake or volcanic eruption close to the lake, collapse of the dam from erosion alone is as imminent and alarming as has been suggested.

Sedimentology and geochemistry of lacustrine sequences of the upper Pleistocene and holocene in intertropical area (Lake Magadi and Green crater lake): paleoclimatic implications

NASA Astrophysics Data System (ADS)

Damnati, B.

1993-05-01

Sedimentological and geochemical analyses have been carried out on lacustrine deposits of East Africa, at Lake Magadi (2°S, 36°E, Kenya) and at Green Crater Lake (0°S, 36°E, Kenya), to determine the parameters controlling climatic and environmental dynamics during late Pleistocene and Holocene. These sedimentary sequences were collected with a stationary piston corer. At Lake Magadi (Fig. 1), sedimentary and geochemical control show three phases of lake level variation which corresponds to climatic change occurring during the last 40 thousand years. These phases were defined by three lithostratigraphic units. Laminated deposits of Lake Magadi were formed during a wet period. Analysis of these laminae define two microfacies: a dark lamina, characterised by lacustrine organic matter and a light lamina enriched in detritus, carbonates (CaCO 3) and magadiite (NaSi 7O 13(OH) 3, 3H 2O). The formation and preservation of each couplet was favoured by climatic contrast, lake stratification and various origin of the sediments (autochthon and allochthon) in the drainage basin. Therefore a relative chronology can be derived from laminae counting and the duration of deposition of each couplet. Spectral analysis applied on variation of the laminae thickness, shows the existence of three main periods, 4-7 years, 8-14 years and 18-30 years, respectively (Fig. 2). These cyclicites of the lacustrine environment precise former determinations established on more recent lacustrine sequences from East Africa. They are related to the global climatic cycle (quasi-biannual oscillations, El Nino Southern Oscillations and the sun spot cycles). At Green Crater Lake, the study of the sedimentary sequence was completed by physico-chemical analysis of the waters and interface sediments which demonstrate the carbonate, sodium, bicarbonate composition and the thermal and chemical stratification of the modern lake. The sedimentary sequence is characterized by volcanic deposits overlain by

In Brief: New atlas of Africa

NASA Astrophysics Data System (ADS)

Showstack, Randy

2008-07-01

A newly revised atlas of Africa features more than 300 satellite images that show striking before and after photographs of environmental changes spanning about 35 years. Africa: Atlas of Our Changing Environment, compiled by the United Nations Environment Programme (UNEP), provides visual evidence of how development choices, population growth, climate change, and, in some cases, conflicts affect Africa, often negatively. The book includes photographs of shrinking glaciers on Mount Kilimanjaro as well as on Uganda's Rwenzori Mountains; deforestation along an expanding road system in the Congo; the drying up of Lake Chad; and the expansion of urban areas such as Cape Town, South Africa, and Dakar, Senegal. Satellite images also indicate some positive signs of environmental management, including action to stop overgrazing in a Tunisian national park, the effects of a management plan for a dam in Zambia that has helped restore seasonal flooding, and positive impacts of wetlands expansion around a national park in Mauritania. For more information, visit http://www.unep.org/dewa/africa/AfricaAtlas.

Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study

PubMed Central

van den Heuvel, Meta; Voskuijl, Wieger; Chidzalo, Kate; Kerac, Marko; Reijneveld, Sijmen A; Bandsma, Robert; Gladstone, Melissa

2017-01-01

Background Early childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe acute malnutrition (SAM). Particularly an important research gap exists in Sub–Saharan Africa where there is a high prevalence of SAM and a high rate of co–occurring HIV (human immune deficiency virus) infection. Our first objective was to assess the prevalence and severity of developmental and behavioural disorders on a cohort of children admitted to an inpatient nutritional rehabilitation centre in Malawi. Our second objective was to compare the developmental and behavioural profiles of children with the two main phenotypes of SAM: kwashiorkor and marasmus. Methods This was a cross–sectional observational study including all children hospitalized with complicated SAM in Blantyre, Malawi over an 8–month period from February to October 2015. At discharge, children were assessed with the well-validated Malawi Developmental Assessment Tool (MDAT) for gross motor, fine motor, language and social development. In children ≥24 months, emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Results 150 children (55% boys) with SAM were recruited; mean age of 27.2 months (standard deviation 17.9), 27 children (18%) had pre–existing neurodisabilities (ND) and 34 (23%) had a co–occurring human immune deficiency virus (HIV) infection. All children with SAM experienced profound delays in the gross and fine motor, language and social domains. Linear regression analysis demonstrated that children with kwashiorkor scored 0.75 standard deviations lower (95% confidence interval –1.43 to –0.07) on language MDAT domain than children with marasmus when adjusted for covariates. The prosocial behaviour score of the SDQ was low

Estimating demand for perennial pigeon pea in Malawi using choice experiments.

PubMed

Waldman, Kurt B; Ortega, David L; Richardson, Robert B; Snapp, Sieglinde S

2017-01-01

Perennial crops have numerous ecological and agronomic advantages over their annual counterparts. We estimate discrete choice models to evaluate farmers' preferences for perennial attributes of pigeon pea intercropped with maize in central and southern Malawi. Pigeon pea is a nitrogen-fixing leguminous crop, which has the potential to ameliorate soil fertility problems related to continuous maize cultivation, which are common in Southern Africa. Adoption of annual pigeon pea is relatively low but perennial production of pigeon pea may be more appealing to farmers due to some of the ancillary benefits associated with perenniality. We model perennial production of pigeon pea as a function of the attributes that differ between annual and perennial production: lower labor and seed requirements resulting from a single planting with multiple harvests, enhanced soil fertility and higher levels of biomass production. The primary tradeoff associated with perennial pigeon pea intercropped with maize is competition with maize in subsequent years of production. While maize yield is approximately twice as valuable to farmers as pigeon pea yield, we find positive yet heterogeneous demand for perenniality driven by soil fertility improvements and pigeon pea grain yield.

Some clinical aspects of HIV infection in Africa.

PubMed

Harries, A

1991-07-01

WHO has estimated the cumulative number of AIDS cases in Africa to have grown from 2978 (1986) to 81,019 (1990). The actual numbers are probably much higher due to under reporting, under diagnosis, and delays in notification. Pathogenicity and clinical features of HIV 2, found mainly in west Africa, are similar to those of HIV 1. 2nd generation HIV-ELISA tests can check for both viruses' antigens. These and other ELISA tests can be used to rapidly identify HIV, but clinical criteria alone can usually determine an accurate diagnosis. In developed countries, AZT (zidovudine) shows some promise of stemming the onset of AIDS in asymptomatic patients. Other promising antiretrovirus drugs are being developed, but are all too expensive for Africa. Almost 33% of HIV positive patients in Africa also have tuberculosis (TB) and, up to 1988, around 40% of TB patients tested HIV positive. In Uganda, Zambia, and Malawi the percentages ranged from 50-65% in TB patients. HIV positive TB patients have a substantial higher mortality than HIV negative TB patients. In some areas of Africa, 66% of AIDS patients have chronic, watery diarrhea and weight loss. The most common pathogens include Cryptosporidium and Isopora belli. Cryptosporidium does not respond to treatment, so there is a concern of a hospital based outbreak in AIDS patients. Cytomegalovirus also causes gastrointestinal illness in African AIDS patients as well as pulmonary disease. Toxoplasma and Cryptococcus often attack the central nervous system of AIDS patients. Oral fluconazole can provide some initial relief from cryptococcal meningitis. Bacteremia is also common. Little evidence exists to suggest an important interaction between HIV and traditional tropical diseases. Unlike Western nations, pneumocystosis and Mycobacterium avium intracellular are uncommon in Africa.

Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi.

PubMed

Shaikh, Masood A; Lloyd, Jennifer; Acquah, Emmanuel; Celedonia, Karen L; L Wilson, Michael

2016-08-19

Suicide is among the top causes of adolescent mortality worldwide. While correlates of suicidal behavior are better understood and delineated in upper-income countries, epidemiologic knowledge of suicidal behavior in low-income countries remains scant, particularly in the African continent. The present study sought to add to the epidemiologic literature on suicidal behavior in Africa by examining the behavioral correlates of suicide attempts among Malawi adolescents. A cross-sectional study using a nationally-representative sample extracted from publically-available data was conducted. Bivariate and multivariate analyses were performed to discern associations between suicide attempts and a host of behavioral variables. 2225 records were included in the study. At the multivariate level, suicide attempters had significantly higher odds of being anxious, being physically bullied, having sustained a serious injury and having a greater number of lifetime sexual partners. Alcohol use (at an early age and within the past 30 days) was also associated with suicide attempts. These findings have the potential to guide public health interventions geared toward suicide prevention in Africa and other, similar regions, as well as provide the impetus for future epidemiologic studies on suicidal behavior in low-income countries.

An overview of the Permian (Karoo) coal deposits of southern Africa

NASA Astrophysics Data System (ADS)

Cairncross, B.

2001-08-01

The coal deposits of southern Africa (Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe) are reviewed. The coal seams formed during two periods, the Early Permian (Artinskian-Kungurian) and the Late Permian (Ufimian-Kazanian). The coals are associated with non-marine terrestrial clastic sedimentary sequences, most commonly mudrock and sandstones, assigned to the Karoo Supergroup. The Early Permian coals are most commonly sandstone-hosted while the younger coals typically occur interbedded with mudstones. The sediments were deposited in varying tectono-sedimentary basins such as foreland, intracratonic rifts and intercratonic grabens and half-grabens. The depositional environments that produced the coal-bearing successions were primarily deltaic and fluvial, with some minor shoreline and lacustrine settings. Coals vary in rank from high-volatile bituminous to anthracite and characteristically have a relatively high inertinite component, and medium- to high-ash content. In countries where coal is mined, it is used for power generation, coking coal, synfuel generation, gasification and for (local) domestic household consumption.

Deforestation in Mwanza District, Malawi, from 1981 to 1992 as determined from Landsat MSS imagery

Treesearch

Andrew T. Hudak; Carol A. Wessman

2000-01-01

Malawi is critically short of fuelwood, the primary energy source for its poverty-stricken populace. Deforestation from 1981 to 1992 in Mwanza District in southern Malawi was assessed using Normalized Difference Vegetation Index (NDVI) values calculated from multitemporal Landsat Multispectral Scanner (MSS) images. A control site, where vegetation change was assumed to...

Water level monitoring using radar remote sensing data: Application to Lake Kivu, central Africa

NASA Astrophysics Data System (ADS)

Munyaneza, Omar; Wali, Umaru G.; Uhlenbrook, Stefan; Maskey, Shreedhar; Mlotha, McArd J.

Satellite radar altimetry measures the time required for a pulse to travel from the satellite antenna to the earth’s surface and back to the satellite receiver. Altimetry on inland lakes generally shows some deviation from in situ level measurements. The deviation is attributed to the geographically varying corrections applied to account for atmospheric effects on radar waves. This study was focused on verification of altimetry data for Lake Kivu (2400 km 2), a large inland lake between Rwanda and the Democratic Republic of Congo (DRC) and estimating the lake water levels using bathymetric data combined with satellite images. Altimetry data obtained from ENVISAT and ERS-2 satellite missions were compared with water level data from gauging stations for Lake Kivu. Gauge data for Lake Kivu were collected from the stations ELECTROGAZ and Rusizi. ENVISAT and ERS-2 data sets for Lake Kivu are in good agreement with gauge data having R2 of 0.86 and 0.77, respectively. A combination of the two data sets improved the coefficient of determination to 95% due to the improved temporal resolution of the data sets. The calculated standard deviation for Lake Kivu water levels was 0.642 m and 0.701 m, for ENVISAT and ERS-2 measurements, respectively. The elevation-surface area characteristics derived from bathymetric data in combination with satellite images were used to estimate the lake level gauge. Consequently, the water level of Lake Kivu could be estimated with an RMSE of 0.294 m and an accuracy of ±0.58 m. In situations where gauges become malfunctioning or inaccessible due to damage or extreme meteorological events, the method can be used to ensure data continuity.

The difficulties of conducting maternal death reviews in Malawi.

PubMed

Kongnyuy, Eugene J; van den Broek, Nynke

2008-09-11

Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi. Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.

Computer-Supported Feedback Message Tailoring for Healthcare Providers in Malawi: Proof-of-Concept.

PubMed

Landis-Lewis, Zach; Douglas, Gerald P; Hochheiser, Harry; Kam, Matthew; Gadabu, Oliver; Bwanali, Mwatha; Jacobson, Rebecca S

2015-01-01

Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to establish proof-of-concept for computer-supported feedback message tailoring in Malawi, Africa. We conducted this research in five stages: clinical performance measurement, modeling the influence of feedback on antiretroviral therapy (ART) performance, creating a rule-based message tailoring process, generating tailored messages for recipients, and finally analysis of performance and message tailoring data. We retrospectively generated tailored messages for 7,448 monthly performance reports from 11 ART clinics. We found that tailored feedback could be routinely generated for four guideline-based performance indicators, with 35% of reports having messages prioritized to optimize the effect of feedback. This research establishes proof-of-concept for a novel approach to improving the use of clinical performance feedback in low-resource settings and suggests possible directions for prospective evaluations comparing alternative designs of feedback messages.

Potential of household environmental resources and practices in eliminating residual malaria transmission: a case study of Tanzania, Burundi, Malawi and Liberia.

PubMed

Semakula, Henry M; Song, Guobao; Zhang, Shushen; Achuu, Simon P

2015-09-01

The increasing protection gaps of insecticide-treated nets and indoor-residual spraying methods against malaria have led to an emergence of residual transmission in sub-Saharan Africa and thus, supplementary strategies to control mosquitoes are urgently required. To assess household environmental resources and practices that increase or reduce malaria risk among children under-five years of age in order to identify those aspects that can be adopted to control residual transmission. Household environmental resources, practices and malaria test results were extracted from Malaria Indicators Survey datasets for Tanzania, Burundi, Malawi and Liberia with 16,747 children from 11,469 households utilised in the analysis. Logistic regressions were performed to quantify the contribution of each factor to malaria occurrence. Cattle rearing reduced malaria risk between 26%-49% while rearing goats increased the risk between 26%-32%. All piped-water systems reduced malaria risk between 30%-87% (Tanzania), 48%-95% (Burundi), 67%-77% (Malawi) and 58%-73 (Liberia). Flush toilets reduced malaria risk between 47%-96%. Protected-wells increased malaria risk between 19%-44%. Interestingly, boreholes increased malaria risk between 19%-75%. Charcoal use reduced malaria risk between 11%-49%. Vector control options for tackling mosquitoes were revealed based on their risk levels. These included cattle rearing, installation of piped-water systems and flush toilets as well as use of smokeless fuels.

Life Skills and Reproductive Health Education Changes Behaviour in Students and Teachers: Evidence from Malawi

ERIC Educational Resources Information Center

Kalanda, Boniface Francis

2010-01-01

Malawi is one of the countries with a youthful population. Youths are susceptible to various social-economic pressures that put their well being into jeopardy. One of the issues that affect youth is early drop out of school, drug abuse and contracting sexually transmitted diseases including HIV. To address these issues, the Malawi Government…

Bearing the Cost: An Examination of the Gendered Impacts of Water Policy Reform in Malawi

ERIC Educational Resources Information Center

Marra, Simona

2008-01-01

Water insecurity is one of the most pressing issues currently faced by Malawi. The consequences of these issues are borne significantly by women, who are most directly involved with water provision and use, particularly at the household level. Since the mid-1990s, Malawi has undertaken a process of water policy reform. Reflective of international…

Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation

PubMed Central

Otañez, M G; Muggli, M E; Hurt, R D; Glantz, S A

2006-01-01

Objectives To examine British American Tobacco and other tobacco industry support of the Eliminating Child Labour in Tobacco Growing Foundation. Design Analyses of internal tobacco industry documents and ethnographic data. Results British American Tobacco co‐founded the Eliminating Child Labour in Tobacco Growing Foundation (ECLT) in October 2000 and launched its pilot project in Malawi. ECLT's initial projects were budgeted at US$2.3 million over four years. Labour unions and leaf dealers, through ECLT funds, have undertook modest efforts such as building schools, planting trees, and constructing shallow wells to address the use of child labour in tobacco farming. In stark contrast, the tobacco companies receive nearly US$40 million over four years in economic benefit through the use of unpaid child labour in Malawi during the same time. BAT's efforts to combat child labour in Malawi through ECLT was developed to support the company's “corporate social responsibility agenda” rather than accepting responsibility for taking meaningful steps to eradicate child labour in the Malawi tobacco sector. Conclusion In Malawi, transnational tobacco companies are using child labour projects to enhance corporate reputations and distract public attention from how they profit from low wages and cheap tobacco. PMID:16728754

Herbalism and divination in southern Malawi.

PubMed

Morris, B

1986-01-01

Although contemporary anthropological studies of African medical systems have indicated their pluralistic and complex nature, many studies still suggest a stark contrast between folk and cosmopolitan medicine, implying that ethnomedicine is primarily concerned with mystical causation. The present paper outlines ethnomedical practices in southern Malawi, stressing the distinctiveness of herbalists and diviners, and the important role of herbal remedies in the empirical treatment of all illnesses.

Lake Challa (Kenya/Tanzania) sediments, a varved climate archive of environmental variability in equatorial East Africa of the last 25.000 years

NASA Astrophysics Data System (ADS)

Wolff, C.; Haug, G.; Plessen, B.; Kristen, I.; Verschuren, D.; Participants, C.

2008-12-01

Recently, an increasing number of climate records from low-latitude regions underscore the importance of tropical atmospheric processes in the global climate system. Nevertheless, the regional synchrony of temperature and humidity variations, as well as teleconnecting mechanisms between high and low latitudes are still poorly understood. The EuroCLIMATE project CHALLACEA aims to provide a continuous high- resolution multi-proxy record of temperature and moisture-balance variability in equatorial East Africa from the Last Glacial Maximum (25 ka BP) to the present. Lake Challa is a crater lake located about 40 km east of Mt. Kilimanjaro at an altitude of 880 m a.s.l. It is a freshwater lake whose water column is stratified during most of the year. It is fed by subsurface inflow which derives mainly from percolation of precipitation falling in the montane forest zone higher up the mountain. Within the lake form lacustrine deposits which predominantly consist of autochthonous components (carbonate, biogenic silica, organic matter). The present study focuses on microfacies analyses and isotope measurements. Fine laminations are preserved over wide parts of a 22 m long sediment profile. Microfacies analyses reveal that the light/dark couplets represent true calcite varves. The darker layers contain organic matter and endogenic calcite. Sediment trap studies show that these layers form during the warm season (Nov to Mar) when water temperatures are high and the lake is biological productive. The light layers consist predominantly of diatom frustules. They accumulate in the sediment trap between June and October. By counting and measuring the thickness of the varves on thin sections, we establish a varve record that currently covers the last 1500 years. Stable isotope analyses on bulk carbonates will complement this record and give further insights into the hydrological variability of the region and enhance our knowledge of climate change in the highly sensitive climate

Biomass Cooking Fuels and Health Outcomes for Women in Malawi

PubMed Central

Das, Ipsita; Jagger, Pamela; Yeatts, Karin

2016-01-01

In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy. PMID:27800583

Microcrystalline sphalerite in resin globules suspended in Lake Kivu, East Africa

USGS Publications Warehouse

Degens, E.T.; Okada, H.; Honjo, S.; Hathaway, J.C.

1972-01-01

The origin and chemical nature of micron-sized spheres found as suspended particles in Lake Kivu are examined. It can be shown that the hollow spheres, with a wall thickness of 500 A??, consist of a complex polymeric resinous material which has little functionality, except for hydroxyl groups. The spheres arise in the process of degassing of water samples at depth. Tiny gas bubbles, about 1 micron in size, act as scavengers of dissolved resinous material. The newly created resinous membrane promotes the selective coordination of zinc dissolved in the water column. In the prevailing H2S regime, formation of sphalerite crystals in induced. The size range of the crystals, 5 to 50 A??, corresponds to 1 to 10 unit cells and suggests that the resinous membrane also acts as a template in sphalerite growth processes. The sources of the zinc and dissolved gases (CO2, CH4, H2S) are hydrothermal springs seeping from the lake bottom into the basin. Water discharge is substantial; about 100 years are required to fill the lake to its present level (ca. 550 km3 water). The average Kivu water contains 2 ppm zinc. Thus, 1 million tons of zinc are contained in Lake Kivu in the form of sphalerite. ?? 1972 Springer-Verlag.

Baseline Trachoma Mapping in Malawi with the Global Trachoma Mapping Project (GTMP).

PubMed

Kalua, Khumbo; Phiri, Menard; Kumwenda, Isaac; Masika, Michael; Pavluck, Alexandre L; Willis, Rebecca; Mpyet, Caleb; Lewallen, Susan; Courtright, Paul; Solomon, Anthony W

2015-01-01

To determine the prevalence of trachoma in all suspected endemic districts in Malawi. A population-based survey conducted in 16 evaluation units from 12 suspected endemic districts in Malawi (population 6,390,517), using the standardized Global Trachoma Mapping Project (GTMP) protocol. A 2-stage cluster-random sampling design selected 30 households from each of 30 clusters per evaluation unit; all residents aged 1 year and older in selected households were examined for evidence of follicular trachoma (TF), intense trachomatous inflammation (TI), and trachomatous trichiasis (TT). Four of the 16 evaluation units were found to be endemic for trachoma, with a prevalence range of 10.0-13.5% for TF and 0.2-0.6% for TT. Nine evaluation units had a TF prevalence between 5.0% and 9.9% while three evaluation units had a TF prevalence <5.0%. The prevalence rates of active trachoma in Malawi were not uniform among suspected endemic evaluation units, with rates higher than the World Health Organization (WHO) threshold for implementation of community-based control measures (TF ≥ 10.0%) in only 4 of the 16 evaluation units. Trachoma remains a disease of public health importance in some parts of Malawi and adjoining (unmapped) districts should be prioritized for mapping. According to the survey, an additional 3,169,362 people require intervention to reduce active disease and 1557 trichiasis surgeries are needed to reduce the prevalence of TT below WHO recommended thresholds.

Contesting Spaces for Implementation: (Im)Possibilities of Religious Education Curriculum Policy for Secondary Schools In Malawi

ERIC Educational Resources Information Center

Sookrajh, Reshma; McCloud, Salanjira

2009-01-01

We review spaces of contest in the formulation and implementation of the Religious Education curriculum through an exploration of the understandings regarding the dual-mode Religious Education (RE) curriculum policy for secondary schools in Malawi. Six leaders of nationally organised faith communities in Malawi were interviewed about their…

Health spending, illicit financial flows and tax incentives in Malawi.

PubMed

O'Hare, B; Curtis, M

2014-12-01

This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes: Illicit financial flows (IFF) from the country, Tax incentives. We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400 million is lost through IFF and corporate utilization of tax incentives each year. The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi's disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.

Stoves or Sugar? Willingness to Adopt Improved Cookstoves in Malawi

PubMed Central

Jagger, Pamela; Jumbe, Charles

2016-01-01

Malawi has set a target of adoption of two million improved cookstoves (ICS) by 2020. Meeting this objective requires knowledge about determinants of adoption, particularly in rural areas where the cost of traditional cooking technologies and fuels are non-monetary, and where people have limited capacity to purchase an ICS. We conducted a discrete choice experiment with 383 households in rural Malawi asking them if they would chose a locally made ICS or a package of sugar and salt of roughly equal value. Six months later, we assessed adoption and stove use patterns. Sixty-six percent of households chose the ICS. We find that having a larger share of crop residues in household fuel supply, awareness of the environmental impacts of woodfuel reliance, time the primary cook devotes to collecting fuelwood, and peer effects at the village-level increase the odds of choosing the ICS. Having a large labor supply for fuelwood collection and experience with a non-traditional cooking technology decreased the odds of choosing the ICS. In a rapid assessment six months after stoves were distributed, we found 80% of households were still using the ICS, but not exclusively. Our findings suggest considerable potential for wide-scale adoption of ICS in Malawi. PMID:27346912

Prevalence and correlates of being bullied among in-school adolescents in Malawi: results from the 2009 Global School-Based Health Survey.

PubMed

Kubwalo, H W; Muula, A S; Siziya, S; Pasupulati, S; Rudatsikira, E

2013-03-01

Physical and emotional violence against adolescents is a neglected, but growing problem globally. Violence against adolescents negatively affects the victim in terms of physical health, school attendance and performance and social adjustment. The literature on the prevalence and associated factors of bullying against adolescents is sparse in southern Africa outside South Africa. Such data are even sparser for Malawi. The current study was conducted to estimate the prevalence of self-reported bullying and its personal and social correlates. A secondary analysis of the Malawi School-Based Student Health Survey (2009) was done. Descriptive analyses were done to describe the sample and estimate the prevalence of reporting history of bullying in the past 30 days preceding the survey. Logistic regression analysis was done to assess the association between several factors and being a victim of bullying. Crude and adjusted odds ratios are reported. A total of 2,264 in-school adolescents participated in the Malawi School-Based Student Health Survey of 2009. Just under half (44.5%) reported having been bullied in the previous month to the survey (44.1% among boys versus 44.9% among girls). Compared to adolescents of age 16 years or older, those who were 12 years old or younger and those who were 14 years of age were more likely to be bullied (AOR=1.54; 95% CI [1.41, 1.76]) and OR=1.26; 95% CI [1.21, 1.31]) respectively. The other risk factors that were identified in the analysis were loneliness (AOR = 2.23; 95% CI [2.20, 2.27]), and being worried (AOR = 2.80; 95% CI [2.76, 2.85[). Adolescents who had no close friends were 14% (AOR = 1.14; 95% CI [1.11-1.17]) more likely to be reporting bullied compared to adolescents who reported having close friends. Adolescents who smoked cigarettes were more than three times more likely to reporting be bullied compared to non-smokers (AOR=3.97; 955 CI [3.83, 4.10]), while those who drank alcohol were more than twice as likely to be

Validation of a Chichewa version of the self-reporting questionnaire (SRQ) as a brief screening measure for maternal depressive disorder in Malawi, Africa.

PubMed

Stewart, Robert C; Kauye, Felix; Umar, Eric; Vokhiwa, Maclean; Bunn, James; Fitzgerald, Margaret; Tomenson, Barbara; Rahman, Atif; Creed, Francis

2009-01-01

Depressive disorder affecting women during the perinatal period is common in low-income countries. The detection and study of maternal depression in a resource-poor setting requires a brief screening tool that is both accurate and practical to administer. A Chichewa version of the Self Reporting Questionnaire (SRQ) was developed through a rigorous process of forward and back translation, focus-group discussion and piloting. Criterion validation was conducted as part of a larger study in a sample of women who had brought their infants to a child health clinic in rural Malawi, using DSM-IV major and minor depressive episode as the gold standard diagnoses. The criterion validation was conducted on 114 subjects who did not differ on health and sociodemographic characteristics from the total study sample (n=501). Test characteristics for each possible SRQ cut-off were calculated and Receiver Operator Characteristic (ROC) curves derived. Area under the ROC curve (AUROC) for detection of current major depressive disorder was 0.856 (95% CI 0.813 to 0.900), and for current major or minor depressive disorder was 0.826 (95% CI 0.783 to 0.869). Internal consistency of the SRQ was high (Cronbach's alpha 0.85). Inter-rater reliability testing was not conducted. This Chichewa version of the SRQ shows utility as a brief screening measure for detection of probable maternal depression in rural Malawi.

Non-Life Threatening Maternal Morbidity: Cross Sectional Surveys from Malawi and Pakistan

PubMed Central

Zafar, Shamsa; Jean-Baptiste, Rachel; Rahman, Atif; Neilson, James P.; van den Broek, Nynke R.

2015-01-01

Background For more accurate estimation of the global burden of pregnancy associated disease, clarity is needed on definition and assessment of non-severe maternal morbidity. Our study aimed to define maternal morbidity with clear criteria for identification at primary care level and estimate the distribution of and evaluate associations between physical (infective and non-infective) and psychological morbidities in two different low-income countries. Methods Cross sectional study with assessment of morbidity in early pregnancy (34%), late pregnancy (35%) and the postnatal period (31%) among 3459 women from two rural communities in Pakistan (1727) and Malawi (1732). Trained health care providers at primary care level used semi-structured questionnaires documenting signs and symptoms, clinical examination and laboratory tests which were bundled to reflect infectious, non-infectious and psychological morbidity. Results One in 10 women in Malawi and 1 in 5 in Pakistan reported a previous pregnancy complication with 1 in 10 overall reporting a previous neonatal death or stillbirth. In the index pregnancy, 50.1% of women in Malawi and 53% in Pakistan were assessed to have at least one morbidity (infective or non-infective). Both infective (Pakistan) and non-infective morbidity (Pakistan and Malawi) was lower in the postnatal period than during pregnancy. Multiple morbidities were uncommon (<10%). There were marked differences in psychological morbidity: 26.9% of women in Pakistan 2.6% in Malawi had an Edinburgh Postnatal Depression Score (EPDS) > 9. Complications during a previous pregnancy, infective morbidity (p <0.001), intra or postpartum haemorrhage (p <0.02) were associated with psychological morbidity in both settings. Conclusions Our findings highlight the need to strengthen the availability and quality of antenatal and postnatal care packages. We propose to adapt and improve the framework and criteria used in this study, ensuring a basic set of diagnostic tests

Bibliometric trends of health economic evaluation in Sub-Saharan Africa.

PubMed

Hernandez-Villafuerte, Karla; Li, Ryan; Hofman, Karen J

2016-08-24

Collaboration between Sub-Saharan African researchers is important for the generation and transfer of health technology assessment (HTA) evidence, in order to support priority-setting in health. The objective of this analysis was to evaluate collaboration patterns between countries. We conducted a rapid evidence assessment that included a random sample of health economic evaluations carried out in 20 countries (Angola, Botswana, Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe, Ghana, Kenya, Nigeria, Ethiopia, Uganda). We conducted bibliometric network analysis based on all first authors with a Sub-Saharan African academic affiliation and their co-authored publications ("network-articles"). Then we produced a connection map of collaboration patterns among Sub-Saharan African researchers, reflecting the number of network-articles and the country of affiliation of the main co-authors. The sample of 119 economic evaluations mostly related to treatments of communicable diseases, in particular HIV/AIDS (42/119, 35.29 %) and malaria (26/119, 21.85 %). The 39 first authors from Sub-Saharan African institutions together co-authored 729 network-articles. The network analysis showed weak collaboration between health economic researchers in Sub-Saharan Africa, with researchers being more likely to collaborate with Europe and North America than with other African countries. South Africa stood out as producing the highest number of health economic evaluations and collaborations. The development and evaluation of HTA research networks in Sub-Saharan Africa should be supported, with South Africa central to any such efforts. Organizations and institutions from high income countries interested in supporting priority setting in Sub-Saharan Africa should include promoting collaboration as part of their agendas, in order to take advantage of the potential transferability of results and methods of the

Recent Warming of Lake Kivu

PubMed Central

Katsev, Sergei; Aaberg, Arthur A.; Crowe, Sean A.; Hecky, Robert E.

2014-01-01

Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12°C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient. PMID:25295730

Recent warming of lake Kivu.

PubMed

Katsev, Sergei; Aaberg, Arthur A; Crowe, Sean A; Hecky, Robert E

2014-01-01

Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12°C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient.

Male circumcision and HIV infection among sexually active men in Malawi.

PubMed

Mutombo, Namuunda; Maina, Beatrice; Jamali, Monica

2015-10-13

The HIV epidemic remains a major health challenge all over the world. In 2013, an estimated 35million people were living with HIV globally. Male circumcision is increasingly being adopted as a method of HIV prevention. WHO and UNAIDS have advised that male circumcision be added to current HIV interventions. Malawi is one of the countries hardest hit by HIV/AIDS with a prevalence rate of 11 % and male circumcision prevalence of 21.6 % in 2010. Prior to 2011, traditional male circumcision in Malawi was the dominant form of male circumcision, mainly for cultural and religious reasons. This paper looks at male circumcision as a prevention method against HIV by examining the relationship between male circumcision and HIV status among Malawian men. The data used were collected as part of the 2010 Malawi Demographic and Health Survey. The methodology used in the 2010 MDHS has been comprehensively described by the National Statistical Office of Malawi and ICF Macro. Our analysis is based on men aged 15-54 years who were tested for HIV and responded to questions on circumcision during the survey. Sixty one percent of the 7175 men interviewed in the MDHS, qualified for this analysis. The sample was weighted to ensure representativeness. Frequencies, cross-tabulations, univariate and multivariate logistic regressions were conducted. Differences in the prevalence of HIV infection among circumcised and uncircumcised men were determined with Chi-squared tests. There is no significant difference in HIV prevalence between circumcised (12 %) and uncircumcised men (10 %). Among circumcised men, age and number of lifetime partners are the dominant correlates of HIV status. Additionally, circumcised men who have had ritual sex are two times more likely (OR = 2.399) to be HIV+ compared to circumcised men who have never had ritual sex. This study has demonstrated that traditional male circumcision was not associated with HIV infection in pre-2010 Malawi. Among circumcised men, age and

Early warnings of hazardous thunderstorms over Lake Victoria

NASA Astrophysics Data System (ADS)

Thiery, Wim; Gudmundsson, Lukas; Bedka, Kristopher; Semazzi, Fredrick H. M.; Lhermitte, Stef; Willems, Patrick; van Lipzig, Nicole P. M.; Seneviratne, Sonia I.

2017-07-01

Weather extremes have harmful impacts on communities around Lake Victoria in East Africa. Every year, intense nighttime thunderstorms cause numerous boating accidents on the lake, resulting in thousands of deaths among fishermen. Operational storm warning systems are therefore crucial. Here we complement ongoing early warning efforts based on numerical weather prediction, by presenting a new satellite data-driven storm prediction system, the prototype Lake Victoria Intense storm Early Warning System (VIEWS). VIEWS derives predictability from the correlation between afternoon land storm activity and nighttime storm intensity on Lake Victoria, and relies on logistic regression techniques to forecast extreme thunderstorms from satellite observations. Evaluation of the statistical model reveals that predictive power is high and independent of the type of input dataset. We then optimise the configuration and show that false alarms also contain valuable information. Our results suggest that regression-based models that are motivated through process understanding have the potential to reduce the vulnerability of local fishing communities around Lake Victoria. The experimental prediction system is publicly available under the MIT licence at http://github.com/wthiery/VIEWS.

Water security for productive economies: Applying an assessment framework in southern Africa

NASA Astrophysics Data System (ADS)

Holmatov, Bunyod; Lautze, Jonathan; Manthrithilake, Herath; Makin, Ian

2017-08-01

Achieving water security has emerged as a major objective in Africa, yet an analytical or diagnostic framework for assessing water security in African countries is not known to exist. This paper applies one key dimension of the 2016 Asian Development Bank's (ADB) Asian Water Development Outlook (AWDO) to assess levels of water security for productive economies in countries of the Southern African Development Community (SADC). Economic aspects of water security cover four areas: economic activities in the broad sense, agriculture, electricity, and industry. Water security in each area is measured through application of a set of indicators; results of indicator application are then aggregated to determine economic water security at a country-level. Results show that economic water security in SADC is greatest in the Seychelles and South Africa, and lowest in Madagascar and Malawi. Opportunities for strengthening economic water security in the majority of SADC countries exist through improving agricultural water productivity, strengthening resilience, and expanding sustainable electricity generation. More profoundly, this paper suggests that there is clear potential and utility in applying approaches used elsewhere to assess economic water security in southern Africa.

Moderating the Demand for Primary Education in Malawi.

ERIC Educational Resources Information Center

Minnis, John R.

1997-01-01

Against the backdrop of declining performance, political transition, and the increasingly dominant role of donor agencies in educational decision making, this paper questions the feasibility and sustainability of educational expansion in Malawi. Three critical features of the Malawian political economy (land scarcity, declining wage economy, and…

Analysis of seasonal characteristics of Sambhar Salt Lake, India, from digitized Space Shuttle photography

NASA Technical Reports Server (NTRS)

Lulla, Kamlesh P.; Helfert, Michael R.

1989-01-01

Sambhar Salt Lake is the largest salt lake (230 sq km) in India, situated in the northwest near Jaipur. Analysis of Space Shuttle photographs of this ephemeral lake reveals that water levels and lake basin land-use information can be extracted by both the digital and manual analysis techniques. Seasonal characteristics captured by the two Shuttle photos used in this study show that additional land use/cover categories can be mapped from the dry season photos. This additional information is essential for precise cartographic updates, and provides seasonal hydrologic profiles and inputs for potential mesoscale climate modeling. This paper extends the digitization and mensuration techniques originally developed for space photography and applied to other regions (e.g., Lake Chad, Africa, and Great Salt Lake, USA).

IBFAN Africa training initiatives: code implementation and lactation management.

PubMed

Mbuli, A

1994-01-01

As part of an ongoing effort to halt the decline of breast feeding rates in Africa, 35 representatives of 12 different African countries met in Mangochi, Malawi, in February 1994. The Code of Marketing of Breastmilk Substitutes was scrutinized. National codes were drafted based on the "Model Law" of the IBFAN Code Documentation Centre (ICDC), Penang. Mechanisms of implementation, specific to each country, were developed. Strategies for the promotion, protection, and support of breast feeding, which is very important to child survival in Africa, were discussed. The training course was organized by ICDC, in conjunction with IBFAN Africa, and with the support of the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Countries in eastern, central, and southern Africa were invited to send participants, who included professors, pediatricians, nutritionists, MCH personnel, nurses, and lawyers. IBFAN Africa has also been conducting lactation management workshops for a number of years in African countries. 26 health personnel (pediatricians, nutritionists, senior nursing personnel, and MCH workers), representing 7 countries in the southern African region, attended a training of trainers lactation management workshop in Swaziland in August, 1993 with the support of their UNICEF country offices. The workshop included lectures, working sessions, discussions, and slide and video presentations. Topics covered included national nutrition statuses, the importance of breast feeding, the anatomy and physiology of breast feeding, breast feeding problems, the International Code of Marketing, counseling skills, and training methods. The field trip to a training course covering primary health care that was run by the Traditional Healers Organization (THO) in Swaziland was of particular interest because of the strong traditional medicine sector in many African countries. IBFAN Africa encourages use of community workers (traditional healers, Rural Health

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

PubMed Central

Gumede-Moyo, Sehlulekile; Filteau, Suzanne; Munthali, Tendai; Todd, Jim; Musonda, Patrick

2017-01-01

Abstract Background: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. Methods: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). Results: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. Conclusion: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa. PMID:28984760

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment.

PubMed

Kohler, Racquel E; Gopal, Satish; Lee, Clara N; Weiner, Bryan J; Reeve, Bryce B; Wheeler, Stephanie B

2017-10-01

Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

PubMed Central

Gopal, Satish; Lee, Clara N.; Weiner, Bryan J.; Reeve, Bryce B.; Wheeler, Stephanie B.

2017-01-01

Purpose Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position. PMID:29094086

A metric-based assessment of flood risk and vulnerability of rural communities in the Lower Shire Valley, Malawi

NASA Astrophysics Data System (ADS)

Adeloye, A. J.; Mwale, F. D.; Dulanya, Z.

2015-06-01

In response to the increasing frequency and economic damages of natural disasters globally, disaster risk management has evolved to incorporate risk assessments that are multi-dimensional, integrated and metric-based. This is to support knowledge-based decision making and hence sustainable risk reduction. In Malawi and most of Sub-Saharan Africa (SSA), however, flood risk studies remain focussed on understanding causation, impacts, perceptions and coping and adaptation measures. Using the IPCC Framework, this study has quantified and profiled risk to flooding of rural, subsistent communities in the Lower Shire Valley, Malawi. Flood risk was obtained by integrating hazard and vulnerability. Flood hazard was characterised in terms of flood depth and inundation area obtained through hydraulic modelling in the valley with Lisflood-FP, while the vulnerability was indexed through analysis of exposure, susceptibility and capacity that were linked to social, economic, environmental and physical perspectives. Data on these were collected through structured interviews of the communities. The implementation of the entire analysis within GIS enabled the visualisation of spatial variability in flood risk in the valley. The results show predominantly medium levels in hazardousness, vulnerability and risk. The vulnerability is dominated by a high to very high susceptibility. Economic and physical capacities tend to be predominantly low but social capacity is significantly high, resulting in overall medium levels of capacity-induced vulnerability. Exposure manifests as medium. The vulnerability and risk showed marginal spatial variability. The paper concludes with recommendations on how these outcomes could inform policy interventions in the Valley.

Marital Aspirations, Sexual Behaviors, and HIV/AIDS in Rural Malawi

PubMed Central

Clark, Shelley; Poulin, Michelle; Kohler, Hans-Peter

2009-01-01

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in-depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long-overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS. PMID:20161389

West African monsoon dynamics inferred from abrupt fluctuations of Lake Mega-Chad

PubMed Central

Armitage, Simon J.; Bristow, Charlie S.; Drake, Nick A.

2015-01-01

From the deglacial period to the mid-Holocene, North Africa was characterized by much wetter conditions than today. The broad timing of this period, termed the African Humid Period, is well known. However, the rapidity of the onset and termination of the African Humid Period are contested, with strong evidence for both abrupt and gradual change. We use optically stimulated luminescence dating of dunes, shorelines, and fluviolacustrine deposits to reconstruct the fluctuations of Lake Mega-Chad, which was the largest pluvial lake in Africa. Humid conditions first occur at ∼15 ka, and by 11.5 ka, Lake Mega-Chad had reached a highstand, which persisted until 5.0 ka. Lake levels fell rapidly at ∼5 ka, indicating abrupt aridification across the entire Lake Mega-Chad Basin. This record provides strong terrestrial evidence that the African Humid Period ended abruptly, supporting the hypothesis that the African monsoon responds to insolation forcing in a markedly nonlinear manner. In addition, Lake Mega-Chad exerts strong control on global biogeochemical cycles because the northern (Bodélé) basin is currently the world’s greatest single dust source and possibly an important source of limiting nutrients for both the Amazon Basin and equatorial Atlantic. However, we demonstrate that the final desiccation of the Bodélé Basin occurred around 1 ka. Consequently, the present-day mode and scale of dust production from the Bodélé Basin cannot have occurred before 1 ka, suggesting that its role in fertilizing marine and terrestrial ecosystems is either overstated or geologically recent. PMID:26124133

Centralization and Experimentation in the Implementation of a National Monitoring and Evaluation System: The Experience of Malawi.

ERIC Educational Resources Information Center

Useem, Michael; Chipande, Graham

1991-01-01

To identify general principles of implementing a system of evaluation, the experience of Malawi in building a national system for agriculture is described. Applying principles of both centralization and decentralization and principles of trial and error has helped translate theories of evaluation into practice in Malawi. (SLD)

Developing Learner-Centred Education among Secondary Trainee Teachers in Malawi: The Dilemma of Appropriation and Application

ERIC Educational Resources Information Center

Mtika, Peter; Gates, Peter

2010-01-01

This article is mainly concerned with the capability of trainee teachers to implement learner-centred practice at one of the teacher education institutions in Malawi. The notion of learner-centred education has assumed a positive policy position for teaching and learning in both primary and secondary sectors not only in Malawi, but also in the…

Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa--methods and results in Northern Malawi.

PubMed

Houben, Rein M G J; Van Boeckel, Thomas P; Mwinuka, Venance; Mzumara, Peter; Branson, Keith; Linard, Catherine; Chimbwandira, Frank; French, Neil; Glynn, Judith R; Crampin, Amelia C

2012-11-15

Decentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. However, few tools exist to evaluate the impact of decentralisation on patient travel time or what proportion of patients attend their nearest clinic. Here we develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi. Clinic position was combined with GPS information on the home village of patients accessing ART services in Karonga District (North Malawi) between July 2005 and July 2009. Potential travel time was estimated as the travel time for an individual attending their nearest clinic, and estimated actual travel time as the time to the clinic attended. This allowed us to calculate changes in potential and actual travel time as new clinics opened and track the proportion and origin of patients not accessing their nearest clinic. The model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open. Integrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.

A full lipid biomarker based record from Lake Challa, Tanzania

NASA Astrophysics Data System (ADS)

Blaga, C. I.; de Leeuw, J. W.; Verschuren, D.; Sinninghe Damsté1, J. S.

2012-04-01

The climate of the regions surrounding the Indian Ocean - East Africa, Arabian and Indian peninsulas - is strongly dominated by the dynamics of the seasonal monsoon. To understand the long and short term driving forces behind the natural climatic variability in this region it is highly important to reconstruct climatic changes in the past and, thereby, predict future changes taking into account also anthropogenic activities. Most low latitude locations lack continuous, highly resolved continental records with good age control. From the few existing records acquired from tropical glacier ice, cave stalagmites and fossil diatoms a thorough understanding of the climatic variations reflected (rainfall and drought or temperature and its effect on precipitation) is scanty. Chemically stratified crater lakes accumulate high-quality climate-proxy records as shown in very recent studies done on the continuous and finely laminated sediment record of Lake Challa situated on the lower East slope of Mt. Kilimanjaro (Verschuren et al. 2009; Wolff et al. 2011). The unique location of this lake in equatorial East Africa implies that the climate variability is influenced by the Indian Ocean and not by the Atlantic due to the Congo Air Boundary (Thierney et al. 2011). The objective of this study is to fully explore the biomarker content of the Lake Challa sedimentary record already characterized by an excellent time resolution and chronology. Various normal chain lipids (n-alkanes, n-fatty acids, n-alcohols), sterols, long-chain diols, triterpenoids and glycolipids in sedimentary organic matter, were determined in their solvent-extractable (free) and saponification-released forms (bound). The changing composition of organic matter content from the investigated lake is used as a framework to trace palaeo-humidity, terrestrial input, algal input, temperature in sediment traps and underlying sediments of Lake Challa to further our palaeo-environmental knowledge based on GDGT's and

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities.

PubMed

Lupafya, Phindile Chitsulo; Mwagomba, Beatrice L Matanje; Hosig, Kathy; Maseko, Lucy M; Chimbali, Henry

2016-04-01

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Program was established with subsequent development of a National Action Plan for prevention and management of NCDs launched in 2013. The current study was designed to identify gaps in implementation of NCD control program policies and action plan strategies by describing current efforts toward prevention and management of NCDs in Malawi with emphasis on challenges and opportunities. Semistructured questionnaires were used to collect quantitative and qualitative data from Malawi Ministry of Health personnel (senior officers, service providers, health education officers, and nutritionists) in 10 health districts and 3 central hospitals. Frequencies were generated for quantitative data. Qualitative data were used to generate themes and most common responses. Results showed that current services focus on facility-based NCD screening and clinical services rather than active screening, prevention, and community awareness and outreach, although respondents emphasized the importance of prevention, lifestyle education, and community outreach. Respondents indicated inadequate resources for NCD services including financial capital, human resources, equipment and supplies, and transportation. While Malawi has begun to address NCDs, policy and practice implications include (a) better integration of services within the existing infrastructure with emphasis on capacity building; (b) greater implementation of planned NCD activities; (c) a stronger, more comprehensive data management system; and (d) innovative funding solutions. © 2015 Society for Public Health Education.

Expressions of climate perturbations in western Ugandan crater lake sediment records during the last 1000 years

NASA Astrophysics Data System (ADS)

Mills, K.; Ryves, D. B.; Anderson, N. J.; Bryant, C. L.; Tyler, J. J.

2014-08-01

Equatorial East Africa has a complex regional patchwork of climate regimes, sensitive to climate fluctuations over a variety of temporal and spatial scales during the late Holocene. Understanding how these changes are recorded in and interpreted from biological and geochemical proxies in lake sedimentary records remains a key challenge to answering fundamental questions regarding the nature, spatial extent and synchroneity of climatic changes seen in East African palaeo-records. Using a paired lake approach, where neighbouring lakes share the same geology, climate and landscape, it might be expected that the systems will respond similarly to external climate forcing. Sediment cores from two crater lakes in western Uganda spanning the last ~1000 years were examined to assess diatom community responses to late Holocene climate and environmental changes, and to test responses to multiple drivers using redundancy analysis (RDA). These archives provide annual to sub-decadal records of environmental change. Lakes Nyamogusingiri and Kyasanduka appear to operate as independent systems in their recording of a similar hydrological response signal via distinct diatom records. However, whilst their fossil diatom records demonstrate an individualistic, indirect response to external (e.g. climatic) drivers, the inferred lake levels show similar overall trends and reflect the broader patterns observed in Uganda and across East Africa. The lakes appear to be sensitive to large-scale climatic perturbations, with evidence of a dry Medieval Climate Anomaly (MCA; ca. AD 1000-1200). The diatom record from Lake Nyamogusingiri suggests a drying climate during the main phase of the Little Ice Age (LIA) (ca. AD 1600-1800), whereas the diatom response from the shallower Lake Kyasanduka is more complex (with groundwater likely playing a key role), and may be driven more by changes in silica and other nutrients, rather than by lake level. The sensitivity of these two Ugandan lakes to regional

An Investigation of the Hydroclimate Variability of Eastern Africa

NASA Astrophysics Data System (ADS)

Smith, K. A.; Semazzi, F. H. M.

2015-12-01

The flow of the Victoria Nile, and the productivity of the dams along it, is determined by the level of Lake Victoria, which is primarily dictated by the rainfall and temperature variability over the Lake Victoria Basin. Notwithstanding the indisputable decline of water resources over the lake basin during the Long Rains of March - May, there is a strong indication based on IPCC climate projections that this trend, which has persisted for several decades, will reverse in the next few decades. This phenomenon has come to be known as the Eastern-Central African climate change paradox and could have profound implications on sustainable development for the next few decades in Lake Victoria Basin. The purpose of this study is to investigate the climate variability associated with the East African Climate Change Paradox for the recent decades. This research analyzes observations to understand the sources of variability and potential physical mechanisms related to the decline in precipitation over Eastern Africa. We then investigate the hydrological factors involved in the decline of Lake Victoria levels in the context of the decline in rainfall. While East Africa has been experiencing persistent decline of the Long Rains for multiple decades, this same decline is not seen in annual rainfall. The remaining seasons show an increase in rainfall which is compensating for the decline of the Long Rains. It is possible that the Long Rains season is shifting in such a way that the season starts earlier, in February, and ending sooner. The corresponding annual Lake Victoria levels modeled using observed rainfall do not decline in the recent decades, except when the Long Rains seasonal variability is considered without variability from other seasons. This shift could impact hydroelectric power planning on a monthly or seasonal time scale, and could potentially have a large impact on agriculture, since it would shift the growing season in the region.

First record of Daphnia lumholtzi Sars in the Great Lakes

USGS Publications Warehouse

Muzinic, Christopher J.

2000-01-01

Adults of the cladoceran Daphnia lumholtzi, native to Australia, Africa, and parts of Asia, were first collected in August 1999 in Lake Erie. Individuals were collected near East Harbor State Park, Lakeside, Ohio from vertical plankton net tows. The average number of D. lumholtzi that were found (0.03/L) indicate that D. lumholtzi is beginning to establish itself in Lake Erie. The morphology of this Daphnia differs greatly from native species because of its elongated head and tail spine. This sighting is important because it acknowledges yet another exotic invader into the Great Lakes basin and it also shows that this, normally, warm water species continues to expand its range northward.

The genomic substrate for adaptive radiation in African cichlid fish

PubMed Central

Malinsky, Milan; Keller, Irene; Fan, Shaohua; Simakov, Oleg; Ng, Alvin Y.; Lim, Zhi Wei; Bezault, Etienne; Turner-Maier, Jason; Johnson, Jeremy; Alcazar, Rosa; Noh, Hyun Ji; Russell, Pamela; Aken, Bronwen; Alföldi, Jessica; Amemiya, Chris; Azzouzi, Naoual; Baroiller, Jean-François; Barloy-Hubler, Frederique; Berlin, Aaron; Bloomquist, Ryan; Carleton, Karen L.; Conte, Matthew A.; D'Cotta, Helena; Eshel, Orly; Gaffney, Leslie; Galibert, Francis; Gante, Hugo F.; Gnerre, Sante; Greuter, Lucie; Guyon, Richard; Haddad, Natalie S.; Haerty, Wilfried; Harris, Rayna M.; Hofmann, Hans A.; Hourlier, Thibaut; Hulata, Gideon; Jaffe, David B.; Lara, Marcia; Lee, Alison P.; MacCallum, Iain; Mwaiko, Salome; Nikaido, Masato; Nishihara, Hidenori; Ozouf-Costaz, Catherine; Penman, David J.; Przybylski, Dariusz; Rakotomanga, Michaelle; Renn, Suzy C. P.; Ribeiro, Filipe J.; Ron, Micha; Salzburger, Walter; Sanchez-Pulido, Luis; Santos, M. Emilia; Searle, Steve; Sharpe, Ted; Swofford, Ross; Tan, Frederick J.; Williams, Louise; Young, Sarah; Yin, Shuangye; Okada, Norihiro; Kocher, Thomas D.; Miska, Eric A.; Lander, Eric S.; Venkatesh, Byrappa; Fernald, Russell D.; Meyer, Axel; Ponting, Chris P.; Streelman, J. Todd; Lindblad-Toh, Kerstin; Seehausen, Ole; Di Palma, Federica

2015-01-01

Cichlid fishes are famous for large, diverse and replicated adaptive radiations in the Great Lakes of East Africa. To understand the molecular mechanisms underlying cichlid phenotypic diversity, we sequenced the genomes and transcriptomes of five lineages of African cichlids: the Nile tilapia (Oreochromis niloticus), an ancestral lineage with low diversity; and four members of the East African lineage: Neolamprologus brichardi/pulcher (older radiation, Lake Tanganyika), Metriaclima zebra (recent radiation, Lake Malawi), Pundamilia nyererei (very recent radiation, Lake Victoria), and Astatotilapia burtoni (riverine species around Lake Tanganyika). We found an excess of gene duplications in the East African lineage compared to tilapia and other teleosts, an abundance of non-coding element divergence, accelerated coding sequence evolution, expression divergence associated with transposable element insertions, and regulation by novel microRNAs. In addition, we analysed sequence data from sixty individuals representing six closely related species from Lake Victoria, and show genome-wide diversifying selection on coding and regulatory variants, some of which were recruited from ancient polymorphisms. We conclude that a number of molecular mechanisms shaped East African cichlid genomes, and that amassing of standing variation during periods of relaxed purifying selection may have been important in facilitating subsequent evolutionary diversification. PMID:25186727

Menstruation and School Absenteeism: Evidence from Rural Malawi

ERIC Educational Resources Information Center

Grant, Monica; Lloyd, Cynthia; Mensch, Barbara

2013-01-01

The provision of toilets and menstrual supplies appears to be a promising strategy to promote adolescent girls' school attendance and performance in less developed countries. In this article, we use the first round of the Malawi Schooling and Adolescent Survey (MSAS) to examine the individual- and school-level factors associated with…

Late Quaternary tectonic activity and lake level change in the Rukwa Rift Basin

NASA Astrophysics Data System (ADS)

Delvaux, D.; Kervyn, F.; Vittori, E.; Kajara, R. S. A.; Kilembe, E.

1998-04-01

Interpretation of remotely sensed images and air photographs, compilation of geological and topographical maps, morphostructural and fault kinematic observations and 14C dating reveal that, besides obvious climatic influences, the lake water extent and sedimentation in the closed hydrological system of Lake Rukwa is strongly influenced by tectonic processes. A series of sandy ridges, palaeolacustrine terraces and palaeounderwater delta fans are related to an Early Holocene high lake level and subsequent progressive lowering. The maximum lake level was controlled by the altitude of the watershed between the Rukwa and Tanganyika hydrological systems. Taking as reference the present elevation of the palaeolacustrine terraces around Lake Rukwa, two orders of vertical tectonic movement are evidenced: i) a general uplift centred on the Rungwe Volcanic Province between the Rukwa and Malawi Rift Basins; and ii) a tectonic northeastward tilting of the entire Rukwa Rift Basin, including the depression and rift shoulders. This is supported by the observed hydromorphological evolution. Local uplift is also induced by the development of an active fault zone in the central part of the depression, in a prolongation of the Mbeya Range-Galula Fault system. The Ufipa and Lupa Border Faults, bounding the Rukwa depression on the southwestern and northeastern sides, respectively, exert passive sedimentation control only. They appear inactive or at least less active in the Late Quaternary than during the previous rifting stage. The main Late Quaternary tectonic activity is represented by dextral strike-slip movement along the Mbeya Range-Galula Fault system, in the middle of the Rukwa Rift Basin, and by normal dip-slip movements along the Kanda Fault, in the western rift shoulder.

Newborn survival in Malawi: a decade of change and future implications.

PubMed

Zimba, Evelyn; Kinney, Mary V; Kachale, Fannie; Waltensperger, Karen Z; Blencowe, Hannah; Colbourn, Tim; George, Joby; Mwansambo, Charles; Joshua, Martias; Chanza, Harriet; Nyasulu, Dorothy; Mlava, Grace; Gamache, Nathalie; Kazembe, Abigail; Lawn, Joy E

2012-07-01

Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV and low health worker density. With neonatal deaths becoming an increasing proportion of under-five deaths, addressing newborn survival is critical for achieving MDG 4. We examine change for newborn survival in the decade 2000-10, analysing mortality and coverage indicators whilst considering other contextual factors. We assess national and donor funding, as well as policy and programme change for newborn survival using standard analyses and tools being applied as part of a multi-country analysis. Compared with the 1990s, progress towards MDG 4 and 5 accelerated considerably from 2000 to 2010. Malawi's neonatal mortality rate (NMR) reduced slower than annual reductions in mortality for children 1-59 months and maternal mortality (NMR reduced 3.5% annually). Yet, the NMR reduced at greater pace than the regional and global averages. A significant increase in facility births and other health system changes, including increased human resources, likely contributed to this decline. High level attention for maternal health and associated comprehensive policy change has provided a platform for a small group of technical and programme experts to link in high impact interventions for newborn survival. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi.

Inferences of Complex Anisotropic Layering and Mantle Flow Beneath the Malawi Rift Zone from Shear-Wave Splitting

NASA Astrophysics Data System (ADS)

Gao, S. S.; Reed, C. A.; Yu, Y.; Liu, K. H.; Chindandali, P. R. N.; Mdala, H. S.; Massinque, B.; Mutamina, D. M.

2016-12-01

Measuring the magnitude and orientation of seismic anisotropy beneath actively extending rift zones provides invaluable estimates of the influence of numerous geodynamic parameters upon their evolution. In order to infer the character and origin of extensional forces acting upon the Malawi Rift Zone (MRZ) and Luangwa Rift Zone (LRZ) of southern Africa, we installed 33 Seismic Arrays For African Rift Initiation (SAFARI) three-component broadband seismic stations in Malawi, Mozambique, and Zambia between 2012-2014. Shear-wave splitting parameters, including the fast-component polarization orientation and the splitting time, are extracted from 142 events recorded during that time period for a total of 642 well-defined PKS, SKKS, and SKS phase measurements. Polarizations trend NE-SW along the western flank of the LRZ, whereupon they demonstrate an abrupt shift to N-S within the rift valley and the eastern flank. SWS orientations shift increasingly counterclockwise toward the east until, at 33°E, they shift from WNW-ESE to ENE-WSW, suggesting a systematic change in dominant mantle fabric orientation. The resulting fast orientations demonstrate remarkable variability within the MRZ, with E-W measurements in the north rotating counterclockwise toward the south to N-S within the southernmost MRZ. Measurements revert to E-W and NE-SW orientations toward the east in Mozambique, suggesting the presence of complex two-layer anisotropy. Azimuthal variations of SWS parameters recorded by stations within the central MRZ exhibit excellent 90° periodicity, further suggesting complex anisotropic layering. Lateral variation of measurements between the northern and southern MRZ imply the modulation of the mantle flow system beneath the active rift zone.

Combining qualitative and quantitative evidence to determine factors leading to late presentation for antiretroviral therapy in Malawi.

PubMed

Parrott, Fiona R; Mwafulirwa, Charles; Ngwira, Bagrey; Nkhwazi, Sothini; Floyd, Sian; Houben, Rein M G J; Glynn, Judith R; Crampin, Amelia C; French, Neil

2011-01-01

Treatment seeking delays among people living with HIV have adverse consequences for outcome. Gender differences in treatment outcomes have been observed in sub-Saharan Africa. To better understand antiretroviral treatment (ART) seeking behaviour in HIV-infected adults in rural Malawi. Qualitative interviews with male and female participants in an ART cohort study at a treatment site in rural northern Malawi triangulated with analysis of baseline clinical and demographic data for 365 individuals attending sequentially for ART screening between January 2008 and September 2009. 43% of the cohort presented with late stage HIV disease classified as WHO stage 3/4. Respondents reported that women's frequency of testing, health awareness and commitment to children led to earlier ART uptake and that men's commitment to wider social networks of influence, masculine ideals of strength, and success with sexual and marital partners led them to refuse treatment until they were sick. Quantitative analysis of the screening cohort provided supporting evidence for these expressed views. Overall, male gender (adjusted OR 2.3, 95% CI1.3-3.9) and never being married (adjusted OR 4.1, 95% CI1.5-11.5) were risk factors for late presentation, whereas having ≥3 dependent children was associated with earlier presentation (adjusted OR 0.31, 95% CI0.15-0.63), compared to those with no dependent children. Gender-specific barriers and facilitators operate throughout the whole process of seeking care. Further efforts to enrol men into care earlier should focus on the masculine characteristics that they value, and the risks to these of severe health decline. Our results emphasise the value of exploring as well as identifying behavioural correlates of late presentation.

Vegetation Response to Climatic Variations in the southern African tropics during the Late- Pleistocene and Holocene

NASA Astrophysics Data System (ADS)

Beuning, K. R.; Zimmerman, K. A.; Ivory, S. J.; Cohen, A. S.

2007-12-01

Pollen records from Lake Malawi, Africa spanning the last 135 kyr show substantial and abrupt vegetation response to multiple episodes of extreme aridity during the mega-drought period (130-90 ka). In contrast, vegetation composition and relative abundance remained fairly constant throughout the last 75 ka with no significant change during the Last Glacial Maxima (LGM) (35-15 ka). During the extremely arid mega-drought time period, fluctuations in pollen production define three distinct zones. The first zone, from 123-117 ka, is characterized by increasing amounts of grass, and decreasing amounts of both Podocarpus and evergreen forest taxa (i.e. Celtis, Ixora, Myrica, Macaranga), which, when matched with charcoal data, suggests a short period of extreme aridity. The disappearance of Brachystegia in this interval in conjunction with a peak in Amaranthaceae suggests conversion of the surrounding miombo woodland to an open grassland community probably caused by increased seasonality with a more prolonged and arid dry season. Peak amounts of Podocarpus (30-40%) along with diminishing levels of grass distinguish zone two (117-105 ka). This assemblage defines zone 2 as a period marked by a cool, dry climate resulting in expansion of montane forest taxa to lower elevations. Marine palynological records from the Angola Margin and Congo Fan show similar peak Podocarpus percentages at this time (oxygen isotope stage 5d) indicating similar latitudinal climates across the African continent. Zone three (105-75 ka) shows the highest and most consistent levels of Poaceae. This evidence, along with markedly low levels of most other taxa, indicates that this period contained the most sustained long-lasting dry spells during the past 135 ka. This episode in African history was severe enough as to cause the disappearance of forest taxa such as Uapaca and Brachystegia as well as montane taxa ( Podocarpus, Olea spp. and Ericaceae) within the pollen source area of Lake Malawi. The

Randomised controlled clinical trial of increased dose and frequency of albendazole and ivermectin on Wuchereria bancrofti microfilarial clearance in northern Malawi.

PubMed

Tafatatha, Terence T; Ngwira, Bagrey M; Taegtmeyer, Miriam; Phiri, Amos J; Wilson, Trevor P; Banda, Louis G; Piston, Wilson N; Koole, Olivier; Horton, John; French, Neil

2015-06-01

In Africa, albendazole and ivermectin are currently used in combination for annual mass drug administration (MDA) for lymphatic filariasis (LF) elimination. Rapid and sustained clearance is desirable for public health impact and elimination of LF. Increasing the dose and/or frequency of albendazole and ivermectin treatment may be more effective in clearing microfilariae than standard MDA. We conducted a randomised controlled open label trial in northern Malawi comparing three modified treatment groups to standard dosage of ivermectin and albendazole in adults with confirmed circulating LF antigen and microfilaria. Participants were followed-up every 6 months for 2 years for repeat microfilarial counts and safety assessments. A total of 1851 adults were screened and 70 with microfilarial counts >80 microfilariae/ml were randomised. All treatment groups achieved a significant reduction of microfilariae levels by 12- and 24-months of follow-up. Doubling the standard dose and administering it twice yearly showed a non-significant tendency towards faster and more complete clearance. There were no serious adverse reactions. In this small study, all regimens effectively cleared microfilaria. Standard treatment may be adequate in settings like Malawi but not in all endemic settings and larger studies are required to demonstrate benefit of higher dosages. [ClinicalTrials.gov identifier: NCT01213576]. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Lake Victoria Intense Storm Early Warning System (VIEWS)

NASA Astrophysics Data System (ADS)

Thiery, Wim; Gudmundsson, Lukas; Bedka, Kristopher; Semazzi, Fredrick; Lhermitte, Stef; Willems, Patrick; van Lipzig, Nicole; Seneviratne, Sonia I.

2017-04-01

Weather extremes have harmful impacts on communities around Lake Victoria in East Africa. Every year, intense nighttime thunderstorms cause numerous boating accidents on the lake, resulting in thousands of deaths among fishermen. Operational storm warning systems are therefore crucial. Here we complement ongoing early warning efforts based on NWP, by presenting a new satellite data-driven storm prediction system, the prototype Lake Victoria Intense storm Early Warning System (VIEWS). VIEWS derives predictability from the correlation between afternoon land storm activity and nighttime storm intensity on Lake Victoria, and relies on logistic regression techniques to forecast extreme thunderstorms from satellite observations. Evaluation of the statistical model reveals that predictive power is high and independent of the input dataset. We then optimise the configuration and show that also false alarms contain valuable information. Our results suggest that regression-based models that are motivated through process understanding have the potential to reduce the vulnerability of local fishing communities around Lake Victoria. The experimental prediction system is publicly available under the MIT licence at http://github.com/wthiery/VIEWS.

Rotarix in developing countries: paving the way for inclusion in national childhood immunization programs in Africa.

PubMed

Pawinski, Robert; Debrus, Serge; Delem, Andrée; Smolenov, Igor; Suryakiran, Pemmaraju V; Han, Htay Htay

2010-09-01

Rotavirus gastroenteritis causes more than half a million deaths annually among children aged <5 years, the great majority of which occur in Africa and Asia. Vaccination is considered to be the most effective public health strategy to prevent rotavirus disease and to reduce the significant global burden of rotavirus gastroenteritis. Rotarix (GlaxoSmithKline Biologicals) is an oral, live attenuated rotavirus vaccine derived from a human G1P[8] rotavirus strain. Results of phase III studies in Europe, Latin America, and Asia have shown that Rotarix offers sustained high protection against severe rotavirus gastroenteritis during the first 2 years of life, when disease burden is highest, with broad protection demonstrated against each of the 5 main rotavirus types that circulate globally (G1, G2, G3, G4, and G9). Coupled with the availability of local burden of disease data and promising interim efficacy data from an ongoing study in Malawi and South Africa, this further reinforces the case for introduction of this rotavirus vaccine in national childhood immunization programs in Africa, where rotavirus-related mortality is significant.

Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia

PubMed Central

Lohela, Terhi J.; Campbell, Oona M. R.; Gabrysch, Sabine

2012-01-01

Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality. PMID:23300599

Seismic Data Reveal Lake-Level Changes in Lake Issyk-Kul, Kyrgyzstan

NASA Astrophysics Data System (ADS)

Gebhardt, C.; Spiess, V.; Keil, H.; Sauermilch, I.; Oberhänsli, H.; Abdrakhmatov, K.; De Batist, M. A.; Naudts, L.; De Mol, L.

2013-12-01

Lake Issyk-Kul is located in an intramontane basin of the Tien Shan, Kyrgyzstan, Central Asia, at 1607 m above sea level. It has formed in a tectonically active region with W-E striking major thrust zones both N and S of the lake. The lake is elongated with 180 km in W-E and 60 km in S-N direction and a water depth of roughly 670 m at its central plain. With a surface area of 6232 km2 and a total water colume of around 1736 km3, Lake Issyk-Kul is the second largest lake in the higher altitudes (De Batist et al., 2002). Two large delta areas have formed at the E and W end. Steep slopes at both the N and S shore separate rather narrow, shallow shelf areas from the central deeper plain. First seismic data of lake Issyk-Kul were acquired in 1982 by the Moscow University with a total of 31 profiles across the lake. In 1997 and 2001, a second and third seismic survey of the lake were carried out by the group of Marc De Batist (Ghent, Belgium) in cooperation with the Royal Museum of Central Africa (Tervuren, Belgium) and the SBRAS (Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia) using a sparker system with a single-channel streamer. These surveys were recently completed by a fourth expedition carried out by the University of Bremen in April 2013. During this expedition, 33 additional profiles were acquired with an airgun and a multi-channel streamer. The sparker surveys mostly cover the delta and shelf areas in high detail, while the airgun survey covers the deeper parts of the lake with penetration beyond the first multiple. Bathymetry data reveal that at the delta areas, the shelf is divided into two parts. The shallower comprises the part down to 110 m water depth with an average inclination of 0.5°, while the deeper part reaches from 110 m to 300 m water depth with an average slope inclination of 1°. Incised paleo-river channels of up to 2-3 km width and 50 m depth are visible both on the eastern and western shelf, but are limited to the

Anticipation and response: pandemic influenza in Malawi, 2009

PubMed Central

Sambala, Evanson Z.; Manderson, Lenore

2017-01-01

ABSTRACT Background: In 2006, Malawi developed a national influenza plan to mitigate, prevent and manage the burden of infection should an outbreak occur. In 2009, it translated its contingency plan to respond to the unfolding influenza pandemic. However, little is known of how Malawi translated its national influenza plan into response actions, or the success of these responses. Objective: To investigate how Malawi translated its preparedness plan and so broaden our understanding of the outcomes of the responses. Methods: We draw on data from 22 in-depth interviews with government policymakers and people working at a policy level in various non-governmental organisations, conducted to assess the level of preparedness and the challenges of translating this. Results: Through a number of public health initiatives, authorities developed communication strategies, strengthened influenza surveillance activities and updated overall goals in pandemic training and education. However, without influenza drills, exercises and simulations to test the plan, activating the pandemic plan, including coordinating and deploying generic infection control measures, was problematic. Responses during the pandemic were at times ‘weak and clumsy’ and failed to mirror the activities and processes highlighted in the preparedness plan. Conclusions: Participants stressed that in order to achieve a coordinated and successful response to mitigate and prevent the further transmission of pandemic influenza, good preparation was critical. The key elements which they identified as relevant for a rapid response included effective communications, robust evidence-based decision-making, strong and reliable surveillance systems and flexible public health responses. To effectively articulate a viable trajectory of pandemic responses, the potential value of simulation exercises could be given more consideration as a mean of sustaining good levels of preparedness and responses against future pandemics

HIV/AIDS and time allocation in rural Malawi

PubMed Central

Bignami-Van Assche, Simona; Van Assche, Ari; Anglewicz, Philip; Fleming, Peter; van de Ruit, Catherine

2012-01-01

AIDS-related morbidity and mortality are expected to have a large economic impact in rural Malawi, because they reduce the time that adults can spend on production for subsistence and on income-generating activities. However, households may compensate for production losses by reallocating tasks among household members. The data demands for measuring these effects are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of qualitative and quantitative data, including biomarkers for HIV, collected by the 2004 Malawi Diffusion and Ideational Change Project, to analyze the association between AIDS-related morbidity and mortality, and time allocation decisions in rural Malawian households. We find that AIDS-related morbidity and mortality have important economic effects on women’s time, whereas men’s time is unresponsive to the same shocks. Most notably, AIDS is shown to induce diversification of income sources, with women (but not men) reallocating their time, generally from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor). PMID:22639544

Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia.

PubMed

Lencucha, Raphael; Reddy, Srikanth K; Labonte, Ronald; Drope, Jeffrey; Magati, Peter; Goma, Fastone; Zulu, Richard; Makoka, Donald

2018-04-01

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study.

PubMed

Hosseinipour, Mina; Nelson, Julie A E; Trapence, Clement; Rutstein, Sarah E; Kasende, Florence; Kayoyo, Virginia; Kaunda-Khangamwa, Blessings; Compliment, Kara; Stanley, Christopher; Cataldo, Fabian; van Lettow, Monique; Rosenberg, Nora E; Tweya, Hannock; Gugsa, Salem; Sampathkumar, Veena; Schouten, Erik; Eliya, Michael; Chimbwandira, Frank; Chiwaula, Levison; Kapito-Tembo, Atupele; Phiri, Sam

2017-06-01

In 2011, Malawi launched Option B+, a program of universal antiretroviral therapy (ART) treatment for pregnant and lactating women to optimize maternal health and prevent pediatric HIV infection. For optimal outcomes, women need to achieve HIVRNA suppression. We report 6-month HIVRNA suppression and HIV drug resistance in the PURE study. PURE study was a cluster-randomized controlled trial evaluating 3 strategies for promoting uptake and retention; arm 1: Standard of Care, arm 2: Facility Peer Support, and arm 3: Community Peer support. Pregnant and breastfeeding mothers were enrolled and followed according to Malawi ART guidelines. Dried blood spots for HIVRNA testing were collected at 6 months. Samples with ART failure (HIVRNA ≥1000 copies/ml) had resistance testing. We calculated odds ratios for ART failure using generalized estimating equations with a logit link and binomial distribution. We enrolled 1269 women across 21 sites in Southern and Central Malawi. Most enrolled while pregnant (86%) and were WHO stage 1 (95%). At 6 months, 950/1269 (75%) were retained; 833/950 (88%) had HIVRNA testing conducted, and 699/833 (84%) were suppressed. Among those with HIVRNA ≥1000 copies/ml with successful amplification (N = 55, 41% of all viral loads > 1000 copies/ml), confirmed HIV resistance was found in 35% (19/55), primarily to the nonnucleoside reverse transcriptase inhibitor class of drugs. ART failure was associated with treatment default but not study arm, age, WHO stage, or breastfeeding status. Virologic suppression at 6 months was <90% target, but the observed confirmed resistance rates suggest that adherence support should be the primary approach for early failure in option B+.

High-coercivity minerals from North African Humid Period soil material deposited in Lake Yoa (Chad)

NASA Astrophysics Data System (ADS)

Just, J.; Kroepelin, S.; Wennrich, V.; Viehberg, F. A.; Wagner, B.; Rethemeyer, J.; Karls, J.; Melles, M.

2015-12-01

The Holocene is a period of fundamental climatic change in North Africa. Humid conditions during the so-called African Humid Period (AHP) have favored the formation of big lake systems. Only very few of these lakes persist until today. One of them is Lake Yoa (19°03'N/20°31'E) in the Ounianga Basin, Chad, which maintains its water level by ground water inflow. Here we present the magnetic characteristics together with proxies for lacustrine productivity and biota of a sediment core (Co1240) from Lake Yoa, retrieved in 2010 within the framework of the Collaborative Research Centre 806 - Our Way to Europe (Deutsche Forschungsgemeinschaft). Magnetic properties of AHP sediments show strong indications for reductive diagenesis. An up to ~ 80 m higher lake level is documented by lacustrine deposits in the Ounianga Basin, dating to the early phase of the AHP. The higher lake level and less strong seasonality restricted deep mixing of the lake. Development of anoxic conditions consequently lead to the dissolution of iron oxides. An exception is an interval with high concentration of high-coercivity magnetic minerals, deposited between 7800 - 8120 cal yr BP. This interval post-dates the 8.2 event, which was dry in Northern Africa and probably caused a reduced vegetation cover. We propose that the latter resulted in the destabilization of soils around Lake Yoa. After the re-establishment of humid conditions, these soil materials were eroded and deposited in the lake. Magnetic minerals appear well preserved in the varved Late Holocene sequence, indicating (sub-) oxic conditions in the lake. This is surprising, because the occurrence of varves is often interpreted as an indicator for anoxic conditions of the lake water. However, the salinity of lake water rose strongly after the AHP. We therefore hypothesize that the conservation of varves and absence of benthic organisms rather relates to the high salinity than to anoxic conditions.

The Effects of a Cognitive Acceleration Intervention Programme on the Performance of Secondary School Pupils in Malawi

NASA Astrophysics Data System (ADS)

Mbano, Nellie

2003-01-01

The use of the 'Cognitive Acceleration through Science Education' (CASE) intervention programme was explored in Malawi to see if the critical period for cognitive transition from concrete operations to formal operations at 12-14 years of age actually exists. The older pupils (16-17 years of age) in secondary school classes in Malawi made similar cognitive gains to younger English pupils after being taught CASE for 2 years. This was taken to suggest that the critical period does not exist. However, in Malawi, girls, who are on average a year younger than boys in the same class, and older boys, had lower academic achievement than younger boys. Explanations for this age and gender interaction are explored.

Utilizing NASA Earth Observations to Assess Landslide Characteristics and Devlelop Susceptibility and Exposure Maps in Malawi

NASA Astrophysics Data System (ADS)

Klug, M.; Cissell, J.; Grossman, M.

2017-12-01

Malawi has become increasingly prone to landslides in the past few decades. This can be attributed to the terrain, types of soil and vegetation, increased human interference, and heavy flooding after long periods of drought. In addition to the floods and droughts, landslides cause extra stress to farmlands, thus exacerbating the current food security crisis in the country. It can be difficult to pinpoint just how many people are affected by landslides in Malawi because landslides often occur in rural areas or are grouped with other disasters, such as floods or earthquakes. This project created a Landslide Susceptibility Map to assess landslide-prone areas in Malawi using variables such as slope, distance to roads, distance to streams, soil type, and precipitation. These variables were derived using imagery from Landsat 8 Operational Land Imager (OLI), Shuttle Radar Topography Mission Version 3 (SRTM-v3), Global Precipitation Measurement (GPM), and Tropical Rainfall Measuring Mission (TRMM) satellites. Furthermore, this project created a Landslide Exposure Map to estimate how much of the local population lives in susceptible areas by intersecting population data with the Landslide Susceptibility Map. Additionally, an assessment of GPM and TRMM precipitation measurements was generated to better understand the reliability of both measurements for landslide monitoring. Finally, this project updated NASA SERVIR's Global Landslide Catalog (GLC) for Malawi by using WorldView data from Google Earth and Landsat 8 OLI. These end products were used by NASA SERVIR and the Regional Centre for Mapping of Resources for Development (RCMRD) for aiding in disaster management throughout Malawi.

Strengthening community health supply chain performance through an integrated approach: Using mHealth technology and multilevel teams in Malawi.

PubMed

Shieshia, Mildred; Noel, Megan; Andersson, Sarah; Felling, Barbara; Alva, Soumya; Agarwal, Smisha; Lefevre, Amnesty; Misomali, Amos; Chimphanga, Boniface; Nsona, Humphreys; Chandani, Yasmin

2014-12-01

In 2010, 7.6 million children under five died globally - largely due to preventable diseases. Majority of these deaths occurred in sub-Saharan Africa. As a strategy to reduce child mortality, the Government of Malawi, in 2008, initiated integrated community case management allowing health surveillance assistants (HSAs) to treat sick children in communities. Malawi however, faces health infrastructure challenges, including weak supply chain systems leading to low product availability. A baseline assessment conducted in 2010 identified data visibility, transport and motivation of HSAs as challenges to continuous product availability. The project designed a mHealth tool as part of two interventions to address these challenges. A mobile health (mHealth) technology - cStock, for reporting on community stock data - was designed and implemented as an integral component of Enhanced Management (EM) and Efficient Product Transport (EPT) interventions. We developed a feasibility and acceptability framework to evaluate the effectiveness and predict the likelihood of scalability and ownership of the interventions. Mixed methods were used to conduct baseline and follow up assessments in May 2010 and February 2013, respectively. Routine monitoring data on community stock level reports, from cStock, were used to analyze supply chain performance over 18-month period in the intervention groups. Mean stock reporting rate by HSAs was 94% in EM group (n = 393) and 79% in EPT group (n = 253); mean reporting completeness was 85% and 65%, respectively. Lead time for HSA drug resupply over the 18-month period was, on average, 12.8 days in EM and 26.4 days in EPT, and mean stock out rate for 6 tracer products was significantly lower in EM compared to EPT group. Results demonstrate that cStock was feasible and acceptable to test users in Malawi, and that based on comparison with the EPT group, the team component of the EM group was an essential pairing with cStock to achieve the best

Analysis of Factors Causing Poor Passing Rates and High Dropout Rates among Primary School Girls in Malawi

ERIC Educational Resources Information Center

Mzuza, Maureen Kapute; Yudong, Yang; Kapute, Fanuel

2014-01-01

Factors that cause poor examination passing rates and high dropout rates among primary school girls in Malawi were analysed. First hand data was collected by conducting a survey in all the three regions of Malawi. The respondents to the questionnaire were girls (402) who are repeating the last class in primary schools (Standard 8), primary school…

Namib Desert, Namibia, Africa

NASA Image and Video Library

1990-04-29

One of the driest regions on Earth, the Namib Desert, Namibia, Africa (23.0N, 15.0E) lies adjacent to the Atlantic coast but the upwelling oceanic water causes a very stable rainless atmosphere. The few local inland rivers do not reach the sea but instead, appear as long indentations where they penetrate the dune fields and end as small dry lakes. The vast dune fields are the result of sands deposited over millions of years by the stream flow.

Namib Desert, Namibia, Africa

NASA Technical Reports Server (NTRS)

1990-01-01

One of the driest regions on Earth, the Namib Desert, Namibia, Africa (23.0N, 15.0E) lies adjacent to the Atlantic coast but upwelling oceanic water causes a very stable rainless atmosphere. The few local inland rivers do not reach the sea but instead appear as long indentations where rivers penetrate the dune fields and end as small dry lakes. The vast dune fields are the result of sands deposited over millions of years by the stream flow.

Namib Desert, Namibia, Africa

NASA Technical Reports Server (NTRS)

1990-01-01

One of the driest regions on Earth, the Namib Desert, Namibia, Africa (23.0N, 15.0E) lies adjacent to the Atlantic coast but the upwelling oceanic water causes a very stable rainless atmosphere. The few local inland rivers do not reach the sea but instead, appear as long indentations where they penetrate the dune fields and end as small dry lakes. The vast dune fields are the result of sands deposited over millions of years by the stream flow.

New Progress on Radiocarbon Geochronology in Southern Lake Tanganyika (East Africa)

NASA Astrophysics Data System (ADS)

McGlue, M. M.; Soreghan, M. J.

2017-12-01

Our limnogeological research in Lake Tanganyika focuses on elucidating the patterns of sediment accumulation on deepwater horsts, outer platforms, and littoral environments in the lake's southern basin ( 6-8°S latitude). Here, we present new radiocarbon (14C) dates from high-quality surface sediment cores, in order to make comparisons with previously published age models, to address the presence and spatiotemporal variability of a reservoir effect, and to constrain sedimentation rates and facies at sites that may be important targets for future scientific drilling. Plant macrofossils are rare in deepwater sediment cores, so charcoal and bulk organic matter have been the primary materials used for dating. On the Kavala Island Ridge (KIR) horst, initial core descriptions revealed variations in laminae presence, thickness, and chemistry. Sediment cores from the KIR at 172m water depth consist of thickly laminated diatom oozes. Charcoal from the bases of these cores returned median ages of 2.1-2.2 cal ka, suggesting linear accumulation rates on the order of 0.51 mm/yr. By contrast, a core from 420 m water depth on the KIR exhibited very thin laminations and diatom layers were much less prominent. Charcoal at the base of this core produced a median age of 8.1 cal ka, suggesting a linear accumulation rate of 0.11 mm/yr. These initial results suggest that sedimentation rates may vary considerably over sublacustrine horst blocks. We will test this initial discovery with additional sedimentation rate information from the Kalya and Nitiri horsts. In addition, we report new 14C dates made on both dead and live-collected shells of the endemic gastropod Neothauma tanganyicense. These shells form vast accumulations along shallow-water platforms of the lake and form an important substrate for a number of other endemic species. The discovery of living snails in southern Lake Tanganyika may allow for the development of a species-specific reservoir correction. A limited N

Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy.

PubMed

Harries, Anthony D; Ford, Nathan; Jahn, Andreas; Schouten, Erik J; Libamba, Edwin; Chimbwandira, Frank; Maher, Dermot

2016-09-06

The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO) in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.

Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi

PubMed Central

Tomlinson, Mark; Sherr, Lorraine; Macedo, Ana; Hunt, Xanthe; Skeen, Sarah

2017-01-01

ABSTRACT Background: Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives: To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods: This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results: Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions: Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed. PMID:29214899

Patient costs associated with accessing HIV/AIDS care in Malawi

PubMed Central

Pinto, Andrew D; van Lettow, Monique; Rachlis, Beth; Chan, Adrienne K; Sodhi, Sumeet K

2013-01-01

Introduction The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub-Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti-retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC). Methods A cross-sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC) at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using χ2 and t-tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data. Results There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio-economic status, with higher educational attainment (p<0.001), personal income (p=0.007) and household income per person (p=0.005) in CC. Travel times were similar (p=0.65), as was time waiting at the clinic (p=0.63) and total time spent seeking care (p=0.65). There was a significant difference in travel-related expenses (p<0.001) related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini-bus to reach the clinic; in DC only 4% reported using a mini-bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out-of-pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1–182 MKW) or US$0.59 represents the adjusted difference in

Gender and power contestations over water use in irrigation schemes: Lessons from the lake Chilwa basin

NASA Astrophysics Data System (ADS)

Nkhoma, Bryson; Kayira, Gift

2016-04-01

Over the past two decades, Malawi has been adversely hit by climatic variability and changes, and irrigation schemes which rely mostly on water from rivers have been negatively affected. In the face of dwindling quantities of water, distribution and sharing of water for irrigation has been a source of contestations and conflicts. Women who constitute a significant section of irrigation farmers in schemes have been major culprits. The study seeks to analyze gender contestations and conflicts over the use of water in the schemes developed in the Lake Chilwa basin, in southern Malawi. Using oral and written sources as well as drawing evidence from participatory and field observations conducted at Likangala and Domasi irrigation schemes, the largest schemes in the basin, the study observes that women are not passive victims of male domination over the use of dwindling waters for irrigation farming. They have often used existing political and traditional structures developed in the management of water in the schemes to competitively gain monopoly over water. They have sometimes expressed their agency by engaging in irrigation activities that fall beyond the control of formal rules and regulations of irrigation agriculture. Other than being losers, women are winning the battle for water and land resources in the basin.

Adult Literacy Policy and Performance in Malawi: An Analysis.

ERIC Educational Resources Information Center

Bhola, H. S.

In Malawi, adult literacy deserves immediate attention in order to promote health, family planning, and productivity. While policy commitment for adult literacy promotion has not been lacking, intensified action has been. In 1979 the government accepted the Unesco Mission Report to undertake a functional literacy program on the successful…

Thermal care of newborns: drying and bathing practices in Malawi and Bangladesh

PubMed Central

Khan, Shane M; Kim, Eunsoo Timothy; Singh, Kavita; Amouzou, Agbessi; Carvajal-Aguirre, Liliana

2018-01-01

Background Thermal care of newborns is one of the recommended strategies to reduce hypothermia, which contributes to neonatal morbidity and mortality. However, data on these two topics have not been collected at the national level in many surveys. In this study, we examine two elements of thermal care: drying and delayed bathing of newborns after birth with the objectives of examining how two countries collected such data and then looking at various associations of these outcomes with key characteristics. Further, we examine the data for potential data quality issues as this is one of the first times that such data are available at the national level. Methods We use data from two nationally-representative household surveys: the Malawi Multiple Indicator Cluster Survey 2014 and the Bangladesh Demographic and Health Survey 2014. We conduct descriptive analysis of the prevalence of these two newborn practices by various socio-demographic, economic and health indicators. Results Our results indicate high levels of immediate drying/drying within 1 hour in Malawi (87%). In Bangladesh, 84% were dried within the first 10 minutes of birth. Bathing practices varied in the two settings; in Malawi, only 26% were bathed after 24 hours but in Bangladesh, 87% were bathed after the same period. While in Bangladesh there were few newborns who were never bathed (less than 5%), in Malawi, over 10% were never bathed. Newborns delivered by a skilled provider tended to have better thermal care than those delivered by unskilled providers. Conclusion These findings reveal gaps in coverage of thermal care and indicate the need to further develop the role of unskilled providers who can give unspecialized care as a means to improve thermal care for newborns. Further work to harmonize data collection methods on these topics is needed to ensure comparable data across countries. PMID:29862028

Prevalence and correlates of probable depression and post-traumatic stress disorder among female sex workers in Lilongwe, Malawi.

PubMed

MacLean, Sarah A; Lancaster, Kathryn E; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C; Pence, Brian W; Gaynes, Bradley N; Hoffman, Irving F; Miller, William C

2018-02-01

Globally, female sex workers (FSW) experience a high prevalence of mental health disorders, but in sub-Saharan Africa these are rarely identified. If left untreated, mental health disorders may place FSW and their partners at risk for HIV/sexually transmitted infections (STIs). We assessed the prevalence and correlates of probable depression, post-traumatic stress disorder (PTSD), and suicidal ideation (SI) in a cohort of 200 FSW in Lilongwe, Malawi. FSW completed the Patient Health Questionnaire-9 and the PTSD Check List-Civilian Version. The prevalence of depression was 8%, as was the prevalence of PTSD. Nearly half (49%) of FSW were experiencing mild depression. FSW were more likely to have probable depression if they completed primary school or initiated sex work before 18 years. They were more likely to have probable PTSD if they had ≥ 20 clients per week or initiated sex work before 18 years. Interventions are needed to diagnose mental health disorders among FSW at great risk for HIV/STIs.

Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa.

PubMed

Appau, Adriana; Drope, Jeffrey; Labonté, Ronald; Stoklosa, Michal; Lencucha, Raphael

2017-11-14

In principle, trade and investment agreements are meant to boost economic growth. However, the removal of trade barriers and the provision of investment incentives to attract foreign direct investments may facilitate increased trade in and/or more efficient production of commodities considered harmful to health such as tobacco. We analyze existing evidence on trade and investment liberalization and its relationship to tobacco trade in Sub-Saharan African countries. We compare tobacco trading patterns to foreign direct investments made by tobacco companies. We estimate and compare changes in the Konjunkturforschungsstelle (KOF) Economic Globalization measure, relative price measure and cigarette prices. Preferential regional trade agreements appear to have encouraged the consolidation of cigarette production, which has shaped trading patterns of tobacco leaf. Since 2002, British American Tobacco has invested in tobacco manufacturing facilities in Nigeria, Kenya and South Africa strategically located to serve different regions in Africa. Following this, British America Tobacco closed factories in Ghana, Rwanda, Uganda, Mauritius and Angola. At the same time, Malawi and Tanzania exported a large percentage of tobacco leaf to European countries. After 2010, there was an increase in tobacco exports from Malawi and Zambia to China, which may be a result of preferential trade agreements the EU and China have with these countries. Economic liberalization has been accompanied by greater cigarette affordability for the countries included in our analysis. However, only excise taxes and income have an effect on cigarette prices within the region. These results suggest that the changing economic structures of international trade and investment are likely heightening the efficiency and effectiveness of the tobacco industry. As tobacco control advocates consider supply-side tobacco control interventions, they must consider carefully the effects of these economic agreements and

How community trust was gained by an NGO in Malawi, Central Africa, to mitigate the impact of HIV/AIDS.

PubMed

MacIntyre, Linda M; Waters, Catherine M; Rankin, Sally H; Schell, Ellen; Laviwa, Jones; Luhanga, Melton Richard

2013-07-01

Trust is valuable social capital that is essential for effective partnerships to improve a community's health. Yet, how to establish trust in culturally diverse communities is elusive for many researchers, practitioners, and agencies. The purpose of this qualitative study was to obtain perspectives of individuals working for a nongovernmental organization (NGO) about gaining community trust in Malawi in order to mitigate the impact of HIV/AIDS. Twenty-six interviews were conducted over 12 months. Content analysis revealed the relationship between NGO staff and the community is crucial to gaining community trust. Gender, social context, and religious factors influence the establishment of trust within the relationship, but NGO assumptions about the community can erode community trust. Nurses and other health professionals working with the NGOs can help create conditions to build trust in an ethically and culturally sensitive manner whereby communities can develop processes to address their own health concerns.

Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi.

PubMed

Sambala, Evanson Z; Manderson, Lenore

2017-02-28

In the late 1990s, in the context of renewed concerns of an influenza pandemic, countries such as Ghana and Malawi established plans for the deployment of vaccines and vaccination strategies. A new pandemic was declared in mid-June 2009, and by April 2011, Ghana and Malawi vaccinated 10% of the population. We examine the public health policy perspectives on vaccination as a means to prevent the spread of infection under post pandemic conditions. In-depth interviews were conducted with 46 policymakers (Ghana, n = 24; Malawi, n = 22), identified through snowballing sampling. Interviews were supplemented by field notes and the analysis of policy documents. The use of vaccination to interrupt the pandemic influenza was affected by delays in the procurement, delivery and administration of vaccines, suboptimal vaccination coverage, refusals to be vaccinated, and the politics behind vaccination strategies. More generally, rolling-out of vaccination after the transmission of the influenza virus had abated was influenced by policymakers' own financial incentives, and government and foreign policy conditionality on vaccination. This led to confusion about targeting and coverage, with many policymakers justifying that the vaccination of 10% of the population would establish herd immunity and so reduce future risk. Ghana succeeded in vaccinating 2.3 million of the select groups (100% coverage), while Malawi, despite recourse to force, succeeded only in vaccinating 1.15 million (74% coverage of select groups). For most policymakers, vaccination coverage was perceived as successful, despite that vaccination delays and coverage would not have prevented infection when influenza was at its peak. While the vaccination strategy was problematic and implemented too late to reduce the effects of the 2009 epidemic, policy makers supported the overall goal of pandemic influenza vaccination to interrupt infection. In this context, there was strong support for governments engaging

Changing times? Gender roles and relationships in maternal, newborn and child health in Malawi.

PubMed

Manda-Taylor, Lucinda; Mwale, Daniel; Phiri, Tamara; Walsh, Aisling; Matthews, Anne; Brugha, Ruairi; Mwapasa, Victor; Byrne, Elaine

2017-09-25

For years, Malawi remained at the bottom of league tables on maternal, neonatal and child health. Although maternal mortality ratios have reduced and significant progress has been made in reducing neonatal morality, many challenges in achieving universal access to maternal, newborn and child health care still exist in Malawi. In Malawi, there is still minimal, though increasing, male involvement in ANC/PMTCT/MNCH services, but little understanding of why this is the case. The aim of this paper is to explore the role and involvement of men in MNCH services, as part of the broader understanding of those community system factors. This paper draws on the qualitative data collected in two districts in Malawi to explore the role and involvement of men across the MNCH continuum of care, with a focus on understanding the community systems barriers and enablers to male involvement. A total of 85 IDIs and 20 FGDs were conducted from August 2014 to January 2015. Semi-structure interview guides were used to guide the discussion and a thematic analysis approach was used for data analysis. Policy changes and community and health care provider initiatives stimulated men to get involved in the health of their female partners and children. The informal bylaws, the health care provider strategies and NGO initiatives created an enabling environment to support ANC and delivery service utilisation in Malawi. However, traditional gender roles in the home and the male 'unfriendly' health facility environments still present challenges to male involvement. Traditional notions of men as decision makers and socio-cultural views on maternal health present challenges to male involvement in MNCH programs. Health care provider initiatives need to be sensitive and mindful of gender roles and relations by, for example, creating gender inclusive programs and spaces that aim at reducing perceptions of barriers to male involvement in MNCH services so that programs and spaces that are aimed at

Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi.

PubMed

Gosoniu, G D; Ganapathy, S; Kemp, J; Auer, C; Somma, D; Karim, F; Weiss, M G

2008-07-01

Tuberculosis (TB) control programmes in Bangladesh, India and Malawi. To compare the interval from symptom onset to diagnosis of TB for men and women, and to assess socio-cultural and gender-related features of illness explaining diagnostic delay. Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay (>90 days), timely diagnosis (< or =30 days) or moderate delay. EMIC interview data were analysed to explain problem delay. The median interval from symptom onset to diagnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangladesh), and status of married woman (India) and housewife (Malawi) were associated with problem delay. Prominent non-specific symptoms--chest pain (Bangladesh) and breathlessness (Malawi)--were also significant. Cough in India, widely associated with TB, was associated with timely diagnosis. Sanitation as a perceived cause linked to poor urban conditions was associated with delayed diagnosis in India. Specific prior help seeking with circuitous referral patterns was identified. The study identified gender- and illness-related features of diagnostic delay. Further research distinguishing patient and provider delay is needed.

High-resolution 14C dating of a 25,000-year lake-sediment record from equatorial East Africa

NASA Astrophysics Data System (ADS)

Blaauw, Maarten; van Geel, Bas; Kristen, Iris; Plessen, Birgit; Lyaruu, Anna; Engstrom, Daniel R.; van der Plicht, Johannes; Verschuren, Dirk

2011-10-01

We dated a continuous, ˜22-m long sediment sequence from Lake Challa (Mt. Kilimanjaro area, Kenya/Tanzania) to produce a solid chronological framework for multi-proxy reconstructions of climate and environmental change in equatorial East Africa over the past 25,000 years. The age model is based on a total of 168 AMS 14C dates on bulk-organic matter, combined with a 210Pb chronology for recent sediments and corrected for a variable old-carbon age offset. This offset was estimated by i) pairing bulk-organic 14C dates with either 210Pb-derived time markers or 14C dates on grass charcoal, and ii) wiggle-matching high-density series of bulk-organic 14C dates. Variation in the old-carbon age offset through time is relatively modest, ranging from ˜450 yr during glacial and late glacial time to ˜200 yr during the early and mid-Holocene, and increasing again to ˜250 yr today. The screened and corrected 14C dates were calibrated sequentially, statistically constrained by their stratigraphical order. As a result their constrained calendar-age distributions are much narrower, and the calibrated dates more precise, than if each 14C date had been calibrated on its own. The smooth-spline age-depth model has 95% age uncertainty ranges of ˜50-230 yr during the Holocene and ˜250-550 yr in the glacial section of the record. The δ 13C values of paired bulk-organic and grass-charcoal samples, and additional 14C dating on selected turbidite horizons, indicates that the old-carbon age offset in Lake Challa is caused by a variable contribution of old terrestrial organic matter eroded from soils, and controlled mainly by changes in vegetation cover within the crater basin.

Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake.

PubMed

Santos, Maria M; Rubagumya, Derick K; Dominic, Imani; Brighton, Amos; Colombe, Soledad; O'Donnell, Philip; Zubkov, Micaella R; Härtl, Roger

2017-11-01

OBJECTIVE Infant hydrocephalus is estimated to affect more than 100,000 new infants each year in sub-Saharan Africa (SSA). Bugando Medical Centre (BMC), a government-funded and patient cost-shared referral center, serves over 13 million people in the Lake and Western regions of Tanzania. The goals of this study were to characterize the infant population affected by hydrocephalus who presented to BMC and were treated with a ventriculoperitoneal shunt (VPS) to determine the rate of early complications associated with this surgical procedure and to assess its potential risk factors. METHODS Data were prospectively collected from all patients less than 1 year of age who, over a period of 7 months, were diagnosed with hydrocephalus and admitted to BMC for insertion of a primary VPS. Demographic data, maternal history, preoperative studies, surgical procedure, and surgical complications developing by the time of the first follow-up visit were analyzed. Risk factors associated with the surgical complications were determined. RESULTS During the 7-month study period, 125 infants eligible for the study were included in the analysis. Overall, 75% were younger than 6 months of age, and 56% were males. Only 7% of mothers had a gestational ultrasound, 98% did not receive preconception folic acid, and 25% delivered their child at home. In most patients with hydrocephalus the etiology was uncertain (56%), and other patients had postinfectious (22.4%) or myelomeningocele-associated (16%) hydrocephalus. Patients' mean head circumference on admission was 51.4 ± 6.3 cm. Their median age at shunt surgery was 137 days, and 22.4% of the patients were operated on without having undergone radiological assessment. The majority of shunts were placed in a right parietooccipital location. Thirteen patients had undergone a previous intraventricular endoscopic procedure. Overall, at least one surgical complication was found in 33.6% of patients up to the first follow-up assessment (median

The upper mantle shear wave velocity structure of East Africa derived from Rayleigh wave tomography

NASA Astrophysics Data System (ADS)

O'Donnell, J.; Nyblade, A.; Adams, A. N.; Weeraratne, D. S.; Mulibo, G.; Tugume, F.

2012-12-01

An expanded model of the three-dimensional shear wave velocity structure of the upper mantle beneath East Africa has been developed using data from the latest phases of the AfricaArray East African Seismic Experiment in conjunction with data from preceding studies. The combined dataset consists of 331 events recorded on a total of 95 seismic stations spanning Kenya, Uganda, Tanzania, Zambia and Malawi. In this latest study, 149 events were used to determine fundamental mode Rayleigh wave phase velocities at periods ranging from 20 to 182 seconds using the two-plane-wave method. These were subsequently combined with the similarly processed published measurements and inverted for an updated upper mantle three-dimensional shear wave velocity model. Newly imaged features include a substantial fast anomaly in eastern Zambia that may have exerted a controlling influence on the evolution of the Western Rift Branch. Furthermore, there is a suggestion that the Eastern Rift Branch trends southeastward offshore eastern Tanzania.

Tectonic and climatic control on evolution of rift lakes in the Central Kenya Rift, East Africa

NASA Astrophysics Data System (ADS)

Bergner, A. G. N.; Strecker, M. R.; Trauth, M. H.; Deino, A.; Gasse, F.; Blisniuk, P.; Dühnforth, M.

2009-12-01

The long-term histories of the neighboring Nakuru-Elmenteita and Naivasha lake basins in the Central Kenya Rift illustrate the relative importance of tectonic versus climatic effects on rift-lake evolution and the formation of disparate sedimentary environments. Although modern climate conditions in the Central Kenya Rift are very similar for these basins, hydrology and hydrochemistry of present-day lakes Nakuru, Elmenteita and Naivasha contrast dramatically due to tectonically controlled differences in basin geometries, catchment size, and fluvial processes. In this study, we use eighteen 14C and 40Ar/ 39Ar dated fluvio-lacustrine sedimentary sections to unravel the spatiotemporal evolution of the lake basins in response to tectonic and climatic influences. We reconstruct paleoclimatic and ecological trends recorded in these basins based on fossil diatom assemblages and geologic field mapping. Our study shows a tendency towards increasing alkalinity and shrinkage of water bodies in both lake basins during the last million years. Ongoing volcano-tectonic segmentation of the lake basins, as well as reorganization of upstream drainage networks have led to contrasting hydrologic regimes with adjacent alkaline and freshwater conditions. During extreme wet periods in the past, such as during the early Holocene climate optimum, lake levels were high and all basins evolved toward freshwater systems. During drier periods some of these lakes revert back to alkaline conditions, while others maintain freshwater characteristics. Our results have important implications for the use and interpretation of lake sediment as climate archives in tectonically active regions and emphasize the need to deconvolve lacustrine records with respect to tectonics versus climatic forcing mechanisms.

Modeling the Sedimentary Infill of Lakes in the East African Rift: A Case Study of Multiple versus Single Rift Basin Segments

NASA Astrophysics Data System (ADS)

Zhang, C.; Scholz, C. A.

2016-12-01

The sedimentary basins in the East African Rift are considered excellent modern examples for investigating sedimentary infilling and evolution of extensional systems. Some lakes in the western branch of the rift have formed within single-segment systems, and include Lake Albert and Lake Edward. The largest and oldest lakes developed within multi-segment systems, and these include Lake Tanganyika and Lake Malawi. This research aims to explore processes of erosion and sedimentary infilling of the catchment area in single-segment rift (SSR) and multi-segment rift (MSR) systems. We consider different conditions of regional precipitation and evaporation, and assess the resulting facies architecture through forward modeling, using state-of-the-art commercial basin modeling software. Dionisos is a three-dimensional numerical stratigraphic forward modeling software program, which simulates basin-scale sediment transport based on empirical water- and gravity-driven diffusion equations. It was classically used to quantify the sedimentary architecture and basin infilling of both marine siliciclastic and carbonate environments. However, we apply this approach to continental rift basin environments. In this research, two scenarios are developed, one for a MSR and the other for a SSR. The modeled systems simulate the ratio of drainage area and lake surface area observed in modern Lake Tanganyika and Lake Albert, which are examples of MSRs and SSRs, respectively. The main parameters, such as maximum subsidence rate, water- and gravity-driven diffusion coefficients, rainfall, and evaporation, are approximated using these real-world examples. The results of 5 million year model runs with 50,000 year time steps show that MSRs are characterized by a deep water lake with relatively modest sediment accumulation, while the SSRs are characterized by a nearly overfilled lake with shallow water depths and thick sediment accumulation. The preliminary modeling results conform to the features

Maternal biomass smoke exposure and birth weight in Malawi: Analysis of data from the 2010 Malawi Demographic and Health Survey.

PubMed

Milanzi, Edith B; Namacha, Ndifanji M

2017-06-01

Use of biomass fuels has been shown to contribute to ill health and complications in pregnancy outcomes such as low birthweight, neonatal deaths and mortality in developing countries. However, there is insufficient evidence of this association in the Sub-Saharan Africa and the Malawian population. We, therefore, investigated effects of exposure to biomass fuels on reduced birth weight in the Malawian population. We conducted a cross-sectional analysis using secondary data from the 2010 Malawi Demographic Health Survey with a total of 9124 respondents. Information on exposure to biomass fuels, birthweight, and size of child at birth as well as other relevant information on risk factors was obtained through a questionnaire. We used linear regression models for continuous birth weight outcome and logistic regression for the binary outcome. Models were systematically adjusted for relevant confounding factors. Use of high pollution fuels resulted in a 92 g (95% CI: -320.4; 136.4) reduction in mean birth weight compared to low pollution fuel use after adjustment for child, maternal as well as household characteristics. Full adjusted OR (95% CI) for risk of having size below average at birth was 1.29 (0.34; 4.48). Gender and birth order of child were the significant confounders factors in our adjusted models. We observed reduced birth weight in children whose mothers used high pollution fuels suggesting a negative effect of maternal exposure to biomass fuels on birth weight of the child. However, this reduction was not statistically significant. More carefully designed studies need to be carried out to explore effects of biomass fuels on pregnancy outcomes and health outcomes in general.

Supporting the development of a health benefits package in Malawi

PubMed Central

Revill, Paul; Manthalu, Gerald; McGuire, Finn; Nkhoma, Dominic; Rollinger, Alexandra; Sculpher, Mark; Claxton, Karl

2018-01-01

Malawi, like many low-income and middle-income countries, has used health benefits packages (HBPs) to allocate scarce resources to key healthcare interventions. With no widely accepted method for their development, HBPs often promise more than can be delivered, given available resources. An analytical framework is developed to guide the design of HBPs that can identify the potential value of including and implementing different interventions. It provides a basis for informing meaningful discussions between governments, donors and other stakeholders around the trade-offs implicit in package design. Metrics of value, founded on an understanding of the health opportunity costs of the choices faced, are used to quantify the scale of the potential net health impact (net disability adjusted life years averted) or the amount of additional healthcare resources that would be required to deliver similar net health impacts with existing interventions (the financial value to the healthcare system). The framework can be applied to answer key questions around, for example: the appropriate scale of the HBP; which interventions represent ‘best buys’ and should be prioritised; where investments in scaling up interventions and health system strengthening should be made; whether the package should be expanded; costs of the conditionalities of donor funding and how objectives beyond improving population health can be considered. This is illustrated using data from Malawi. The framework was successfully applied to inform the HBP in Malawi, as a core component of the country’s Health Sector Strategic Plan II 2017–2022. PMID:29662689

Human Rights Violations among Men Who Have Sex with Men in Southern Africa: Comparisons between Legal Contexts

PubMed Central

Zahn, Ryan; Grosso, Ashley; Scheibe, Andrew; Bekker, Linda-Gail; Ketende, Sosthenes; Dausab, Friedel; Iipinge, Scholastica; Beyrer, Chris; Trapance, Gift; Baral, Stefan

2016-01-01

In 1994, South Africa approved a constitution providing freedom from discrimination based on sexual orientation. Other Southern African countries, including Botswana, Malawi, and Namibia, criminalize same-sex behavior. Men who have sex with men (MSM) have been shown to experience high levels of stigma and discrimination, increasing their vulnerability to negative health and other outcomes. This paper examines the relationship between criminalization of same-sex behavior and experiences of human rights abuses by MSM. It compares the extent to which MSM in peri-urban Cape Town experience human rights abuses with that of MSM in Gaborone, Botswana; Blantyre and Lilongwe, Malawi; and Windhoek, Namibia. In 2008, 737 MSM participated in a cross-sectional study using a structured survey collecting data regarding demographics, human rights, HIV status, and risk behavior. Participants accrued in each site were compared using bivariate and multivariate logistic regression. Encouragingly, the results indicate MSM in Cape Town were more likely to disclose their sexual orientation to family or healthcare workers and less likely to be blackmailed or feel afraid in their communities than MSM in Botswana, Malawi, or Namibia. However, South African MSM were not statistically significantly less likely experience a human rights abuse than their peers in cities in other study countries, showing that while legal protections may reduce experiences of certain abuses, legislative changes alone are insufficient for protecting MSM. A comprehensive approach with interventions at multiple levels in multiple sectors is needed to create the legal and social change necessary to address attitudes, discrimination, and violence affecting MSM. PMID:26764467

Human Rights Violations among Men Who Have Sex with Men in Southern Africa: Comparisons between Legal Contexts.

PubMed

Zahn, Ryan; Grosso, Ashley; Scheibe, Andrew; Bekker, Linda-Gail; Ketende, Sosthenes; Dausab, Friedel; Iipinge, Scholastica; Beyrer, Chris; Trapance, Gift; Baral, Stefan

2016-01-01

In 1994, South Africa approved a constitution providing freedom from discrimination based on sexual orientation. Other Southern African countries, including Botswana, Malawi, and Namibia, criminalize same-sex behavior. Men who have sex with men (MSM) have been shown to experience high levels of stigma and discrimination, increasing their vulnerability to negative health and other outcomes. This paper examines the relationship between criminalization of same-sex behavior and experiences of human rights abuses by MSM. It compares the extent to which MSM in peri-urban Cape Town experience human rights abuses with that of MSM in Gaborone, Botswana; Blantyre and Lilongwe, Malawi; and Windhoek, Namibia. In 2008, 737 MSM participated in a cross-sectional study using a structured survey collecting data regarding demographics, human rights, HIV status, and risk behavior. Participants accrued in each site were compared using bivariate and multivariate logistic regression. Encouragingly, the results indicate MSM in Cape Town were more likely to disclose their sexual orientation to family or healthcare workers and less likely to be blackmailed or feel afraid in their communities than MSM in Botswana, Malawi, or Namibia. However, South African MSM were not statistically significantly less likely experience a human rights abuse than their peers in cities in other study countries, showing that while legal protections may reduce experiences of certain abuses, legislative changes alone are insufficient for protecting MSM. A comprehensive approach with interventions at multiple levels in multiple sectors is needed to create the legal and social change necessary to address attitudes, discrimination, and violence affecting MSM.

Sex, Money, and Premarital Relationships in Southern Malawi

PubMed Central

Poulin, Miss Michelle J.

2009-01-01

In this paper, I argue two main points: (1), the purpose of money exchange in premarital, sexual partnerships in rural Malawi extends beyond the alleviation of female partners’ economic constraints, and (2), by elucidating this broader purpose, it becomes possible to recognize where women exert control over their own sexual selves. These findings come from field observations and a rich set of in-depth interviews (N=54), bolstered on occasion by survey data, conducted with young women and men, aged 15 to 24 years, in the Balaka district in the southern region of the country. My research demonstrates that, contrary to typical expectations, money and gift transfers in sexual partnerships are part and parcel of the courting practices of young Malawian women and men. Transfers are as much about the expression of love and commitment as they are about meeting the financial “needs” of women or the acquisition of sex for men. Using narrative information to shed light on the semiotics of the sex-money link, these findings from Malawi offer a new perspective that broadens usual interpretations of “transactional” sex, the understanding of which is critical in fighting AIDS. PMID:17764797

Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa

PubMed Central

2014-01-01

Background The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa. Methods We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling. Results In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N’Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N’Djamena (Chad) in 2005. In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV. Conclusions Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control. PMID:24559281

The role of seizure disorders in burn injury and outcome in Sub-Saharan Africa.

PubMed

Boschini, Laura P; Tyson, Anna F; Samuel, Jonathan C; Kendig, Claire E; Mjuweni, Stephano; Varela, Carlos; Cairns, Bruce A; Charles, Anthony G

2014-01-01

Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. The authors compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi. The authors conducted a retrospective study of patients admitted to the Kamuzu Central Hospital burn ward from July 2011 to December 2012. Descriptive analysis of patient characteristics and unadjusted and adjusted analyses of risk factors for mortality were conducted for patients with and without seizure disorder. Prevalence of seizure disorder was 10.7% in the study population. Adults with burns were more likely to have seizure disorder than children. Flame injury was most common in patients with seizure disorder, whereas scalds predominated among patients without seizure disorder. Whereas mortality did not differ between the groups, mean length of stay was longer for patients with seizure disorder, 42.1 days vs 21.6 days. Seizure disorder continues to be a significant risk factor for burn injury in adults in Malawi. Efforts to mitigate epilepsy will likely lead to significant decreases in burns among adults in Sub-Saharan Africa and must be included in an overall burn prevention strategy in our environment.

The role of seizure disorders on burn injury and outcome in sub-Saharan Africa

PubMed Central

Boschini, Laura P.; Tyson, Anna F.; Samuel, Jonathan C.; Kendig, Claire E.; Mjuweni, Stephano; Varela, Carlos; Cairns, Bruce A.; Charles, Anthony G.

2014-01-01

OBJECTIVE Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. We compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi. METHODS We conducted a retrospective study of patients admitted to the Kamuzu Central Hospital burn ward from July 2011 to December 2012. Descriptive analysis of patient characteristics and unadjusted and adjusted analyses of risk factors for mortality were conducted for patients with and without seizure disorder. RESULTS Prevalence of seizure disorder was 10.7% in our population. Adults with burns were more likely to have seizure disorder than children. Flame injury was most common in patients with seizure disorder, whereas scalds predominated among patients without seizure disorder. While mortality did not differ between the groups, mean length of stay was longer for patients with seizure disorder, 42.1 days versus 21.6 days. CONCLUSION Seizure disorder continues to be a significant risk factor for burn injury in adults in Malawi. Efforts to mitigate epilepsy will likely lead to significant decreases in burns among adults in sub Saharan Africa and must be included in an overall burn prevention strategy in our environment. PMID:24918949

Using space photography of the Earth in the classroom: Drought in Africa

NASA Technical Reports Server (NTRS)

Kinsler, Margaret C.

1986-01-01

A script of a classroom presentation based on space photographs of Africa is presented. The intended audience is elementary and secondary school teachers. Photographs of Lake Chad are used to illustrate climatic developments that exemplify the African drought problem.

Field-based random sampling without a sampling frame: control selection for a case-control study in rural Africa.

PubMed

Crampin, A C; Mwinuka, V; Malema, S S; Glynn, J R; Fine, P E

2001-01-01

Selection bias, particularly of controls, is common in case-control studies and may materially affect the results. Methods of control selection should be tailored both for the risk factors and disease under investigation and for the population being studied. We present here a control selection method devised for a case-control study of tuberculosis in rural Africa (Karonga, northern Malawi) that selects an age/sex frequency-matched random sample of the population, with a geographical distribution in proportion to the population density. We also present an audit of the selection process, and discuss the potential of this method in other settings.

The long sediment record of lake Challa: a unique equatorial archive, potentially crucial for understanding early human dispersal

NASA Astrophysics Data System (ADS)

Van Daele, Maarten; Moernaut, Jasper; De Batist, Marc; Verschuren, Dirk

2013-04-01

Lake Challa (Mt. Kilimanjaro, Kenya/Tanzania) is located in a key site for reconstructing the climate and landscape history of equatorial East Africa and hence, climatic influences on the living environment of early modern humans, Homo sapiens. Seismic-reflection data from this crater lake reveal a ~210-m thick sedimentary infill containing distinct seismic-stratigraphic signatures of late-Quaternary lake-level fluctuations. Extrapolation of a well-constrained age model on the cored upper part of the sequence shows that the signatures of these lake-level fluctuations represent a detailed record of climatic moisture-balance variation in equatorial East Africa, continuous over at least the last 140 kyr and encompassing in total ~250 kyr. The most severe aridity occurred during peak Penultimate glaciation immediately before 130 kyr BP (coeval with Heinrich event 11) and during a Last Interglacial 'megadrought' period between ~115 and ~98 kyr BP; in comparison, Last Glacial Maximum (LGM) aridity was modest. The LGM was preceded by ~75,000 years of relatively stable and moist climate conditions interrupted by eleven short-lived dry spells, five of which match the timing of Heinrich events 2 to 6. Also in the lower part of the sedimentary infill the seismic stratigraphy provides evidence for short-lived dry spells, but artefacts and changes in basin geometry complicate their detailed interpretation and dating, respectively. The ICDP deep-drilling project DeepCHALLA aims to core the entire sedimentary sequence, which will allow reconstructing regional climate and ecological dynamics for the past ~250 kyr, i.e., the entire documented existence of anatomically modern humans in East Africa. Knowledge of climate history in this equatorial region, where the northeasterly and southeasterly monsoons strongly interact, is crucial for documenting the severity and geographical distribution of prolonged drought episodes across tropical Africa, and thus for understanding the early

Wind-driven Water Bodies : a new paradigm for lake geology

NASA Astrophysics Data System (ADS)

Nutz, A.; Schuster, M.; Ghienne, J. F.; Roquin, C.; Bouchette, F. A.

2015-12-01

In this contribution we emphasize the importance in some lakes of wind-related hydrodynamic processes (fair weather waves, storm waves, and longshore, cross-shore and bottom currents) as a first order forcing for clastics remobilization and basin infill. This alternative view contrasts with more classical depositional models for lakes where fluvial-driven sedimentation and settling dominates. Here we consider three large lakes/paleo-lakes that are located in different climatic and geodynamic settings: Megalake Chad (north-central Africa), Lake Saint-Jean (Québec, Canada), and Lake Turkana (Kenya, East African Rift System). All of these three lake systems exhibit well developed modern and ancient high-energy littoral morphosedimentary structures which directly derive from wind-related hydrodynamics. The extensive paleo-shorelines of Megalake Chad are composed of beach-foredune ridges, spits, wave-dominated deltas, barriers, and wave-ravinment surface. For Lake Saint-Jean the influence of wind is also identified below the wave-base at lake bottom from erosional surfaces, and sediment drifts. In the Lake Turkana Basin, littoral landforms and deposits are identified for three different time intervals (today, Holocene, Plio-Pleistocene) evidencing that wind-driven hydrodynamics can be preserved in the geological record. Moreover, a preliminary global survey suggests that numerous modern lakes (remote sensing) and paleo-lakes (bibliographic review) behave as such. We thus coin the term "Wind-driven Water Bodies" (WWB) to refer to those lake systems where sedimentation (erosion, transport, deposition) is dominated by wind-induced hydrodynamics at any depth, as it is the case in the marine realm for shallow seas. Integrating wind forcing in lake models has strong implications for basin analysis (paleoenvironments and paleoclimates restitutions, resources exploration), but also for coastal engineering, wildlife and reservoirs management, or leisure activities.

Village registers for vital registration in rural Malawi.

PubMed

Singogo, E; Kanike, E; van Lettow, M; Cataldo, F; Zachariah, R; Bissell, K; Harries, A D

2013-08-01

Paper-based village registers were introduced 5 years ago in Malawi as a tool to measure vital statistics of births and deaths at the population level. However, usage, completeness and accuracy of their content have never been formally evaluated. In Traditional Authority Mwambo, Zomba district, Malawi, we assessed 280 of the 325 village registers with respect to (i) characteristics of village headmen who used village registers, (ii) use and content of village registers, and (iii) whether village registers provided accurate information on births and deaths. All village headpersons used registers. There were 185 (66%) registers that were regarded as 95% completed, and according to the registers, there were 115 840 people living in the villages in the catchment area. In 2011, there were 1753 births recorded in village registers, while 6397 births were recorded in health centre registers in the same catchment area. For the same year, 199 deaths were recorded in village registers, giving crude death rates per 100 000 population of 189 for males and 153 for females. These could not be compared with death rates in health centre registers due to poor and inconsistent recording in these registers, but they were compared with death rates obtained from the 2010 Malawi Demographic Health Survey that reported 880 and 840 per 100 000 for males and females, respectively. In conclusion, this study shows that village registers are a potential source for vital statistics. However, considerable inputs are needed to improve accuracy of births and deaths, and there are no functional systems for the collation and analysis of data at the traditional authority level. Innovative ways to address these challenges are discussed, including the use of solar-powered electronic village registers and mobile phones, connected with each other and the health facilities and the District Commissioner's office through the cellular network and wireless coverage. © 2013 John Wiley & Sons Ltd.

Characterisation of the Subaquatic Groundwater Discharge That Maintains the Permanent Stratification within Lake Kivu; East Africa

PubMed Central

Ross, Kelly Ann; Gashugi, Elisée; Gafasi, Augustin; Wüest, Alfred; Schmid, Martin

2015-01-01

Warm and cold subaquatic groundwater discharge into Lake Kivu forms the large-scale density gradients presently observed in the lake. This structure is pertinent to maintaining the stratification that locks the high volume of gases in the deepwater. Our research presents the first characterisation of these inflows. Temperature and conductivity profiling was conducted from January 2010 to March 2013 to map the locations of groundwater discharge. Water samples were obtained within the lake at the locations of the greatest temperature anomalies observed from the background lake-profile. The isotopic and chemical signatures of the groundwater were applied to assess how these inflows contribute to the overall stratification. It is inferred that Lake Kivu’s deepwater has not been completely recharged by the groundwater inflows since its turnover that is speculated to have occurred within the last ~1000 yrs. Given a recent salinity increase in the lake constrained to within months of seismic activity measured beneath the basin, it is plausible that increased hydrothermal-groundwater inflows into the deep basin are correlated with episodic geologic events. These results invalidate the simple two-component end-member mixing regime that has been postulated up to now, and indicate the importance of monitoring this potentially explosive lake. PMID:25799098

Climate and Health Vulnerability to Vector-Borne Diseases: Increasing Resilience under Climate Change Conditions in Africa

NASA Astrophysics Data System (ADS)

Ceccato, P.

2015-12-01

The International Research Institute for Climate and Society (IRI), the City University of New York (CUNY) and NASA Jet Propulsion Laboratory (JPL) in collaboration with NASA SERVIR are developing tools to monitor climate variables (precipitation, temperature, vegetation, water bodies, inundation) that help projects in Africa to increase resilience to climate change for vector-borne diseases ( malaria, trypanosomiasis, leishmaniasis, and schistosomiasis). Through the development of new products to monitor precipitation, water bodies and inundation, IRI, CUNY and JPL provide tools and capacity building to research communities; ministries of health; the WMO Global Framework for Climate and Services; and World Health Organization in Africa to: 1) Develop research teams' ability to appropriately use climate data as part of their research 2) Enable research teams and ministries to integrate climate information into social and economic drivers of vulnerability and opportunities for adaptation to climate change 3) Inform better policies and programs for climate change adaptation. This oral presentation will demonstrate how IRI, CUNY, and JPL developed new products, tools and capacity building to achieve the three objectives mentioned above with examples in South Africa, Zimbabwe, Tanzania and Malawi.

The Antlion Project with School Pupils in Zomba, Malawi

ERIC Educational Resources Information Center

Young, Simon

2013-01-01

This article presents an account of a practical outdoor science project using the larvae of antlions with year 5 and 6 (age 10-11) pupils from Sir Harry Johnston International Primary School in Zomba, Malawi. Aim: To conduct a science project outdoors using scientific enquiry and knowledge in a typical African school environment and to see whether…

Criteria for clinical audit of women friendly care and providers' perception in Malawi

PubMed Central

Kongnyuy, Eugene J; van den Broek, Nynke

2008-01-01

Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers. PMID:18647388

Criteria for clinical audit of women friendly care and providers' perception in Malawi.

PubMed

Kongnyuy, Eugene J; van den Broek, Nynke

2008-07-22

There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

Mitigation of environmental problems in Lake Victoria, East Africa: causal chain and policy options analyses.

PubMed

Odada, Eric O; Olago, Daniel O; Kulindwa, Kassim; Ntiba, Micheni; Wandiga, Shem

2004-02-01

Lake Victoria is an international waterbody that offers the riparian communities a large number of extremely important environmental services. Over the past three decades or so, the lake has come under increasing and considerable pressure from a variety of interlinked human activities such as overfishing, species introductions, industrial pollution, eutrophication, and sedimentation. In this paper we examine the root causes for overfishing and pollution in Lake Victoria and give possible policy options that can help remediate or mitigate the environmental degradation.

Environmental risk factors for oesophageal cancer in Malawi: A case-control study.

PubMed

Mlombe, Y B; Rosenberg, N E; Wolf, L L; Dzamalala, C P; Chalulu, K; Chisi, J; Shaheen, N J; Hosseinipour, M C; Shores, C G

2015-09-01

There is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context. A hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated. Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and 6.6 (95% CI: 2.3-19.3), respectively. Several modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.

Identifying Water Insecurity Hotspots in the Lake Victoria Basin of Eastern Africa

NASA Astrophysics Data System (ADS)

Pricope, N. G.; Shukla, S.; Linard, C.; Gaughan, A.

2014-12-01

The Lake Victoria Basin (LVB), one of Africa's most populated transboundary watersheds and home to more than 30 million inhabitants, is increasingly challenged by both water quality problems and water quantity shortages against a backdrop of climate variability and change; and other environmental challenges. As a result of pollution, droughts, more erratic rainfall, heightened demand for water for both consumption and agricultural needs as well as differences in water allocation among the riverine countries of Uganda, Tanzania, Kenya, Rwanda and Burundi, many parts of this region are already experiencing water scarcity on a recurrent basis. Furthermore, given projected annual population growth rates of 2.5 to 3.5% for the next 20 years, water shortages are likely to be exacerbated in the future. Analyzing historical changes in the water resources of this region is hence important to identify "hot spots" that might be most sensitive to future changes in climate and demography. In this presentation, we report the findings of a comprehensive analysis performed to (i) examine changes in water resources of LVB in recent decades and (ii) identify overlap between regions of significant changes in water resources with land cover changes and high population centers that are also projected to grow the fastest over the coming decades. We first utilize several satellite, stations and model(s) based climatic and hydrologic datasets to assess changes in water resources in this region. We then use a quality-controlled Moderate Resolution Imaging Spectroradiometer (MODIS) land cover product to identify areas of significant land cover changes. Simultaneously we use projections of gridded population density based on differential growth rates for rural and urban population to estimate fastest projected human population growth for 2030 and 2050 relative to 2010 data. Using the outcomes of these change analysis we identify water insecurity hotspots in the LVB.

Measuring Institutions: Indicators of Political and Property Rights in Malawi

ERIC Educational Resources Information Center

Fedderke, Johannes; Garlick, Julia

2012-01-01

This paper constructs a new set of institutional indicators for Malawi. We develop indicators of political rights, of freehold, traditional (communitarian) and intellectual property rights, based on the Malawian legislative framework. In exploring the association between our rights measures and a range of indicators of socio-economic development,…

Screening for tuberculosis among adults newly diagnosed with HIV in sub-Saharan Africa: a cost-effectiveness analysis

PubMed Central

Zwerling, Alice A.; Sahu, Maitreyi; Ngwira, Lucky G.; Khundi, McEwen; Harawa, Tina; Corbett, Elizabeth L.; Chaisson, Richard E.; Dowdy, David W.

2015-01-01

Objective New tools, including light emitting diode (LED) fluorescence microscopy and the molecular assay Xpert MTB/RIF® offer increased sensitivity for TB in persons with HIV but come with higher costs. Using operational data from rural Malawi we explored the potential cost-effectiveness of on-demand screening for TB in low-income countries of sub-Saharan Africa. Design & Methods Costs were empirically collected in four clinics and one hospital using a micro-costing approach, through direct interview and observation from the national TB program perspective. Using decision analysis newly diagnosed persons with HIV were modeled as being screened by one of three strategies: Xpert, LED or standard of care (i.e., at the discretion of the treating physician). Results Cost-effectiveness of TB screening among persons newly diagnosed with HIV was largely determined by two factors: prevalence of active TB among patients newly diagnosed with HIV and volume of testing. In facilities screening at least 50 people with a 6.5% prevalence of TB, or at least 500 people with a 2.5% TB prevalence, screening with Xpert is likely to be cost-effective. At lower prevalence – including that observed in Malawi – LED microscopy may be the preferred strategy, whereas in settings of lower TB prevalence or small numbers of eligible patients, no screening may be reasonable (such that resources can be deployed elsewhere). Conclusions TB screening at the point of HIV diagnosis may be cost-effective in low-income countries of sub-Saharan Africa, but only if a relatively large population with high prevalence of TB can be identified for screening. PMID:26049281

The Bioethanol Industry in Sub-Saharan Africa: History, Challenges, and Prospects

PubMed Central

Deenanath, Evanie Devi; Iyuke, Sunny; Rumbold, Karl

2012-01-01

Recently, interest in using bioethanol as an alternative to petroleum fuel has been escalating due to decrease in the availability of crude oil. The application of bioethanol in the motor-fuel industry can contribute to reduction in the use of fossil fuels and in turn to decreased carbon emissions and stress of the rapid decline in crude oil availability. Bioethanol production methods are numerous and vary with the types of feedstock used. Feedstocks can be cereal grains (first generation feedstock), lignocellulose (second generation feedstock), or algae (third generation feedstock) feedstocks. To date, USA and Brazil are the leading contributors to global bioethanol production. In sub-Saharan Africa, bioethanol production is stagnant. During the 1980s, bioethanol production has been successful in several countries including Zimbabwe, Malawi, and Kenya. However, because of numerous challenges such as food security, land availability, and government policies, achieving sustainability was a major hurdle. This paper examines the history and challenges of bioethanol production in sub-Saharan Africa (SSA) and demonstrates the bioethanol production potential in SSA with a focus on using bitter sorghum and cashew apple juice as unconventional feedstocks for bioethanol production. PMID:22536020

Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi.

PubMed

Price, Alison J; Crampin, Amelia C; Amberbir, Alemayehu; Kayuni-Chihana, Ndoliwe; Musicha, Crispin; Tafatatha, Terence; Branson, Keith; Lawlor, Debbie A; Mwaiyeghele, Elenaus; Nkhwazi, Lawrence; Smeeth, Liam; Pearce, Neil; Munthali, Elizabeth; Mwagomba, Beatrice M; Mwansambo, Charles; Glynn, Judith R; Jaffar, Shabbar; Nyirenda, Moffat

2018-03-01

Sub-Saharan Africa is in rapid demographic transition, and non-communicable diseases are increasingly important causes of morbidity and mortality. We investigated the burden of diabetes, overweight and obesity, hypertension, and multimorbidity, their treatment, and their associations with lifestyle and other factors in Malawi, a very poor country with a predominantly rural-but rapidly growing urban-population, to identify high-risk populations and inform appropriate interventions. In this cross-sectional, population-based study, we enrolled all adults (≥18 years) residing in two defined geographical areas within Karonga District and Lilongwe city. All adults self-defining as usually resident in the study areas were eligible, and recruited at household level. Participants were interviewed, had anthropometry and blood pressure measured, and had fasting blood samples collected. The study outcomes were prevalence estimates and risk ratios for diabetes (defined as fasting blood glucose of at least 7·0 mmol/L or self-report of a previous diagnosis of diabetes), hypertension (systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or self-report of current antihypertensive medication), overweight (BMI of 25·0-29·9 kg/m 2 ) and obesity (BMI of 30·0 kg/m 2 or more), and multimorbidity (two or more of the above conditions) by location-specific (urban vs rural), age-specific, and sex-specific groups, calculated using negative binomial regression. We used χ 2 likelihood ratio tests to assess heterogeneity by age, location, and sex. Between May 16, 2013, and Feb 8, 2016, we enrolled 15 013 (62%) of 24 367 eligible urban adults in Lilongwe and 13 878 (88%) of 15 806 eligible rural adults in Karonga District. Overweight and obesity, hypertension, and diabetes were highly prevalent, more so in urban residents, the less poor, and better educated than in rural, the poorest, and least educated participants. 18% of urban men (961 of

Temporal and spatial characteristics of annual and seasonal rainfall in Malawi

NASA Astrophysics Data System (ADS)

Ngongondo, Cosmo; Xu, Chong-Yu; Gottschalk, Lars; Tallaksen, Lena M.; Alemaw, Berhanu

2010-05-01

An understanding of the temporal and spatial characteristics of rainfall is central to water resources planning and management. However, such information is often limited in many developing countries like Malawi. In an effort to bridge the information gap, this study examined the temporal and spatial charecteristics of rainfall in Malawi. Rainfall readings from 42 stations across Malawi from 1960 to 2006 were analysed at monthly, annual and seasonal scales. The Malawian rainfall season lasts from November to April. The data were firstly subjected to quality checks through the cumulative deviations test and the Standard Normal Homogeinity Test (SNHT). Monthly distribution in a typical year, called heterogeneity, was investigated using the Precipitation Concentration Index (PCI). Further, normalized precipitation anomaly series of annual rainfall series (AR) and the PCI (APCI) were used to test for interannual rainfall variability. Spatial variability was characterised by fitting the Spatial Correlation function (SCF). The nonparametric Mann-Kendall statistic was used to investigate the temporal trends of the various rainfall variables. The results showed that 40 of the stations passed both data quality tests. For the two stations that failed, the data were adjusted using nearby stations. Annual and seasonal rainfall were found to be characterised by high spatial variation. The country mean annual rainfall was 1095 mm with mean interannual variability of 26%. The highland areas to the north and southeast of the country exhibited the highest rainfall and lowest interannual variability. Lowest rainfall coupled with high interannual variability was found in the Lower Shire basin, in the southern part of Malawi. This simillarity is the pattern of annual and seasonal rainfall should be expected because all stations had over 90% of their observed annual rainfall in the six month period between November and April. Monthly rainfall was found to be highly variable both

Resources for controlling tuberculosis in Malawi.

PubMed Central

Harries, A. D.; Kwanjana, J. H.; Hargreaves, N. J.; Van Gorkom, J.; Salaniponi, F. M.

2001-01-01

OBJECTIVE: To document resources for controlling tuberculosis (TB) in Malawi. METHODS: We performed a countrywide study of all 43 hospitals (3 central, 22 district and 18 mission) which register and treat patients with TB. To collect data for 1998 on the TB-related workload, diagnostic facilities, programme staff and treatment facilities, we used laboratory, radiographic and TB registers, conducted interviews and visited hospital facilities. FINDINGS: The data show that in 1998, 88,257 TB suspects/patients contributed approximately 230,000 sputum specimens for smear microscopy, 55,667 chest X-rays were performed and 23,285 patients were registered for TB treatment. There were 86 trained laboratory personnel, 44 radiographers and 83 TB programme staff. Of these, about 40% had periods of illness during 1998. Approximately 20% of the microscopes and X-ray machines were broken. Some 16% of the hospital beds were designated for TB patients in special wards, but even so, the occupancy of beds in TB wards exceeded 100%. Although stocks of anti-TB drugs were good, there was a shortage of full-time TB ward nurses and 50% of district hospitals conducted no TB ward rounds. In general, there was a shortage of facilities for managing associated HIV-related disease; central hospitals, in particular, were underresourced. CONCLUSION: Malawi needs better planning to utilize its manpower and should consider cross-training hospital personnel. The equipment needs regular maintenance, and more attention should be paid to HIV-related illness. The policies of decentralizing resources to the periphery and increasing diagnostic and case-holding resources for central hospitals should be continued. PMID:11357212

Integrated Numerical Model for the East African Rift System: Plume-induced Rifting and Continental Break-up from Lake Malawi to Red Sea

NASA Astrophysics Data System (ADS)

Koptev, A.; Leroy, S. D.; Calais, E.; Gerya, T.

2016-12-01

We present numerical experiments that target to reveal the role of active mantle plume, far-field tectonic forces and pre-existing lithospheric heterogeneities in structural development of the East African Rift system (EARS). Starting with models capturing the essential geophysical features of the central and southern parts of the EARS (two «cratonic» bodies (Tanzanian craton and Bangweulu block) embedded into a «normal» surrounding lithosphere) we show that development of the magmatic Eastern branch, the amagmatic Western branch and its southern prolongation (Malawi rift) can be the result of non-uniform splitting of some hot plume material that has been initially seeded underneath the southern part of Tanzanian craton. The second series of experiments has been designed in order to investigate northern segment of the EARS where Afro-Arabian plate separation is supposed to be related with the impact of Afar mantle plume. These models permit us to reproduce observed orientation and relative position of two spreading axes (Red Sea, Gulf of Aden) and rifting (Main Ethiopian rift) one. All are joining at Afar triple junction. Finally, for laterally extended experiment we have used parameters of the best-fit models for the southern and northern segments of the EARS in order to define the position of Kenyan plume and the velocity boundary conditions. This model cover all rifting and spreading structure associated with both Afar and Kenyan plumes: Red Sea Rift and the Aden Ridge to the north of the Afar Triple Junction; Main Ethiopian Rift running to the south that continues as the Kenyan Rift; Western Rift and its southern prolongation corresponding to Malawi rift.We argue that main features of the EARS can be reproduced in a relatively simple context of the interaction between two mantle anomalies corresponding to Afar and Kenyan plumes and pre-stressed rheologically stratified continental lithosphere containing only first-order structural heterogeneities (such as

Evaluation and costs of different haemoglobin methods for use in district hospitals in Malawi

PubMed Central

Medina Lara, A; Mundy, C; Kandulu, J; Chisuwo, L; Bates, I

2005-01-01

Aims: To evaluate the characteristics of manual haemoglobin methods in use in Malawi and provide evidence for the Ministry of Health in Malawi to enable them to choose a suitable method for district hospitals. Methods: Criteria on accuracy, clinical usefulness, user friendliness, speed, training time, and economic costs were determined by local health professionals and used to compare six different manual haemoglobin methods. These were introduced sequentially into use in a district hospital in Malawi alongside the reference method. Results: HemoCue was the optimal method based on most of the outcome measures but was also the most expensive (US$0.75/test). DHT meter and Jenway colorimeter were the second choice because they were cheaper (US$0.20–0.35/test), but they were not as accurate or user friendly as HemoCue. Conclusions: The process for choosing appropriate laboratory methods is complex and very little guidance is available for health managers in poorer countries. This paper describes the development and testing of a practical model for gathering evidence about test efficiency that could be adapted for use in other resource poor settings. PMID:15623483

Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model.

PubMed

Emina, Jacques B O; Madise, Nyovani; Kuepie, Mathias; Zulu, Eliya M; Ye, Yazoume

2013-05-28

To identify HIV-socioeconomic predictors as well as the most-at-risk groups of women in Malawi. A cross-sectional survey. Malawi The study used a sample of 6395 women aged 15-49 years from the 2010 Malawi Health and Demographic Surveys. Individual HIV status: positive or not. Findings from the Pearson χ(2) and χ(2) Automatic Interaction Detector analyses revealed that marital status is the most significant predictor of HIV. Women who are no longer in union and living in the highest wealth quintiles households constitute the most-at-risk group, whereas the less-at-risk group includes young women (15-24) never married or in union and living in rural areas. In the light of these findings, this study recommends: (1) that the design and implementation of targeted interventions should consider the magnitude of HIV prevalence and demographic size of most-at-risk groups. Preventive interventions should prioritise couples and never married people aged 25-49 years and living in rural areas because this group accounts for 49% of the study population and 40% of women living with HIV in Malawi; (2) with reference to treatment and care, higher priority must be given to promoting HIV test, monitoring and evaluation of equity in access to treatment among women in union disruption and never married or women in union aged 30-49 years and living in urban areas; (3) community health workers, households-based campaign, reproductive-health services and reproductive-health courses at school could be used as canons to achieve universal prevention strategy, testing, counselling and treatment.

Children as research collaborators: issues and reflections from a mobility study in sub-Saharan Africa.

PubMed

Porter, Gina; Hampshire, Kate; Bourdillon, Michael; Robson, Elsbeth; Munthali, Alister; Abane, Albert; Mashiri, Mac

2010-09-01

This paper reflects on issues raised by work with children in an ongoing child mobility study in three sub-Saharan African countries: Ghana, Malawi and South Africa. There are now 70 school pupils of varying ages involved in the project, but the paper is particularly concerned with the participation of those children 14 years and under. We examine the significant ethical issues associated with working with younger child researchers, and linked questions concerning the spaces open to them in African contexts where local cultural constructions of childhood and associated economic imperatives (which commonly drive family and household endeavour) help shape the attitudes of adults to children's rights and responsibilities and inter-generational power relations.

Methanotrophy within the water column of a large meromictic tropical lake (Lake Kivu, East Africa)

NASA Astrophysics Data System (ADS)

Morana, C.; Borges, A. V.; Roland, F. A. E.; Darchambeau, F.; Descy, J.-P.; Bouillon, S.

2015-04-01

The permanently stratified Lake Kivu is one of the largest freshwater reservoirs of dissolved methane (CH4) on Earth. Yet CH4 emissions from its surface to the atmosphere have been estimated to be 2 orders of magnitude lower than the CH4 upward flux to the mixed layer, suggesting that microbial CH4 oxidation is an important process within the water column. A combination of natural abundance stable carbon isotope analysis (δ13C) of several carbon pools and 13CH4-labelling experiments was carried out during the rainy and dry season to quantify (i) the contribution of CH4-derived carbon to the biomass, (ii) methanotrophic bacterial production (MBP), and (iii) methanotrophic bacterial growth efficiency (MBGE), defined as the ratio between MBP and gross CH4 oxidation. We also investigated the distribution and the δ13C of specific phospholipid fatty acids (PLFAs), used as biomarkers for aerobic methanotrophs. Maximal MBP rates were measured in the oxycline, suggesting that CH4 oxidation was mainly driven by oxic processes. Moreover, our data revealed that methanotrophic organisms in the water column oxidized most of the upward flux of CH4, and that a significant amount of CH4-derived carbon was incorporated into the microbial biomass in the oxycline. The MBGE was variable (2-50%) and negatively related to CH4 : O2 molar ratios. Thus, a comparatively smaller fraction of CH4-derived carbon was incorporated into the cellular biomass in deeper waters, at the bottom of the oxycline where oxygen was scarce. The aerobic methanotrophic community was clearly dominated by type I methanotrophs and no evidence was found for an active involvement of type II methanotrophs in CH4 oxidation in Lake Kivu, based on fatty acids analyses. Vertically integrated over the water column, the MBP was equivalent to 16-60% of the average phytoplankton particulate primary production. This relatively high magnitude of MBP, and the substantial contribution of CH4-derived carbon to the overall

Prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi.

PubMed

Muula, A S

2007-01-01

Tobacco smoking is a major risk factor for non-communicable diseases such as ischaemic heart disease, stroke, chronic obstructive airways disease and several cancers. There is little data about the prevalence and determinants of smoking among adolescents in southern Africa. This study aimed to determine the prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi. Cross-sectional data were obtained from school-going adolescents in Blantyre in 2001 using the Global Youth Tobacco Survey data collection instrument. Data were analysed to determine prevalence of current and ever cigarette smoking, and predictors of smoking. The prevalence of current smoking and ever smoking were 3.0% and 15.6%, respectively. Predictors of current tobacco smoking included male gender, having friends or parents who smoked, having been exposed to advertisements about tobacco brands on television and having seen a lot of advertisements in newspapers and magazines. School programmes that included being taught about smoking in class and a class discussion on the dangers of tobacco were not associated with reduced current smoking. Intervention programmes aiming to curb tobacco smoking among adolescents should focus on dealing also with parental smoking, peer influence and pay special attention toward male gender. School-based programmes to prevent smoking should be evaluated as some may have little impact in influencing current smoking status.

Determination of Genetic Diversity in Chilo partellus, Busseola fusca, and Spodoptera frugiperda Infesting Sugarcane in Southern Malawi Using DNA Barcodes.

PubMed

Kasambala Donga, Trust; Meadow, Richard

2018-06-22

Sugarcane is one of the most valuable crops in the world. Native and exotic Lepidopteran stemborers significantly limit sugarcane production. However, the identity and genetic diversity of stemborers infesting sugarcane in Malawi is unknown. The main objectives for this study were to identify and determine genetic diversity in stemborers infesting sugarcane in Malawi. We conducted field surveys between June 2016 and March 2017 in the Lower Shire Valley district of Chikwawa and Nsanje, southern Malawi. Molecular identification was based amplification the partial cytochrome oxidase subunit I (COI) gene region. Phylogenetic trees for sequences were generated and published GenBank accessions for each species were constructed. We found that Malawi Busseola fusca (Lepidoptera: Noctuidae) specimens belonged to clade II, Spodoptera frugiperda sp. 1 (Lepidoptera: Noctuidae) and Chilo partellus (Lepidoptera: Crambidae) were infesting sugarcane. Interspecific divergence ranged from 8.7% to 15.3%. Intraspecific divergence was highest for B. fusca , 3.6%. There were eight haplotypes for B. fusca , three for S. frugiperda and three for C. partellus . The importance of accurate species identification and genetic diversity on stemborer management is presented.

Omo River Delta, Lake Turkana, Ethiopia/Kenya border, Africa

NASA Technical Reports Server (NTRS)

1991-01-01

As a result of land clearing operations in the local area, the Omo River Delta (4.5N, 36.0E) at the north end of Lake Turkana, on the Ethiopia/Kenya border has become enlarged through topsoil erosion. The delta measured 800 sq. km. in 1981 doubled to 1,600 sq. km. by 1988 and was up to 1,800 sq. km. in 1991. This is the same area where the Leaky Anthropological Team discovered the earliest remains of human ancestors.

Layered Crustal and Mantle Structure and Anisotropy beneath the Afar Depression and Malawi Rift Zone

NASA Astrophysics Data System (ADS)

Reed, Cory Alexander

Although a wealth of geophysical data sets have been acquired within the vicinity of continental rift zones, the mechanisms responsible for the breakup of stable continental lithosphere are ambiguous. Eastern Africa is host to the largest contemporary rift zone on Earth, and is thus the most prominent site with which to investigate the processes which govern the rupture of continental lithosphere. The studies herein represent teleseismic analyses of the velocity and thermomechanical structure of the crust and mantle beneath the Afar Depression and Malawi Rift Zone (MRZ) of the East African Rift System. Within the Afar Depression, the first densely-spaced receiver function investigation of crustal thickness and inferred velocity attenuation across the Tendaho Graben is conducted, and the largest to-date study of the topography of the mantle transition zone (MTZ) beneath NE Africa is provided, which reveals low upper-mantle velocities beneath the Afar concordant with a probable mantle plume traversing the MTZ beneath the western Ethiopian Plateau. In the vicinity of the MRZ, a data set comprised of 35 seismic stations is employed that was deployed over a two year period from mid-2012 to mid-2014, belonging to the SAFARI (Seismic Arrays For African Rift Initiation) experiment. Accordingly, the first MTZ topography and shear wave splitting analyses were conducted in the region. The latter reveals largely plate motion-parallel anisotropy that is locally modulated by lithospheric thickness abnormalities adjacent to the MRZ, while the former reveals normal MTZ thicknesses and shallow discontinuities that support the presence of a thick lithospheric keel within the MRZ region. These evidences strongly argue for the evolution of the MRZ via passive rifting mechanisms absent lower-mantle influences.

Impact of Urbanization on Precipitation Distribution and Intensity over Lake Victoria Basin

NASA Astrophysics Data System (ADS)

Gudoshava, M.; Semazzi, F. H. M.

2014-12-01

In this study, sensitivity simulations on the impact of rapid urbanization over Lake Victoria Basin in East Africa were done using a Regional Climate Model (RegCM4.4-rc29) with the Hostetler lake model activated. The simulations were done for the rainy seasons that is the long rains (March-April-May) and short rains (October-November-December). Africa is projected to have a surge in urbanization with an approximate rate of 590% in 2030 over their 2000 levels. The Northern part of Lake Victoria Basin and some parts of Rwanda and Burundi are amongst the regions with high urbanization projections. Simulations were done with the land cover for 2000 and the projected 2030 urbanization levels. The results showed that increasing the urban fraction over the northern part of the basin modified the physical parameters such as albedo, moisture and surface energy fluxes, aerodynamic roughness and surface emissivity, thereby altering the precipitation distribution, intensity and frequency in the region. The change in the physical parameters gave a response of an average increase in temperature of approximately 2oC over the urbanized region. A strong convergence zone was formed over the urbanized region and thereby accelerating the lake-breeze front towards the urbanized region center. Precipitation in the urbanized region and regions immediate to the area increased by approximately 4mm/day, while drying up the southern (non-urbanized) side of the basin. The drying up of the southern side of the basin could be a result of divergent flow and subsidence that suppresses vertical development of storms.

Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi.

PubMed

Uwemedimo, Omolara T; Lewis, Todd P; Essien, Elsie A; Chan, Grace J; Nsona, Humphreys; Kruk, Margaret E; Leslie, Hannah H

2018-01-01

Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi. Data were obtained from the 2013-2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity. 3136 clinical visits for children 2-59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity. Care quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity

Diversification of de-agrarianization? Income diversification, labor, and processes of agrarian change in southern and northern Malawi, mid-1930s to mid-1950s.

PubMed

Green, Erik

2008-01-01

This article investigates the links between market-oriented activities and subsistence production among peasant farmers in the Thyolo and Mzimba districts in Malawi from the mid-1930s to the mid-1950s. The two districts were chosen because of their differences in terms of land-labor ratios, quality of soils, and structure of market engagement. Exploring the different paths of agrarian change in these two districts demonstrates that they were dependent on the structure of market engagement and its effects on the supply and flexibility of labor. African agricultural history is best understood when agricultural systems are viewed in connection to the overall economic activities of rural households. More simply put, the dynamics of agrarian change in rural Africa cannot be understood without linking such changes to the wider economy and their impact on local labor processes.

Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi

PubMed Central

Mazenga, Alick C.; Simon, Katie; Yu, Xiaoying; Ahmed, Saeed; Nyasulu, Phoebe; Kazembe, Peter N.; Ngoma, Stanley; Abrams, Elaine J.

2018-01-01

Background The well-documented shortages of health care workers (HCWs) in sub-Saharan Africa are further intensified by the increased human resource needs of expanding HIV treatment programs. Burnout is a syndrome of emotional exhaustion (EE), depersonalization (DP), and a sense of low personal accomplishment (PA). HCWs’ burnout can negatively impact the delivery of health services. Our main objective was to examine the prevalence of burnout amongst HCWs in Malawi and explore its relationship to self-reported suboptimal patient care. Methods A cross-sectional study among HCWs providing HIV care in 89 facilities, across eight districts in Malawi was conducted. Burnout was measured using the Maslach Burnout Inventory defined as scores in the mid-high range on the EE or DP subscales. Nine questions adapted for this study assessed self-reported suboptimal patient care. Surveys were administered anonymously and included socio-demographic and work-related questions. Validated questionnaires assessed depression and at-risk alcohol use. Chi-square test or two-sample t-test was used to explore associations between variables and self-reported suboptimal patient care. Bivariate analyses identified candidate variables (p < 0.2). Final regression models included variables with significant main effects. Results Of 520 HCWs, 62% met criteria for burnout. In the three dimensions of burnout, 55% reported moderate-high EE, 31% moderate-high DP, and 46% low-moderate PA. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%). In multivariate analysis, only burnout remained associated with self-reported suboptimal patient care (OR 3.22, [CI 2.11 to 4.90]; p<0.0001). Conclusion Burnout was common among HCWs providing HIV care and was associated with self-reported suboptimal

Chemical safety of cassava products in regions adopting cassava production and processing--experience from Southern Africa.

PubMed

Nyirenda, D B; Chiwona-Karltun, L; Chitundu, M; Haggblade, S; Brimer, L

2011-03-01

The cassava belt area in Southern Africa is experiencing an unforeseen surge in cassava production, processing and consumption. Little documentation exists on the effects of this surge on processing procedures, the prevailing levels of cyanogenic glucosides of products consumed and the levels of products commercially available on the market. Risk assessments disclose that effects harmful to the developing central nervous system (CNS) may be observed at a lower exposure than previously anticipated. We interviewed farmers in Zambia and Malawi about their cultivars, processing procedures and perceptions concerning cassava and chemical food safety. Chips, mixed biscuits and flour, procured from households and markets in three regions of Zambia (Luapula-North, Western and Southern) as well as products from the Northern, Central and Southern regions of Malawi, were analyzed for total cyanogenic potential (CNp). Processed products from Luapula showed a low CNp, <10 mg HCN equiv./kg air dried weight, while samples from Mongu, Western Province, exhibited high levels of CNp, varying from 50 to 290 mg HCN equiv./kg. Even the lowest level is five times higher than the recommended safety level of 10mg/kg decided on for cassava flour. Our results call for concerted efforts in promoting gender oriented processing technologies. Copyright © 2010 Elsevier Ltd. All rights reserved.

Patterns of chloroquine use and resistance in sub-Saharan Africa: a systematic review of household survey and molecular data

PubMed Central

2011-01-01

Background As a result of widespread chloroquine and sulphadoxine-pyrimethamine (SP) resistance, 90% of sub-Saharan African countries had adopted policies of artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria by 2007. In Malawi, cessation of chloroquine use was followed by the re-emergence of chloroquine-susceptible malaria. It was expected that introduction of ACT would lead to a return in chloroquine susceptibility throughout Africa, but this has not yet widely occurred. This observation suggests that there is continuing use of ineffective anti-malarials in Africa and that persistent chloroquine-resistant malaria is due to ongoing drug pressure despite national policy changes. Methods To estimate drug use on a national level, 2006-2007 Demographic Health Survey and Multiple Indicator Cluster Survey data from 21 African countries were analysed. Resistance data were compiled by systematic review of the published literature on the prevalence of the Plasmodium falciparum chloroquine resistance transporter polymorphism at codon 76, which causes chloroquine resistance. Results Chloroquine was the most common anti-malarial used according to surveys from 14 of 21 countries analysed, predominantly in West Africa. SP was most commonly reported in two of 21 countries. Among eight countries with longitudinal molecular resistance data, the four countries where the highest proportion of children treated for fever received chloroquine (Uganda, Burkina Faso, Guinea Bissau, and Mali) also showed no significant declines in the prevalence of chloroquine-resistant infections. The three countries with low or decreasing chloroquine use among children who reported fever treatment (Malawi, Kenya, and Tanzania) had statistically significant declines in the prevalence of chloroquine resistance. Conclusions This study demonstrates that in 2006-2007, chloroquine and SP continued to be used at high rates in many African countries. In countries reporting

Land Cover Mapping for the Development of Green House Gas (GHG) Inventories in the Eastern and Southern Africa Region

NASA Astrophysics Data System (ADS)

Wakhayanga, J. A.; Oduor, P.; Korme, T.; Farah, H.; Limaye, A. S.; Irwin, D.; Artis, G.

2014-12-01

Anthropogenic activities are responsible for the largest share of green house gas (GHG) emissions. Research has shown that greenhouse gases cause radioactive forcing in the stratosphere, leading to ozone depletion. Different land cover types act as sources or sinks of carbon dioxide (CO2), the most dominant GHG.Under the oversight of the United Nations Framework Convention on Climate Change (UNFCCC) the Eastern and Southern Africa (ESA) region countries are developing Sustainable National GHG Inventory Management Systems. While the countries in the ESA region are making substantial progress in setting up GHG inventories, there remains significant constraints in the development of quality and sustainable National GHG Inventory Systems. For instance, there are fundamental challenges in capacity building and technology transfer, which can affect timely and consistent reporting on the land use, land-use change and forestry (LULUCF) component of the GHG inventory development. SERVIR Eastern and Southern Africa is a partnership project between the National Aeronautics and Space Administration (NASA) and the Regional Center for Mapping of Resources for Development (RCMRD), an intergovernmental organization in Africa, with 21 member states in the ESA region. With support from the United States Agency for International Development (USAID), SERVIR ESA is implementing the GHG Project in 9 countries. The main deliverables of the project are land cover maps for the years 2000 and 2010 (also 1990 for Malawi and Rwanda), and related technical reports, as well as technical training in land cover mapping using replicable methodologies. Landsat imagery which is freely available forms the main component of earth observation input data, in addition to ancillary data collected from each country. Supervised classification using maximum likelihood algorithm is applied to the Landsat images. The work is completed for the initial 6 countries (Malawi, Zambia, Rwanda, Tanzania, Botswana, and

Molecular Detection of Tick-Borne Pathogen Diversities in Ticks from Livestock and Reptiles along the Shores and Adjacent Islands of Lake Victoria and Lake Baringo, Kenya.

PubMed

Omondi, David; Masiga, Daniel K; Fielding, Burtram C; Kariuki, Edward; Ajamma, Yvonne Ukamaka; Mwamuye, Micky M; Ouso, Daniel O; Villinger, Jandouwe

2017-01-01

Although diverse tick-borne pathogens (TBPs) are endemic to East Africa, with recognized impact on human and livestock health, their diversity and specific interactions with tick and vertebrate host species remain poorly understood in the region. In particular, the role of reptiles in TBP epidemiology remains unknown, despite having been implicated with TBPs of livestock among exported tortoises and lizards. Understanding TBP ecologies, and the potential role of common reptiles, is critical for the development of targeted transmission control strategies for these neglected tropical disease agents. During the wet months (April-May; October-December) of 2012-2013, we surveyed TBP diversity among 4,126 ticks parasitizing livestock and reptiles at homesteads along the shores and islands of Lake Baringo and Lake Victoria in Kenya, regions endemic to diverse neglected tick-borne diseases. After morphological identification of 13 distinct Rhipicephalus, Amblyomma , and Hyalomma tick species, ticks were pooled (≤8 individuals) by species, host, sampling site, and collection date into 585 tick pools. By supplementing previously established molecular assays for TBP detection with high-resolution melting analysis of PCR products before sequencing, we identified high frequencies of potential disease agents of ehrlichiosis (12.48% Ehrlichia ruminantium , 9.06% Ehrlichia canis ), anaplasmosis (6.32% Anaplasma ovis , 14.36% Anaplasma platys , and 3.08% Anaplasma bovis ,), and rickettsiosis (6.15% Rickettsia africae , 2.22% Rickettsia aeschlimannii , 4.27% Rickettsia rhipicephali , and 4.95% Rickettsia spp.), as well as Paracoccus sp. and apicomplexan hemoparasites (0.51% Theileria sp., 2.56% Hepatozoon fitzsimonsi , and 1.37% Babesia caballi ) among tick pools. Notably, we identified E. ruminantium in both Amblyomma and Rhipicephalus pools of ticks sampled from livestock in both study areas as well as in Amblyomma falsomarmoreum (66.7%) and Amblyomma nuttalli (100%) sampled

Molecular Detection of Tick-Borne Pathogen Diversities in Ticks from Livestock and Reptiles along the Shores and Adjacent Islands of Lake Victoria and Lake Baringo, Kenya

PubMed Central

Omondi, David; Masiga, Daniel K.; Fielding, Burtram C.; Kariuki, Edward; Ajamma, Yvonne Ukamaka; Mwamuye, Micky M.; Ouso, Daniel O.; Villinger, Jandouwe

2017-01-01

Although diverse tick-borne pathogens (TBPs) are endemic to East Africa, with recognized impact on human and livestock health, their diversity and specific interactions with tick and vertebrate host species remain poorly understood in the region. In particular, the role of reptiles in TBP epidemiology remains unknown, despite having been implicated with TBPs of livestock among exported tortoises and lizards. Understanding TBP ecologies, and the potential role of common reptiles, is critical for the development of targeted transmission control strategies for these neglected tropical disease agents. During the wet months (April–May; October–December) of 2012–2013, we surveyed TBP diversity among 4,126 ticks parasitizing livestock and reptiles at homesteads along the shores and islands of Lake Baringo and Lake Victoria in Kenya, regions endemic to diverse neglected tick-borne diseases. After morphological identification of 13 distinct Rhipicephalus, Amblyomma, and Hyalomma tick species, ticks were pooled (≤8 individuals) by species, host, sampling site, and collection date into 585 tick pools. By supplementing previously established molecular assays for TBP detection with high-resolution melting analysis of PCR products before sequencing, we identified high frequencies of potential disease agents of ehrlichiosis (12.48% Ehrlichia ruminantium, 9.06% Ehrlichia canis), anaplasmosis (6.32% Anaplasma ovis, 14.36% Anaplasma platys, and 3.08% Anaplasma bovis,), and rickettsiosis (6.15% Rickettsia africae, 2.22% Rickettsia aeschlimannii, 4.27% Rickettsia rhipicephali, and 4.95% Rickettsia spp.), as well as Paracoccus sp. and apicomplexan hemoparasites (0.51% Theileria sp., 2.56% Hepatozoon fitzsimonsi, and 1.37% Babesia caballi) among tick pools. Notably, we identified E. ruminantium in both Amblyomma and Rhipicephalus pools of ticks sampled from livestock in both study areas as well as in Amblyomma falsomarmoreum (66.7%) and Amblyomma nuttalli (100%) sampled from

The research, policy and practice interface: reflections on using applied social research to promote equity in health in Malawi.

PubMed

Theobald, Sally; Nhlema-Simwaka, Bertha

2008-09-01

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.

Is there a threshold level of maternal education sufficient to reduce child undernutrition? Evidence from Malawi, Tanzania and Zimbabwe.

PubMed

Makoka, Donald; Masibo, Peninah Kinya

2015-08-22

Maternal education is strongly associated with young child nutrition outcomes. However, the threshold of the level of maternal education that reduces the level of undernutrition in children is not well established. This paper investigates the level of threshold of maternal education that influences child nutrition outcomes using Demographic and Health Survey data from Malawi (2010), Tanzania (2009-10) and Zimbabwe (2005-06). The total number of children (weighted sample) was 4,563 in Malawi; 4,821 children in Tanzania; and 3,473 children in Zimbabwe Demographic and Health Surveys. Using three measures of child nutritional status: stunting, wasting and underweight, we employ a survey logistic regression to analyse the influence of various levels of maternal education on child nutrition outcomes. In Malawi, 45% of the children were stunted, 42% in Tanzania and 33% in Zimbabwe. There were 12% children underweight in Malawi and Zimbabwe and 16% in Tanzania.The level of wasting was 6% of children in Malawi, 5% in Tanzania and 4% in Zimbabwe. Stunting was significantly (p values < 0.0001) associated with mother's educational level in all the three countries. Higher levels of maternal education reduced the odds of child stunting, underweight and wasting in the three countries. The maternal threshold for stunting is more than ten years of schooling. Wasting and underweight have lower threshold levels. These results imply that the free primary education in the three African countries may not be sufficient and policies to keep girls in school beyond primary school hold more promise of addressing child undernutrition.

Disconnect between discourse and behavior regarding concurrent sexual partnerships and condom use: findings from a qualitative study among youth in Malawi.

PubMed

Romero, Stacy L; Ellis, Amy A; Gurman, Tilly A

2012-12-01

The practice of concurrent sexual partnerships (CP) is posited to be a contributor to the elevated risk of HIV transmission among youth in Malawi. The lens through which Malawian youth conceptualize the practices of CP and condom use has yet to be fully explored. The current study--a secondary data analysis of semi-structured in-depth interviews (n = 19) with Malawian youth aged 18 to 22 years--addresses this gap. Participants were interviewed about their sexual relationships and behavior, as well as their perceptions and knowledge regarding condom use and CP. In order to ensure that youth engaged in CP were oversampled, the recruitment process asked potential respondents to self-identify whether they currently participated in CP. Of the total sample (n = 19), 13 self-identified as currently engaging in CP. Data were analyzed using a grounded theory approach. This qualitative study highlights a disconnect between the high level of knowledge youth exhibit about HIV prevention methods and their actual reported condom use and CP behaviors. While some youth claimed to use condoms, their discourse demonstrated fluidity in that use changed over time, or interest in changing behavior was expressed, or was inconsistent between partnerships. The disconnect between knowledge of the consequences of risky sexual behavior and actual behavior was most evident among inconsistent condom users engaged in CP. This finding indicates knowledge alone has a limited role in the adoption of lower risk behaviors such as condom use and reduction of CP among youth. Moreover, findings from this study can inform HIV prevention programs operating in Malawi and the sub-Saharan Africa region by enabling them to provide tailored, more persuasive health promotion and prevention messaging.

Variations in sedimentological properties in Lake Challa, East Africa: Understanding the source to sink processes

NASA Astrophysics Data System (ADS)

Meyer, Inka; Eloy, Jonas; Verschuren, Dirk; De Batist, Marc

2016-04-01

The clastic mineral fraction of lacustrine sediments has been proven to provide valuable information about sedimentation dynamics within a lake, and it can be used to define distinct terrestrial source areas and transport mechanisms from source to sink. Down-core variation in the properties of the clastic mineral fraction yields indications for changes in terrestrial sediment sources over time. However, in order to use terrestrial proxies in palaeo-environmental reconstruction, we have to understand and quantify the modern conditions of sediment provenance and deposition at the study site. In this study we present data on grain-size distribution, mineralogy and particle shape of the clastic mineral component of lacustrine sediments from Lake Challa, a small freshwater lake of volcanic origin, located on the eastern slope of Mt. Kilimanjaro. Situated close to the equator, it contains a uniquely long and continuous sediment sequence allowing the study of inter-hemispheric climate dynamics. The finely laminated profundal sediments of Lake Challa are characterized by a fine-grained texture and are mainly composed of organic matter, biogenic silica and authigenic carbonate, with a relatively minor component of detrital mineral that can either originate from erosion of the steep volcanic crater walls or was mobilized by wind from unvegetated areas of the surrounding scrub savannah landscape. In order to distinguish between these two sources of terrestrial sediment input (i.e., local run-off versus distant aeolian) into Lake Challa, and to map out differences in sediment properties, samples were investigated from profundal surface sediments and short cores, as well as on-shore soils from several locations around the lake and from beyond the crater catchment. Variation in grain-size distribution and mineralogy can be linked to distinct terrestrial sources, whereas the shape of single particles gives additional information about transport dynamics. In future, the results

Bacterial meningitis and Haemophilus influenzae type b conjugate vaccine, Malawi.

PubMed

McCormick, David W; Molyneux, Elizabeth M

2011-04-01

A retrospective database review showed that Haemophilus influenzae type b conjugate vaccine decreased the annual number of cases of H. influenzae type b meningitis in children in Blantyre, Malawi. Among young bacterial meningitis patients, HIV prevalence was high (36.7% during 1997-2009), and pneumococcus was the most common etiologic agent (57% in 2009).

Climate Change Adaptation and Climate Related Disaster Risk Reduction Strategies in Zimbabwe and Malawi

NASA Astrophysics Data System (ADS)

Mubaya, C. P.; Ngepah, N.; Seyama, W.

2015-12-01

Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR) have similar aims and mutual benefits, and there is a very strong rationale for adopting a more integrated approach to these issues rather than analysing each of them as distinct from the other. One of the gaps that have been noted in this context is the lack of evidence in systematic integration of CCA and DRR in Southern Africa. In this regard, this study builds on understanding CCA and DRR policies from the perspectives of vulnerable groups- women and smallholder farmers, and conducts institutional and policy analysis of CCA and DRR in southern Africa, with specific focus on Malawi and Zimbabwe. Both quantitative and qualitative methodologies were employed to collect data for this study in the two countries. The analysis is centred on the conceptualization of DRR in the context of recovery time and CCA on livelihood changes. Findings of the study show that drought is no longer viewed as a hazard as it is a perennial and chronic occurrence in selected climate hotspots, with heightened intensity in certain identified years. Households are able to quickly recover from slow onset hazards such as droughts and dry spells more than they are able to recover from sudden onset floods, implying more capacity towards CCA than DRR. Government programmes and policies are also focused more on CCA than on DRR efforts that appear not to be a priority. Findings point towards female vulnerability from perceptions and practice where males tend to dominate where they are set to benefit from external assistance. We need to strengthen government capacity in implementation of DRR programmes, which is currently limited and development initiatives must deliberately target building the resilience of women.

Challenges of training and delivery of pediatric surgical services in Africa.

PubMed

Chirdan, Lohfa B; Ameh, Emmanuel A; Abantanga, Francis A; Sidler, Daniel; Elhalaby, Essam A

2010-03-01

The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa. A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL). Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty. The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international

Public engagement in Malawi through a health-talk radio programme ' Umoyo nkukambirana': A mixed-methods evaluation.

PubMed

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O'byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2018-02-01

Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ' Umoyo nkukambirana' was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings.

Separated by sand, fused by dropping water: habitat barriers and fluctuating water levels steer the evolution of rock-dwelling cichlid populations in Lake Tanganyika.

PubMed

Koblmüller, Stephan; Salzburger, Walter; Obermüller, Beate; Eigner, Eva; Sturmbauer, Christian; Sefc, Kristina M

2011-06-01

The conditions of phenotypic and genetic population differentiation allow inferences about the evolution, preservation and loss of biological diversity. In Lake Tanganyika, water level fluctuations are assumed to have had a major impact on the evolution of stenotopic littoral species, though this hypothesis has not been specifically examined so far. The present study investigates whether subtly differentiated colour patterns of adjacent Tropheus moorii populations are maintained in isolation or in the face of continuous gene flow, and whether the presumed influence of water level fluctuations on lacustrine cichlids can be demonstrated in the small-scale population structure of the strictly stenotopic, littoral Tropheus. Distinct population differentiation was found even across short geographic distances and minor habitat barriers. Population splitting chronology and demographic histories comply with our expectation of old and rather stable populations on steeper sloping shore, and more recently established populations in a shallower region. Moreover, population expansions seem to coincide with lake level rises in the wake of Late Pleistocene megadroughts ~100 KYA. The imprint of hydrologic events on current population structure in the absence of ongoing gene flow suggests that phenotypic differentiation among proximate Tropheus populations evolves and persists in genetic isolation. Sporadic gene flow is effected by lake level fluctuations following climate changes and controlled by the persistence of habitat barriers during lake level changes. Since similar demographic patterns were previously reported for Lake Malawi cichlids, our data furthermore strengthen the hypothesis that major climatic events synchronized facets of cichlid evolution across the East African Great Lakes. © 2011 Blackwell Publishing Ltd.

Bacterial Meningitis and Haemophilus influenzae Type b Conjugate Vaccine, Malawi

PubMed Central

Molyneux, Elizabeth M.

2011-01-01

A retrospective database review showed that Haemophilus influenzae type b conjugate vaccine decreased the annual number of cases of H. influenzae type b meningitis in children in Blantyre, Malawi. Among young bacterial meningitis patients, HIV prevalence was high (36.7% during 1997–2009), and pneumococcus was the most common etiologic agent (57% in 2009). PMID:21470461

Mainstreaming environment and sustainability: an analysis of a master's in environmental science and a tree-planting project at Chancellor College, University of Malawi

NASA Astrophysics Data System (ADS)

Chiotha, Sosten S.

2010-06-01

In 2004, Mainstreaming Environment and Sustainability in African Universities (MESA) was formally launched by UNEP, UNESCO and the Association of African Universities. This paper sets the stage for a critical analysis of ESD by reviewing historical perspectives of conservation in Africa as a means of appreciating the need for African universities to mainstream both environmental concerns and those relating to sustainability. Two case studies from Chancellor College, University of Malawi are discussed to illustrate that good practice in mainstreaming environment and sustainability requires challenges to be refined and knowledge to be extended on an ongoing basis. To analyse the reorientation of the curriculum for Education for Sustainable Development (ESD), the paper examines the introduction of an Environmental Science Master's programme at the college and notes how environmental issues are covered. The article also looks at the college's tree-planting programme in terms of the training, research and outreach involved.

Why Rural Community Day Secondary Schools Students' Performance in Physical Science Examinations Is Poor in Lilongwe Rural West Education District in Malawi

ERIC Educational Resources Information Center

Mlangeni, Angstone Noel J. Thembachako; Chiotha, Sosten Staphael

2015-01-01

A study was conducted to investigate factors that affect students' poor performance in physical science examinations at Malawi School Certificate of Education and Junior Certificate of Education levels in Community day secondary schools (CDSS) in Lilongwe Rural West Education District in Malawi. Students' performance was collected from schools'…

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi.

PubMed

Muula, Adamson S; Chipeta, John; Siziya, Seter; Rudatsikira, Emmanuel; Mataya, Ronald H; Kataika, Edward

2007-12-19

Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals. We obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART) using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions. There were 610 clinicians (396 clinical officers and 214 physicians), 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs) and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7-31.4% of all physicians and clinical officers, 66.5-199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of nurses, 118.1% to 354.2% of all the available pharmacists and

Decadal Trends and Common Dynamics of the Bio-Optical and Thermal Characteristics of the African Great Lakes

PubMed Central

Loiselle, Steven; Cózar, Andrés; Adgo, Enyew; Ballatore, Thomas; Chavula, Geoffrey; Descy, Jean Pierre; Harper, David M.; Kansiime, Frank; Kimirei, Ismael; Langenberg, Victor; Ma, Ronghua; Sarmento, Hugo; Odada, Eric

2014-01-01

The Great Lakes of East Africa are among the world’s most important freshwater ecosystems. Despite their importance in providing vital resources and ecosystem services, the impact of regional and global environmental drivers on this lacustrine system remains only partially understood. We make a systematic comparison of the dynamics of the bio-optical and thermal properties of thirteen of the largest African lakes between 2002 and 2011. Lake surface temperatures had a positive trend in all Great Lakes outside the latitude of 0° to 8° south, while the dynamics of those lakes within this latitude range were highly sensitive to global inter-annual climate drivers (i.e. El Niño Southern Oscillation). Lake surface temperature dynamics in nearly all lakes were found to be sensitive to the latitudinal position of the Inter Tropical Convergence Zone. Phytoplankton dynamics varied considerably between lakes, with increasing and decreasing trends. Intra-lake differences in both surface temperature and phytoplankton dynamics occurred for many of the larger lakes. This inter-comparison of bio-optical and thermal dynamics provides new insights into the response of these ecosystems to global and regional drivers. PMID:24699528

Development of a subspecialty cardiology curriculum for paediatric registrars in Malawi: Implementation of a long-distance hybrid model.

PubMed

Newberry, Laura; Kennedy, Neil; Greene, Elizabeth A

2016-06-01

Malawi has a high burden of paediatric cardiac disease but a limited number of health providers familiar with these chronic diseases. Given the rising number of Malawian postgraduate paediatric trainees at the University of Malawi College of Medicine, we sought to remedy this lack of basic cardiology training with a long-distance, module-based curriculum that could be utilised independently, as needed, with on-site teaching. We also wished to evaluate the initial modules for utility and improvement in knowledge and confidence in each topic. After an initial site visit to determine curriculum needs, online modules with interactive evaluations and quizzes were developed by a paediatric cardiologist in the United States, in collaboration with paediatric registrar training directors in Malawi. This online interactive curriculum was followed by several site visits to Malawi, by the United States-based paediatric cardiologist, to provide bedside teaching, case-based discussions and hands-on skill training in cardiac ultrasound and electrocardiogram interpretation. Evaluation of the curriculum model included post-module quizzes on cardiac topics as well as registrar self-assessments regarding confidence in content areas. The average post-module quiz score was 93.6%. Repeat testing with the same questions four months later yielded an average score of 78%, with a range from 60 to 100%. Pre- and post-module registrar self-assessment regarding confidence in content areas showed a substantial gain in knowledge and confidence mean. In their qualitative feedback, registrars noted that the modules were helpful in studying for their certifying examinations, and all four of the registrars sitting Part I of their Malawian and South African paediatric certifying examinations passed. Our innovative hybrid approach, combining online educational modules with in-person teaching visits, is a useful approach in expanding paediatric cardiology subspecialty education in Malawi.

Early childhood development: the role of community based childcare centres in Malawi.

PubMed

Munthali, Alister C; Mvula, Peter M; Silo, Lois

2014-01-01

Somatic changes including growth and development of the brain of a human being occur very early in life. Programmes that enhance early childhood development (ECD) therefore should be part of the national agenda. Cognizant of this fact, the Malawi Government together with development partners facilitated the establishment of community-based child care centres (CBCCs) which are owned and managed by community members. This study was aimed at understanding how CBCCs operated and their core functions. Using information from databases kept by the District Social Welfare Officers from all the 28 districts in Malawi, coupled with snowballing, all functioning CBCCs were enumerated. A questionnaire was administered to the head of the CBCC or a care giver. Highly trained Research Assistants also carried our observations of the structures around the centres and the activities that actually happened. Data was analysed using a Statistical Package for Social Sciences. Communities provide structures, support for care givers, food, utensils, labour and play materials for the children in CBCCs. The first ECD centre was established in 1966 but the real surge in establishing these happened towards the end of the 1990s and by 2007 there were 5,665 CBCCs in Malawi caring for 407,468 children aged between 3 and 5 years. CBCCs were established to provide pre-primary school learning, and in some cases provide special care to orphans and other vulnerable. Despite the fact that most CBCC premises and structures fell short of the standards laid down by the CBCC profile, the activities and services provided were mostly to the book. Children were provided with nutritious foods and subjected to play that stimulated their cognitive and mental development. Despite the fact that some members of the community do not realize the value of the CBCCs, the existence of these institutions is an opportunity for the community to take care of their children communally, a task that has become imperative as a

Assessment of strategies for male involvement in the prevention of mother-to-child transmission of HIV services in Blantyre, Malawi.

PubMed

Nyondo, Alinane Linda; Muula, Adamson Sinjani; Chimwaza, Angela Faith

2013-12-16

Despite the documented benefits of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) services, the uptake remains low in sub-Saharan Africa. The lack of male involvement (MI) may be one of the reasons for this. However, there are limited data on strategies for MI in PMTCT. The objective of this study was to identify strategies that may promote MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face-to-face key informant interviews (KIIs) with healthcare workers and four focus group discussions (FGDs) with 18 men and 17 pregnant women attending ANC at SLHC. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analyzed using thematic content analysis. Three major themes with several subcategories emerged. Theme 1 was a gatekeeping strategy with two subcategories: (1) healthcare workers refusing service provision to women accessing antenatal clinic without their partners and (2) women refusing ANC attention in the absence of a partner. Theme 2 comprised extending invitations and had six subcategories: (1) word of mouth, (2) card invites, (3) woman's health passport book invites, (4) telephonic invites, (5) use of influential people, and (6) home visits. Theme 3 was information education and communication, such as health education forums and advertisements. Of all the strategies, an invitation card addressed to the male partner was most preferred by study participants. There are several strategies by which men may be involved in PMTCT. Healthcare workers should offer a pregnant woman all strategies available for MI for her to select the appropriate one. Further research and consultations with men should continue to achieve higher levels

Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership: the ETATMBA cluster randomised controlled trial.

PubMed

Ellard, David R; Chimwaza, Wanangwa; Davies, David; Simkiss, Doug; Kamwendo, Francis; Mhango, Chisale; Quenby, Siobhan; Kandala, Ngianga-Bakwin; O'Hare, Joseph Paul

2016-01-01

The ETATMBA (Enhancing Training And Technology for Mothers and Babies in Africa) project-trained associate clinicians (ACs/clinical officers) as advanced clinical leaders in emergency obstetric and neonatal care. This trial aimed to evaluate the impact of training on obstetric health outcomes in Malawi. A cluster randomised controlled trial with 14 districts of Malawi (8 intervention, 6 control) as units of randomisation. Intervention districts housed the 46 ACs who received the training programme. The primary outcome was district (health facility-based) perinatal mortality rates. Secondary outcomes included maternal mortality ratios, neonatal mortality rate, obstetric and birth variables. The study period was 2011-2013. Mortality rates/ratios were examined using an interrupted time series (ITS) to identify trends over time. The ITS reveals an improving trend in perinatal mortality across both groups, but better in the control group (intervention, effect -3.58, SE 2.65, CI (-9.85 to 2.69), p=0.20; control, effect -17.79, SE 6.83, CI (-33.95 to -1.64), p=0.03). Maternal mortality ratios are seen to have improved in intervention districts while worsening in the control districts (intervention, effect -38.11, SE 50.30, CI (-157.06 to 80.84), p=0.47; control, effect 11.55, SE 87.72, CI (-195.87 to 218.98), p=0.90). There was a 31% drop in neonatal mortality rate in intervention districts while in control districts, the rate rises by 2%. There are no significant differences in the other secondary outcomes. This is one of the first randomised studies looking at the effect of structured training on health outcomes in this setting. Notwithstanding a number of limitations, this study suggests that up-skilling this cadre is possible, and could impact positively on health outcomes. ISRCTN63294155; Results.

Institutional Challenges to Viable Civil-Military Relations in Malawi

DTIC Science & Technology

2008-03-01

teacher who was responsible for discipline and physical education and was the most feared teacher at every institution. In short, Banda successfully...of guidance is particularly evident in the higher education program of the armed forces. The Malawi Defense Force, in 2007, established a Centre for...has lost respect, due to what he termed childish and irresponsible, with opposition MPs and their leaders who use abusive language while transacting

Moral maps and medical imaginaries: clinical tourism at Malawi's College of Medicine.

PubMed

Wendland, Claire L

2012-01-01

At an understaffed and underresourced urban African training hospital, Malawian medical students learn to be doctors while foreign medical students, visiting Malawi as clinical tourists on short-term electives, learn about “global health.” Scientific ideas circulate fast there; clinical tourists circulate readily from outside to Malawi but not the reverse; medical technologies circulate slowly, erratically, and sometimes not at all. Medicine's uneven globalization is on full display. I extend scholarship on moral imaginations and medical imaginaries to propose that students map these wards variously as places in which—or from which—they seek a better medicine. Clinical tourists, enacting their own moral maps, also become representatives of medicine “out there”: points on the maps of others. Ethnographic data show that for Malawians, clinical tourists are colleagues, foils against whom they construct ideas about a superior and distinctly Malawian medicine and visions of possible alternative futures for themselves.

A tribal level phylogeny of Lake Tanganyika cichlid fishes based on a genomic multi-marker approach

PubMed Central

Meyer, Britta S.; Matschiner, Michael; Salzburger, Walter

2015-01-01

The species-flocks of cichlid fishes in the East African Great Lakes Victoria, Malawi and Tanganyika constitute the most diverse extant adaptive radiations in vertebrates. Lake Tanganyika, the oldest of the lakes, harbors the morphologically and genetically most diverse assemblage of cichlids and contains the highest number of endemic cichlid genera of all African lakes. Based on morphological grounds, the Tanganyikan cichlid species have been grouped into 12–16 distinct lineages, so-called tribes. While the monophyly of most of the tribes is well established, the phylogenetic relationships among the tribes remain largely elusive. Here, we present a new tribal level phylogenetic hypothesis for the cichlid fishes of Lake Tanganyika that is based on the so far largest set of nuclear markers and a total alignment length of close to 18 kb. Using next-generation amplicon sequencing with the 454 pyrosequencing technology, we compiled a dataset consisting of 42 nuclear loci in 45 East African cichlid species, which we subjected to maximum likelihood and Bayesian inference phylogenetic analyses. We analyzed the entire concatenated dataset and each marker individually, and performed a Bayesian concordance analysis and gene tree discordance tests. Overall, we find strong support for a position of the Oreochromini, Boulengerochromini, Bathybatini and Trematocarini outside of a clade combining the substrate spawning Lamprologini and the mouthbrooding tribes of the ‘H-lineage’, which are both strongly supported to be monophyletic. The Eretmodini are firmly placed within the ‘H-lineage’, as sister-group to the most species-rich tribe of cichlids, the Haplochromini. The phylogenetic relationships at the base of the ‘H-lineage’ received less support, which is likely due to high speciation rates in the early phase of the radiation. Discordance among gene trees and marker sets further suggests the occurrence of past hybridization and/or incomplete lineage sorting in

HIV and childhood disability: a case-controlled study at a paediatric antiretroviral therapy centre in Lilongwe, Malawi.

PubMed

Devendra, Akash; Makawa, Atupele; Kazembe, Peter N; Calles, Nancy R; Kuper, Hannah

2013-01-01

As paediatric antiretroviral therapy (ART) is rapidly scaled up in Southern Africa, Human Immunodeficiency Virus (HIV) infection is becoming a chronic illness. Children growing up with HIV may begin to encounter disabilities. The relationship between HIV, disability and the need for rehabilitation has added an additional element that needs to be addressed by paediatric HIV treatment programmes. 1) Estimate the prevalence of disabilities in HIV-infected and HIV-uninfected children in Lilongwe, Malawi. 2) Examine types of disability and associated clinical and socio-demographic factors. 3) Identify needs, opportunities and barriers for rehabilitation in Malawi. A case-controlled study of 296 HIV-infected children aged 2-9 years attending an ART centre in Lilongwe (cases) and their uninfected siblings (controls) was conducted. Disability was assessed using the WHO Ten Question Screen (TQS). Socio-demographic and clinical data were collected using a parent-proxy questionnaire and medical records. Of 296 case and control pairs recruited, 33% (98) versus 7% (20) screened positive for a disability (OR 8.4, 4.4-15.7) respectively. Of these 98 HIV-infected cases, 6%, 36%, 33%, 53%, 46% and 6% had a vision, hearing; physical, learning/comprehension, speech or seizure-related disability respectively and 51% had multiple coexisting disabilities. HIV-infected cases with a disability were more likely to be WHO stage III or IV at enrolment (71% vs. 52%, OR 2.7, 1.5-4.2), to have had TB (58% vs. 39%, OR 2.3, 1.4-3.8) and to have below-average school grades (18% vs. 2%, OR 11.1, 2.2-54.6) than those without. Sixty-seven percent of cases with a disability had never attended any rehabilitative service. Twenty-nine percent of caregivers reported facing stigma and discrimination because of the child's disability. This study reveals the magnitude of disability among HIV-infected children and the large unmet need for rehabilitation services. This expanding issue demands further

The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi

PubMed Central

Kidane, Teklay; Chirwa, Geoffrey; Tesfaye, Neghist; Prescott, Marta R; Scotney, Soleine T; Valle, Moussa; Abebe, Sintayehu; Tambuli, Adija; Malewezi, Bridget; Mohammed, Tahir; Kobayashi, Emily; Wootton, Emily; Wong, Renee; Dosani, Rahima; Subramaniam, Hamsa; Joseph, Jessica; Yavuz, Elif; Apple, Aliza; Le Tallec, Yann; Kang’ethe, Alice

2016-01-01

Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction. PMID:26856361

Living with disabled children in Malawi: Challenges and rewards

PubMed Central

Barlindhaug, Grete; Umar, Eric; Wazakili, Margaret

2016-01-01

Background Rehabilitation personnel need to be sensitive to the cultural aspects that constitute the environment of a disabled child’s family life. Objectives The aim of this study was to gain insight on how families experience parenting of disabled children and how the families experience the support provided by the rehabilitation system in Malawi. Method An anthropological field study combining interviews and observations was conducted in a rural district of Malawi in 2011. Permission was granted to follow four families, and this study presents the stories of two families, whose children have severe disabilities. We used phenomenological and narrative analyses to make sense of the stories. Results The findings indicate that families with disabled children invest time and emphasise care for their disabled children. They feel enriched by their experience despite challenging situations with little support from the rehabilitation services. High standards of care demonstrating positive and moral attitudes have earned these families respect in their communities. Storytelling has created an opportunity for the families to understand and interpret their challenging situation with inherent contextual meaning. Conclusion This study shows that families with disabled children draw on cultural and structural strengths that rehabilitation professionals should be aware of in their support to mothers and other caregivers of children with disabilities. PMID:28730057

Origin, imports and exports of HIV-1 subtype C in South Africa: A historical perspective.

PubMed

Wilkinson, Eduan; Rasmussen, David; Ratmann, Oliver; Stadler, Tanja; Engelbrecht, Susan; de Oliveira, Tulio

2016-12-01

While the HIV epidemic in South Africa had a later onset than epidemics in other southern African countries, prevalence grew rapidly during the 1990's when the country was going through socio-political changes with the end of Apartheid. South Africa currently has the largest number of people living with HIV in the world and the epidemic is dominated by a unique subtype, HIV-1 subtype C. This large epidemic is also characterized by high level of genetic diversity. We hypothesize that this diversity is due to multiple introductions of the virus during the period of change. In this paper, we apply novel phylogeographic methods to estimate the number of viral imports and exports from the start of the epidemic to the present. We assembled 11,289 unique subtype C pol sequences from southern Africa. These represent one of the largest sequence datasets ever analyzed in the region. Sequences were stratified based on country of sampling and levels of genetic diversity were estimated for each country. Sequences were aligned and a maximum-likelihood evolutionary tree was inferred. Least-Squares Dating was then used to obtain a dated phylogeny from which we estimated the number of introductions into and exports out of South Africa using parsimony-based ancestral location reconstructions. Our results identified 189 viral introductions into South Africa with the largest number of introductions attributed to Zambia (n=109), Botswana (n=32), Malawi (n=26) and Zimbabwe (n=13). South Africa also exported many viral lineages to its neighbours. The bulk viral imports and exports appear to have occurred between 1985 and 2000, coincident with the period of socio-political transition. The high level of subtype C genetic diversity in South Africa is related to multiple introductions of the virus to the country. While the number of viral imports and exports we identified was highly sensitive to the number of samples included from each country, they mostly clustered around the period of

Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model

PubMed Central

Emina, Jacques B O; Madise, Nyovani; Kuepie, Mathias; Zulu, Eliya M; Ye, Yazoume

2013-01-01

Objectives To identify HIV-socioeconomic predictors as well as the most-at-risk groups of women in Malawi. Design A cross-sectional survey. Setting Malawi Participants The study used a sample of 6395 women aged 15–49 years from the 2010 Malawi Health and Demographic Surveys. Interventions N/A Primary and secondary outcome measures Individual HIV status: positive or not. Results Findings from the Pearson χ2 and χ2 Automatic Interaction Detector analyses revealed that marital status is the most significant predictor of HIV. Women who are no longer in union and living in the highest wealth quintiles households constitute the most-at-risk group, whereas the less-at-risk group includes young women (15–24) never married or in union and living in rural areas. Conclusions In the light of these findings, this study recommends: (1) that the design and implementation of targeted interventions should consider the magnitude of HIV prevalence and demographic size of most-at-risk groups. Preventive interventions should prioritise couples and never married people aged 25–49 years and living in rural areas because this group accounts for 49% of the study population and 40% of women living with HIV in Malawi; (2) with reference to treatment and care, higher priority must be given to promoting HIV test, monitoring and evaluation of equity in access to treatment among women in union disruption and never married or women in union aged 30–49 years and living in urban areas; (3) community health workers, households-based campaign, reproductive-health services and reproductive-health courses at school could be used as canons to achieve universal prevention strategy, testing, counselling and treatment. PMID:23793677

Facilitating factors and barriers to malaria research utilization for policy development in Malawi.

PubMed

Mwendera, Chikondi A; de Jager, Christiaan; Longwe, Herbert; Phiri, Kamija; Hongoro, Charles; Mutero, Clifford M

2016-10-19

Research on various determinants of health is key in providing evidence for policy development, thereby leading to successful interventions. Utilization of research is an intricate process requiring an understanding of contextual factors. The study was conducted to assess enhancing factors and barriers of research utilization for malaria policy development in Malawi. Qualitative research approach was used through in-depth interviews with 39 key informants that included malaria researchers, policy makers, programme managers, and key stakeholders. Purposive sampling and snowballing techniques were used in identifying key informants. Interview transcripts were entered in QSR Nvivo 11 software for coding and analysis. Respondents identified global efforts as key in advancing knowledge translation, while local political will has been conducive for research utilization. Other factors were availability of research, availability of diverse local researchers and stakeholders supporting knowledge translation. While barriers included: lack of platforms for researcher-public engagement, politics, researchers' lack of communication skills, lack of research collaborations, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository. Overall, the study identified facilitating factors to malaria research utilization for policy development in Malawi. These factors need to be systematically coordinated to address the identified barriers and improve on malaria research utilization in policy development. Malaria research can be key in the implementation of evidence-based interventions to reduce the malaria burden and assist in the paradigm shift from malaria control to elimination in Malawi.

Evaluating land cover changes in Eastern and Southern Africa from 2000 to 2010 using validated Landsat and MODIS data

NASA Astrophysics Data System (ADS)

Al-Hamdan, Mohammad Z.; Oduor, Phoebe; Flores, Africa I.; Kotikot, Susan M.; Mugo, Robinson; Ababu, Jaffer; Farah, Hussein

2017-10-01

In this study, we assessed land cover land use (LCLU) changes and their potential environmental drivers (i.e., precipitation, temperature) in five countries in Eastern & Southern (E&S) Africa (Rwanda, Botswana, Tanzania, Malawi and Namibia) between 2000 and 2010. Landsat-derived LCLU products developed by the Regional Centre for Mapping of Resources for Development (RCMRD) through the SERVIR (Spanish for ;to serve;) program, a joint initiative of NASA and USAID, and NASA's Moderate Resolution Imaging Spectroradiometer (MODIS) data were used to evaluate and quantify the LCLU changes in these five countries. Given that the original development of the MODIS land cover type standard products included limited training sites in Africa, we performed a two-level verification/validation of the MODIS land cover product in these five countries. Precipitation data from CHIRPS dataset were used to evaluate and quantify the precipitation changes in these countries and see if it was a significant driver behind some of these LCLU changes. MODIS Land Surface Temperature (LST) data were also used to see if temperature was a main driver too. Our validation analysis revealed that the overall accuracies of the regional MODIS LCLU product for this African region alone were lower than that of the global MODIS LCLU product overall accuracy (63-66% vs. 75%). However, for countries with uniform or homogenous land cover, the overall accuracy was much higher than the global accuracy and as high as 87% and 78% for Botswana and Namibia, respectively. In addition, the wetland and grassland classes had the highest user's accuracies in most of the countries (89%-99%), which are the ones with the highest number of MODIS land cover classification algorithm training sites. Our LCLU change analysis revealed that Botswana's most significant changes were the net reforestation, net grass loss and net wetland expansion. For Rwanda, although there have been significant forest, grass and crop expansions in

Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa.

PubMed

Mastellos, Nikolaos; Tran, Tammy; Dharmayat, Kanika; Cecil, Elizabeth; Lee, Hsin-Yi; Wong, Cybele C Peng; Mkandawire, Winnie; Ngalande, Emmanuel; Wu, Joseph Tsung-Shu; Hardy, Victoria; Chirambo, Baxter Griphin; O'Donoghue, John Martin

2018-04-02

Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The 'Introduction to Information and Communication Technology and eHealth' course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach. Two questionnaires were developed and tested for face validity and reliability in a pilot course with 20 CHWs. Those were designed to measure CHWs' knowledge of and attitudes towards the use of ICT, before and after each course, as well as their satisfaction with each learning approach. Following validation, a randomised controlled trial was conducted to assess the effectiveness of the two learning approaches. A total of 40 CHWs were recruited, stratified by position, gender and computer experience, and allocated to the traditional or blended learning group using block randomisation. Participants completed the baseline and follow-up questionnaires before and after each course to assess the impact of each learning approach on their knowledge, attitudes, and satisfaction. Per-item, pre-post and between-group, mean differences for each approach were calculated using paired and unpaired t-tests, respectively. Per-item, between-group, satisfaction scores were compared using unpaired t-tests. Scores across all scales improved after attending the traditional and blended learning courses. Self-rated ICT knowledge was significantly improved in both groups with significant differences between groups in seven domains. However, actual ICT knowledge scores were similar across groups. There were no significant differences between groups in attitudinal gains. Satisfaction with the course was generally high in both

18O 16O ratios in cherts associated with the saline lake deposits of East Africa

USGS Publications Warehouse

O'Neil, J.R.; Hay, R.L.

1973-01-01

The cherts formed from sodium silicate precursors in East African saline, alkaline lakes have ??18O values ranging from 31.1 to 44.1. The ??18O values correlate in general with lake salinities as inferred from geologic evidence, indicating that most chert was formed from its precursor in contact with lake water trapped at the time of deposition. A few of the analyzed cherts probably formed in contact with dilute meteoric water. From the widely varying ??18O values we conclude that precursors were transformed to chert in fluids of widely varying salinity and aNa+/aH+ ratio. ?? 1973.